Effect of Initial Graft Tension on Knee Stability and Graft Tension Pattern in Double-Bundle Anterior Cruciate Ligament Reconstruction

Koga, Hideyuki; Muneta, Takeshi; Yagishita, Kazuyoshi; Watanabe, Toshifumi; Mochizuki, Takashi; Horie, Masafumi; Nakamura, Tomomasa; Otabe, Koji; Sekiya, Ichiro

doi:10.1016/j.arthro.2015.03.012

Cited by 23 publications

(17 citation statements)

References 30 publications

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“…The optimum tension required during graft fixation using the current ACL reconstruction techniques is controversial 1 , 2 , 3 , 4 and it is unclear whether the tension measured by a tensioner is reproduced after fixation. To enable the adjustment of graft tibial tension after initial fixation, 5 we used the modified graft wherein an adjustable loop-button device (TightRope™) is applied on the tibial side for double-bundle ACL reconstruction.…”

Section: Discussionmentioning

confidence: 99%

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Evaluating different closed loop graft preparation technique for tibial suspensory fixation in ACL reconstruction using TightRope™

Sasho

Sasaki

Hoshi

et al. 2018

Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilit

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In most anterior cruciate ligament (ACL) reconstructions, grafts are fixed to the femoral side first followed by the tibial side. Various techniques have been reported to achieve optimal tension on the grafts, but once the grafts are fixed it is difficult to adjust graft tension further. To enable post fixation tension control we have invented a new graft configuration using an adjustable loop-device (TightRopeTM, Arthrex, FL, USA) on the tibial side. In this paper, biomechanical properties of this configuration using soft tissue were examined in terms of graft diameter and various suture techniques (referred to as base suture) to make a closed circle to support TightRopeTM.Two experiments were conducted under different conditions. In each experiment, cyclic load, followed by a pull-to-failure load, was applied to the grafts and elongation and failure mode were recorded. (1) To evaluate the effects of diameter, 5.0 or 6.0 mm grafts were prepared by a single locking loop stitch as the base suture (SLL5, SLL6). (2) To evaluate different base sutures, 5.0 mm tendons were used, and grafts were prepared using five kinds of base sutures (SLL, ZLL: zigzag locking loop, DZLL: double zigzag locking loop, DK: double Krackow, DK w/o TR: double Krackow without TightRopeTM). In the first experiment, tearing was observed in 2 of 6 cases in the SLL5 test group, whereas no tearing was observed with SLL6. In the second experiment, no tearing was observed with DZLL or DK. Elongation was smaller in these two groups compared to the other groups. Mechanical strength decreases with a smaller graft diameter. Biomechanical properties differed with different base sutures and, among them, the double-zigzag-suture stitch and double Krackow provided less elongation and higher ultimate load in this graft configuration.

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Section: Discussionmentioning

confidence: 99%

“…Several studies have reported the optimum tension required for graft fixation during anterior cruciate ligament (ACL) reconstruction. 1 , 2 , 3 , 4 However, in the clinical setting, there is no standard guideline for surgical techniques to achieve this appropriate tension. Fixation is frequently performed manually at maximum force.…”

Section: Introductionmentioning

confidence: 99%

Evaluating different closed loop graft preparation technique for tibial suspensory fixation in ACL reconstruction using TightRope™

Sasho

Sasaki

Hoshi

et al. 2018

Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilit

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“…However, considering stress relaxation, graft remodelling and tunnel enlargement after graft fixation, it seems plausible to apply somewhat greater initial tension than the laxity match pretension to restore normal stability after ACL reconstruction. A recent study has shown that 20 N of the initial tension was high enough to yield good anteroposterior (AP) stability after anatomic DB ACL reconstruction,57 whereas the minimum required tension to restore rotational stability could be larger than 20 N 58 59. Graft fixation angles also affect AP and rotational knee laxity in DB ACL reconstruction.…”

Section: Current State Of the Artmentioning

confidence: 99%

Revision anterior cruciate ligament surgery: state of the art

Koga

Engebretsen

et al. 2017

Journal of ISAKOS

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“…The response of tendon grafts subjected to tension has been studied [11,12], but the behavior of the grafts used in ACL reconstruction is complex, as commonly two tendons (gracilis and semitendinosus) are used together to reconstruct the ACL [13]. During normal activities, tendons and ligaments in humans are subjected to strain b 5%, which is the upper physiological limit before plastic deformation takes place [14,15].…”

Section: Introductionmentioning

confidence: 99%

Static tensioning promotes hamstring tendons force relaxation more reliably than cycling tensioning

et al. 2017

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Effect of Initial Graft Tension on Knee Stability and Graft Tension Pattern in Double-Bundle Anterior Cruciate Ligament Reconstruction

Cited by 23 publications

References 30 publications

Evaluating different closed loop graft preparation technique for tibial suspensory fixation in ACL reconstruction using TightRope™

Evaluating different closed loop graft preparation technique for tibial suspensory fixation in ACL reconstruction using TightRope™

Revision anterior cruciate ligament surgery: state of the art

Static tensioning promotes hamstring tendons force relaxation more reliably than cycling tensioning

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