Optimization of Graft Fixation at the Time of Anterior Cruciate Ligament Reconstruction

Abstract

Excessive initial tension at the time of ACL reconstruction may potentially bring deleterious effects to the articular surface, leading to cartilage degeneration.

Computer-assisted anatomically placed double-bundle ACL reconstruction: An in vitro experiment with different tension angles for the AM and the PL graft

“…This AP-error has previously been reported in other in vitro reconstruction studies [7,11,14,[26][27][28]. In agreement with those studies, the reconstructed knees showed the largest APerrors in extension.…”

“…In agreement with those studies, the reconstructed knees showed the largest APerrors in extension. In the higher flexion angles the AP-error was smaller since the posterior cruciate ligament restrained the posterior tibial translation [26]. The AP-error can be explained by the graft forces generated during graft tensioning and subsequent fixation.…”

Effect of tibial drill-guide angle on the mechanical environment at bone tunnel aperture after anatomic single-bundle anterior cruciate ligament reconstruction

“…This was similarly reported by the previous study [10]. Both the graft tension and graft-bone force remained within a safe range of the routine surgery procedure [4,25]. The graft-bone force would even decrease with knee flexion [4].…”

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

“…[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.…”