Abstract
BackgroundIn anatomic double-bundle anterior cruciate ligament (ACL) reconstruction, there are great controversies concerning the ideal graft tension protocols. The purpose of this study was to clarify differences in the effect of two graft tension protocols on the clinical outcome after anatomic double-bundle anterior cruciate ligament (ACL) reconstruction by comparing the minimum 2-year clinical results.MethodsNinety-seven patients with unilateral anatomic double-bundle ACL reconstruction were divided into two groups. In the first 44 patients (Group I), a 40-N tension was applied to each of the two hamstring autografts at 30° of knee flexion, and simultaneously fixed onto the tibia. In the remaining 53 patients (Group II), a 30-N tension was applied to each graft at 10° of knee flexion, and simultaneously fixed onto the tibia. Each patient was examined 2 years after surgery.ResultsThere wasn’t a significant difference in the background of the two groups. There was no significant difference in the postoperative anterior laxity between the two groups. The average was 1.1 mm and 0.9 mm in Groups I and II, respectively. There wasn't any differences between the two groups in Lysholm knee score, International Knee Documentation Committee (IKDC) evaluation and muscle strength. Four patients had loss of knee extension in a range of 5° and 10° in Group I and none of the patients in Group II exhibited any loss in knee extension; which was statistically significant (p = 0.025).ConclusionThe two initial graft tension protocols did not result in any significant differences in the Lysholm knee score and IKDC grade. However, it was noted that the 40-N tension applied to each graft at 30° of knee flexion more significantly induced loss of knee extension in comparison to the 30-N tension applied to each graft at 10°. From a clinical viewpoint, the loss of knee extension is one of the pathological conditions that should be absolutely avoided after ACL reconstruction. Therefore, the 30-N tension applied to each graft at 10° is preferable to the other graft tension protocol.
Highlights
In anatomic double-bundle anterior cruciate ligament (ACL) reconstruction, there are great controversies concerning the ideal graft tension protocols
The loss of knee extension is one of the pathological conditions that should be absolutely avoided after ACL reconstruction [29]
The 2 initial graft tension protocols did not result in any significant differences in the Lysholm knee score and International Knee Documentation Committee (IKDC) grade
Summary
In anatomic double-bundle anterior cruciate ligament (ACL) reconstruction, there are great controversies concerning the ideal graft tension protocols. The single-bundle ACL reconstruction procedure remains the gold standard, anatomic double-bundle ACL reconstruction procedures have recently attracted a great deal of attention due to their in vitro biomechanical advantages [1,2,3,4,5] In both ACL reconstruction procedures, the graft tension technique, which includes applying a certain magnitude of initial tension to a graft and fixing the graft at a certain degree of knee flexion, has been recognized as one of the most important variables [5,6,7,8,9,10,11], because it will have impacts on the outcome of the surgery. Many investigators have tried to apply various combinations of initial tension magnitudes to the anteromedial (AM) and posterolateral (PL) bundle grafts at different angles of knee flexion [19,20,21,22,23,24,25,26] In these studies, the clinical outcome, the postoperative knee stability, differed significantly.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
