Effects of Initial Graft Tension on the Tibiofemoral Compressive Forces and Joint Position after Anterior Cruciate Ligament Reconstruction

Brady, Mark F.; Bradley, Michael P.; Fleming, Braden C.; Fadale, Paul D.; Hulstyn, Michael J.; Banerjee, Rahul

doi:10.1177/0363546506294363

Cited by 68 publications

(60 citation statements)

References 75 publications

(106 reference statements)

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“…The size and type of meniscal defect may have attributed to discrepancies in stability between knees as much as the ACL reconstruction drilling technique [7,14,17,48]. Another factor that may play a role in postoperative stability is graft tension [12,18]. Although graft tension was not measured in this study, it was confirmed for all patients using a standard tension protocol.…”

Section: Discussionmentioning

confidence: 86%

Does Anteromedial Portal Drilling Improve Footprint Placement in Anterior Cruciate Ligament Reconstruction?

Arno

Bell

Alaia

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Considerable debate remains over which anterior cruciate ligament (ACL) reconstruction technique can best restore knee stability. Traditionally, femoral tunnel drilling has been done through a previously drilled tibial tunnel; however, potential nonanatomic tunnel placement can produce a vertical graft, which although it would restore sagittal stability, it would not control rotational stability. To address this, some suggest that the femoral tunnel be created independently of the tibial tunnel through the use of an anteromedial (AM) portal, but whether this results in a more anatomic footprint or in stability comparable to that of the intact contralateral knee still remains controversial. Questions/purposes (1) Does the AM technique achieve footprints closer to anatomic than the transtibial (TT) technique? (2) Does the AM technique result in stability equivalent to that of the intact contralateral knee? (3) Are there differences in patient-reported outcomes between the two techniques? Methods Twenty male patients who underwent a bonepatellar tendon-bone autograft were recruited for this study, 10 in the TT group and 10 in the AM group. Patients in each group were randomly selected from four surgeons at our institution with both groups demonstrating similar demographics. The type of procedure chosen for each patient was based on the preferred technique of the surgeon. Some surgeons exclusively used the TT technique, whereas other surgeons specifically used the AM technique. Surgeons had no input on which patients were chosen to participate in this study. Mean postoperative time was 13 ± 2.8 and 15 ± 3.2 months for the TT and AM groups, respectively. Patients were identified retrospectively as having either the TT or AM Technique from our institutional database. At followup, clinical outcome scores were gathered as well as the footprint placement and knee stability assessed. To assess the footprint placement and knee stability, three-dimensional surface models of the femur, tibia, and ACL were created from MRI scans. The femoral and tibial footprints of the ACL reconstruction as compared with the intact contralateral ACL were determined. In addition, the AP displacement and rotational displacement of the femur were determined. Lastly, as a secondary measurement of stability, KT-1000 measurements were obtained at the followup visit. An a priori sample size calculation indicated that with 2n = 20 patients, we could detect a difference of 1 mm with 80% power at p \ 0.05. A Welch two-sample t-test (p \ 0.05) was performed to determine differences in the footprint measurements, AP displacement, rotational displacement, and KT-1000 measurements between the TT and AM groups. We further used the confidence interval approach with 90% confidence intervals on the pairwise mean group differences using a Games-Howell post hoc test to assess equivalence between the TT and AM groups for the previously mentioned measures. Results The AM and TT techniques were the same in terms of footprint except in the distal...

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Section: Discussionmentioning

confidence: 86%

Does Anteromedial Portal Drilling Improve Footprint Placement in Anterior Cruciate Ligament Reconstruction?

Arno

Bell

Alaia

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…1). 4 The remaining five degrees of freedom of joint motion were left unconstrained via a sliding universal joint that was attached to the distal tibia. Thus, the natural motion of the tibia was permitted as the knee was passively flexed and extended by the arm of the test fixture while protecting the specimen from out of plane loads by the examiner.…”

Section: Custom Test Fixturementioning

confidence: 99%

“…4 The AP laxity of the TF joint in the ACL-intact, capsule-open, sensor-implanted ("Open+Tek") state was then evaluated to ensure that the sensor did not significantly change the joint laxity response. The quasi-static flexion-extension joint positions and TF compressive loads in the "Open+Tek" state were then recorded as described above.…”

Section: Experimental Protocolmentioning

confidence: 99%

Tibiofemoral Compression Force Differences Using Laxity- and Force-Based Initial Graft Tensioning Techniques in the Anterior Cruciate Ligament–Reconstructed Cadaveric Knee

Fleming

Brady

Bradley

et al. 2008

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Purpose-To document the tibiofemoral (TF) compression forces produced during clinical initial graft tension protocols.Methods-An image analysis system was used to track the position of the tibia relative to the femur in 11 cadaver knees. TF compression forces were quantified using thin-film pressure sensors. Prior to performing ACL reconstructions with patellar tendon grafts, measurements of TF compression force were obtained from the ACL-intact knee with knee flexion. ACL reconstructions were then performed using "force-based" and "laxity-based" graft tension approaches. Within each approach, high-and low-tension conditions were compared to the ACL-intact condition over the range of knee flexion angles.Results-The TF compression forces for all initial graft tension conditions were significantly greater than that of the normal knee when the knee was in full extension (0°). The TF compression forces when using the laxity-based approach were greater than those produced with the force-based approach. However the laxity-based approach was necessary to restore normal laxity at the time of surgery.Conclusions-The initial graft tension conditions produce different TF compressive force profiles at the time of surgery. A compromise must be made between restoring knee laxity or TF compressive forces when reconstructing the ACL with patellar tendon graft.Clinical Relevance-The TF compression forces were greater in the ACL-reconstructed knee for all the initial graft tension conditions when compared to the ACL-intact knee, and that clinically relevant initial graft tension conditions produce different TF compressive forces.

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“…[8][9][10][11] It has been reported that excessive initial tension might lead to over-constraining the knee joint, resulting in loss of range of motion, graft failure, or articular cartilage degeneration in single-bundle ACL reconstruction. [12][13][14][15] Therefore some studies have focused on the laxity match pre-tensiondwhich is the minimal required tension to restore normal laxity compared with the healthy kneedto determine the optimal setting of the initial tension. 16,17 However, considering stress relaxation, graft remodeling, and tunnel enlargement after graft fixation, it seems plausible to apply somewhat greater initial tension than the laxity match pre-tension to restore normal stability after ACL reconstruction.…”

mentioning

confidence: 99%

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

Koga

Muneta

Yagishita

et al. 2015

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Effects of Initial Graft Tension on the Tibiofemoral Compressive Forces and Joint Position after Anterior Cruciate Ligament Reconstruction

Abstract: The tibiofemoral compressive force and neutral joint position were best replicated with a low graft tension (1-15 N) when using a patellar tendon graft.

Cited by 68 publications

References 75 publications

Does Anteromedial Portal Drilling Improve Footprint Placement in Anterior Cruciate Ligament Reconstruction?

Does Anteromedial Portal Drilling Improve Footprint Placement in Anterior Cruciate Ligament Reconstruction?

Tibiofemoral Compression Force Differences Using Laxity- and Force-Based Initial Graft Tensioning Techniques in the Anterior Cruciate Ligament–Reconstructed Cadaveric Knee

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

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