The Effect of Initial Graft Tension in Anterior Cruciate Ligament Reconstruction on the Mechanical Behaviors of the Femur-Graft-Tibia Complex during Cyclic Loading

Numazaki, Hironori; Tohyama, Harukazu; Nakano, H; Kikuchi, Shinichi; Yasuda, Kazunori

doi:10.1177/03635465020300060801

Cited by 69 publications

(58 citation statements)

References 11 publications

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“…5 This should be taken into account, independent of the type of fixation device. 25 For tibial internal rotation torque, the anatomic doublebundle reconstruction restored the tibial rotation of the ACL to the level of the intact knee, whereas the singlebundle reconstruction did not: cutting the ACL increased the laxity by a mean of 4°at 20°of knee flexion, the single-bundle reconstruction only reduced this by a mean of 1°while the double-bundle reconstruction reduced it by a mean of 3.5°. Because the single-bundle reconstruction approximated the AM bundle, the graft was more vertical than the PL bundle of the ACL so it could not effectively stabilize knee rotation near the full extension position.…”

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confidence: 98%

“…Furthermore, the conclusions reached refer to time-zero conditions and may be influenced subsequently by the effects of chronic graft relaxation and graft remodeling, which have been demonstrated to affect the fate of ACL reconstruction. 25 These limitations have been offset by the ability to make a series of comparative intraspecimen tests on a range of ACL reconstruction protocols. Further, the test setup allowed carefully controlled loads to be applied and full 6 degrees of freedom kinematic data to be collected by motion sensors attached directly to the bones.…”

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confidence: 99%

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Biomechanical Comparisons of Knee Stability After Anterior Cruciate Ligament Reconstruction Between 2 Clinically Available Transtibial Procedures

et al. 2010

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Biomechanical Comparisons of Knee Stability After Anterior Cruciate Ligament Reconstruction Between 2 Clinically Available Transtibial Procedures

et al. 2010

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“…Having an interference screw in place effectively shortens the tendon construct by not allowing the tendon length inside the bone tunnel to stretch when loaded. By preventing this section of the tendon from stretching, laxity due to inadequate initial graft tensioning becomes less pronounced [9]. The screw also mitigates stretching of the EndoButton loop, which is another factor in increasing construct stiffness.…”

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confidence: 99%

Stiffness characteristics of hamstring tendon graft fixation methods at the femoral site

Benfield

Otto

Bagnall

et al. 2004

International Orthopaedics (SICOT)

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In ACL reconstruction, stiffness and strength of a tendon graft complex are important features for knee stability and rehabilitation. The fixation between tendon and bone is known to be one of the weakest components of the graft complex. We examined the tensile loaddisplacement characteristics of looped semitendinosus tendons in a porcine femoral tunnel. Two groups of six cadaveric semitendinosus tendons and porcine femurs were tested, secured with either an aperture or nonaperture fixation method. Constructs were tested at 1 mm/s until failure in a materials testing machine, which allowed force and displacement data to be recorded. The nonaperture fixation group was significantly less stiff for the first 4 mm of displacement and had significantly higher ultimate failure loads. Provided that adequate ultimate strength can be achieved, stiffness properties of a tendon graft will be improved by using aperture fixation in femoral-site ACL reconstruction.Résumé Dans la reconstruction du LCA la rigidité et la résistance du complexe greffe-tendon sont des éléments importants pour la stabilité du genou et la récupération fonctionnelle. La fixation entre le tendon et l'os est connue pour être un des maillons faibles de l'ensemble. Nous avons examiné les caractéristiques de l'élasticité sous traction de tendons du demi-tendineux insérés en boucle dans un tunnel fémoral porcin. Deux groupes de six tendons cadavériques ont été testés, amarrés par une fixation avec ou sans ouverture. Les constructions ont été testées à 1 mm/s jusqu'à la rupture avec une machine á traction qui permet d'enregistrer la force et le déplace-ment. Le groupe avec la fixation sans ouverture était significativement moins rigide pour les premiers 4 mm de déplacement et avait une charge de rupture nettement plus haute. A condition que la tension de rupture puisse être atteinte, les propriétés de rigidité d'une greffe tendineuse seront améliorées en utilisant la fixation avec ouverture au niveau du site fémoral dans la reconstruction du LCA.

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“…The graft load in the button-fixation technique was low, probably due to slight slippage of the button. When the graft was fixed under maximum manual tension, the graft loads at completion of fixation for the interference fit screw, fixation post, and button techniques were the effect of fixation method on residual load of the ACL graft [5,19,21], and its significance has not been clarified.…”

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confidence: 99%

The load of an implanted graft during and after fixation in anterior cruciate ligament reconstruction

Yoshihara

Yoshiya

Kurosaka

et al. 2004

Knee Surg Sports Traumatol Arthrosc

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Although the importance of initial graft load has been discussed in the literature, it has not been confirmed whether a surgeon can provide the desired load to an implanted graft in anterior cruciate ligament reconstruction. The purpose of this study was to compare the set force (initial load given to the graft before fixation) and residual load in the implanted graft using three different fixation techniques. A total of ninety porcine knees were tested using bone-patellar tendon-bone autograft. Each bone-tendon-bone autograft was fixed to the tibia with either the interference-fit screw, fixation post, or button technique. Graft load was monitored during fixation procedures, and for 10 min after fixation. Residual graft load with each fixation technique exhibited unique features. Highest graft load was obtained by the interference-screw fixation technique; however, the graft was usually over-loaded beyond the intended set force with this technique. In the fixation-post technique, the load of the graft increased while the screw was retightened. The graft load in the button-fixation technique was low, probably due to slight slippage of the button. When the graft was fixed under maximum manual tension, the graft loads at completion of fixation for the interference fit screw, fixation post, and button techniques were 116.3, 54.2, and 25.9 N respectively.

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The Effect of Initial Graft Tension in Anterior Cruciate Ligament Reconstruction on the Mechanical Behaviors of the Femur-Graft-Tibia Complex during Cyclic Loading

Abstract: Considering the tension of the normal anterior cruciate ligament (16 to 87 N), an initial tension of 20 N appears to be high enough for a patellar tendon graft. For a flexor tendon graft with interference screws, an increase in initial tension above 80 N has no biomechanical advantages.

Cited by 69 publications

References 11 publications

Biomechanical Comparisons of Knee Stability After Anterior Cruciate Ligament Reconstruction Between 2 Clinically Available Transtibial Procedures

Biomechanical Comparisons of Knee Stability After Anterior Cruciate Ligament Reconstruction Between 2 Clinically Available Transtibial Procedures

Stiffness characteristics of hamstring tendon graft fixation methods at the femoral site

The load of an implanted graft during and after fixation in anterior cruciate ligament reconstruction

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