Biomechanical evaluation of different numbers, sizes and placement configurations of ligaclips required to secure cellophane bands.

Objective: To determine the number, size, and configuration of ligaclips most resistant to tensile forces when applied to cellophane bands.

Study Design: In vitro mechanical evaluation.

Sample Population: Single-layer and triple-layer cellophane bands, 9.0 and 11.5 mm ligaclips.

Methods: Triple-layer bands were secured with a different number (2-5), size (9.0 or 11.5 mm) or configuration (linear or alternating placement) of ligaclips and mechanically tested. Force-deformation curves were generated and yield load in Newtons (N) was determined for each variable. A 3-way analysis of variance with post hoc Tukey's tests was used for statistical comparisons. Yield load for single-layer and triple-layer bands secured with 4 alternating 11.5 mm ligaclips was compared using a paired-sample (independent) t-test with P<.05 considered significant.

Results: Mean yield load increased as the number of ligaclips applied increased, but this effect began to plateau after application of the 4th clip. Mean yield load for 11.5 mm ligaclips was significantly higher than for 9.0 mm ligaclips (P<.001) and for the alternating configuration compared with the linear configuration (P<.001). Yield load for 4 alternating 11.5 mm ligaclips applied to triple-layer cellophane bands was significantly greater than the same configuration applied to single-layer cellophane bands (P<.001).

Conclusion: 11.5 mm ligaclips applied in an alternating configuration and on triple-layer cellophane provided most resistance to tensile forces. The resistance to tensile forces increased significantly as the number of ligaclips applied increased from 1 to 4/band.

Clinical Relevance: Surgeons should be aware that the number, size, and configuration of ligaclips and cellophane thickness affect their resistance to tensile forces.