The effects of graft tensioning on the laxity and kinematics of the anterior cruciate ligament reconstructed knee

Melby, Arne; Noble, Jeffrey S.; Askew, Michael J.; Boom, A.; Hurst, Frank W.

doi:10.1016/0749-8063(91)90123-f

Cited by 113 publications

(58 citation statements)

References 24 publications

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“…Brower et al [4] used the Genucom setup and found that approximately 60% of the increase in i/e rotation after cutting the ACL was due to additional internal rotation. Melby et al [12], also using the Genucom, on the other hand, found no increase in i/e rotation at all after cutting the ACL. Lane et al [10] discovered that 75% of the additional i/e rotation was internal.…”

Section: Discussionmentioning

confidence: 99%

The anterior cruciate ligament does play a role in controlling axial rotation in the knee

Andersen

Dyhre‐Poulsen

1997

Knee Surgery, Sports Traumatology, Arthroscopy

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This study deals with the influence of peroperative ligament tension on total tibial rotation at different knee flexion angles. Fourteen human cadaver knees with a mean age of 56 years (range 42-84 years) were examined. The cadaver knees were subjected to internal/external (i/e) rotational torque of 6 Nm, at 10, 30, 50, 70 and 90 deg of knee flexion. The mean total i/e rotation with the anterior cruciate ligament (ACL) intact at 10 deg of knee flexion was 30.4 deg and after removing the ACL, 33.1 deg. At 10 and 30 deg of knee flexion, the increase in i/e rotation was significant, while there was no significant difference in mean values at greater knee flexion. Ligament reconstruction with a tension of 5 N at 30 deg of knee flexion using either the over the top or through the femoral condyle reconstructive procedure restored normal tibial rotation. With increased graft tension the knee motion was increasingly restricted at low angles of knee flexion. Our results indicate that the ACL does play a role in limiting axial rotation, and even minor tensioning forces introduced in any of the two ACL reconstructions used produced restricted knee motion.

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Section: Discussionmentioning

confidence: 99%

The anterior cruciate ligament does play a role in controlling axial rotation in the knee

Andersen

Dyhre‐Poulsen

1997

Knee Surgery, Sports Traumatology, Arthroscopy

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“…High graft tension may cause both abnormal kinematics of the knee and also impaired remodeling of the graft. Abnormal knee kinematics include an overconstrained 225 N anterior limit of motion, posterior subluxation of the tibia [2,14,30], and inhibited knee extension [2]. Impairments to the graft include excessive graft wear at the femoral tunnel margin [ 191, and poor revavascularization, myxoid degeneration, and inferior mechanical properties [23,46].…”

Section: Importance and Interpretutionmentioning

confidence: 99%

“…If the initial tension is excessive, then the corresponding increase in graft tension could reach the failure load of the graft-fixation complex [27]. Posterior tibial subluxation, also caused by excessive initial tension, will alter the A/P load-displacement behavior of the knee [30].…”

Section: Introductionmentioning

confidence: 99%

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How the fixation method stiffness and initial tension affect anterior load?displacement of the knee and tension in anterior cruciate ligament grafts: a study in cadaveric knees using a double-loop hamstrings graft

EAGAR

2004

Journal of Orthopaedic Research

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There were two objectives to this study. The first was to investigate the relationship of graft fixation stiffness and graft initial tension on the anterior load-displacement behavior of knees reconstructed with a double-loop hamstrings tendon graft. The second was to determine the corresponding graft tensions at 225 N of anterior force applied to the knee. To satisfy these objectives, the anterior-load displacement curves were measured for seven cadaveric knees with the ACL intact a t flexion angles ranging from 0" to 90". The ACL was reconstructed in the same knees using a double-loop hamstrings graft. A/P load-displacement curves of the knee and graft tension were measured as the fixation method stiffness and the initial tension applied at full extension were varied (25-326 N/mm and 25-300 N). The 0 N posterior limit (unloaded position of tibia) and the anterior laxity (difference between the 0 N posterior limit and 225 N anterior limit) were computed to characterize the A/P load-displacement of the intact and reconstructed knees. The key results were that the 0 N posterior limit of the tibia was insensitive to changes in stiffness (p > 0.6503) but that increasing initial tension caused increasing posterior subluxation of the tibia with respect to the femur (p = 0.0001). The tibia was subluxed posteriorly by 5-6 mm on average at high levels of initial tension. Both initial tension and stiffness significantly affected the anterior laxity (p = 0.0001 for both factors). Anterior laxity was restored closely to normal (i.e. < I mm difference) by relatively high initial tension of 200 N in combination with low stiffness of 25 N/mm and by low initial tension of 25 N in combination with higher stiffness ranging between 94 and 326 Nlmm. When anterior laxity is restored to normal using a high initial tension-low stiffness combination however, the tibia undergoes a large posterior subluxation with respect to the femur in the unloaded state (approximately 5 mm) and a relatively high graft tension of 275 N is developed at 225 N of anterior force. Both the tibial subluxation and graft tension are reduced substantially with low initial tension-higher stiffness combinations because the amount of initial tension required to restore anterior laxity to normal is reduced by about 200 N.

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“…They introduced the term "over corrected knees" for these specimens. Melby et al [17] confirmed the findings of Lewis et al [15] and stated that abnormal joint stiffness in ACL reconstructed knees results in excessive long-term joint wear. Bylski-Austrow et al [3] and Fleming et al [7] found that increasing pretensions of the artificial ligaments cause increased posterior shifts of the tibia.…”

Section: Kinematicsmentioning

confidence: 66%

Effect of pretension in reconstructions of the anterior cruciate ligament with a Dacron prosthesis

Heerwaarden

Stellinga

Frudiger

1996

Knee Surg, Sports traumatol, Arthroscopy

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To study the effect of the pretension level in reconstructions of the anterior cruciate ligament (ACL) we examined 26 patients with isolated ACL insufficiency and intact Dacron ligament prosthesis at 4-year follow-up. The patients were divided into two groups of 13 each, based on pretension level applied at the reconstruction: in group I the ligament was pretensioned to 60 N and in group II to 40 N. The patients were evaluated by the Tegner and Lysholm scores, KT-1000 arthrometer measurements, and isokinetic muscle performance testing and were assessed by the Knee Ligament Standard Evaluation Form of the International Knee Documentation Committee. At follow-up there were no differences between the two groups in any of the evaluated parameters except for squatting ability. The two groups differed significantly (P < 0.01) with regard to the squatting score: 11 patients in group I had decreased squatting ability, and 6 of these were not able to squat beyond 90 degrees of flexion. In contrast, only 4 patients in group II had slightly impaired squatting ability. It is likely that this difference between the two groups is related to the magnitude of the pretension applied to the ligament prosthesis, and that the pretension exerts its influence through a change in the knee kinematics introduced at the time of the reconstruction.

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The effects of graft tensioning on the laxity and kinematics of the anterior cruciate ligament reconstructed knee

Cited by 113 publications

References 24 publications

The anterior cruciate ligament does play a role in controlling axial rotation in the knee

The anterior cruciate ligament does play a role in controlling axial rotation in the knee

How the fixation method stiffness and initial tension affect anterior load?displacement of the knee and tension in anterior cruciate ligament grafts: a study in cadaveric knees using a double-loop hamstrings graft

Effect of pretension in reconstructions of the anterior cruciate ligament with a Dacron prosthesis

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