Abstract
It has always been a matter of debate whether graft tensioning at the time of fixation plays an important role for long-term function of the knee joint following reconstruction of the anterior cruciate ligament (ACL). Conceptionally, it is easily understood that an ACL must not be loose at the time of fixation. However, there is no agreement on the ideal loads for graft tensioning. The following chapter will summarize the current knowledge on the impact of graft tensioning at the time of reconstruction on the clinical and functional outcome after ACL reconstruction.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsReferences
Amis AA, Jakob RP (1998) Anterior cruciate ligament graft positioning, tensioning and twisting. Knee Surg Sports Traumatol Arthrosc 6(Suppl 1):S2–S12
Arneja S, McConkey MO, Mulpuri K et al (2009) Graft tensioning in anterior cruciate ligament reconstruction: a systematic review of randomized controlled trials. Arthroscopy 25(2):200–207
Bastian JD, Tomagra S, Schuster AJ, Werlen S, Jakob RP, Zumstein MA (2013) ACL reconstruction with physiological graft tension by intraoperative adjustment of the anteroposterior translation to the uninjured contralateral knee. Knee Surg Sports Traumatol Arthrosc 21(5):1226–33
Boylan D, Greis PE, West JR, Bachus KN, Burks RT (2003) Effects of initial graft tension on knee stability after anterior cruciate ligament reconstruction using hamstring tendons: a cadaver study. Arthroscopy 19(7):700–705
Brady MF, Bradley MP, Fleming BC, Fadale PD, Hulstyn MJ, Banerjee R (2007) Effects of initial graft tension on the tibiofemoral compressive forces and joint position after anterior cruciate ligament reconstruction. Am J Sports Med 35(3):395–403
Brown CH, Wilson DR, Hecker AT, Ferragamo M (2004) Graft-bone motion and tensile properties of hamstring and patellar tendon anterior cruciate ligament femoral graft fixation under cyclic loading. Arthroscopy 20(9):922–935
Burks RT, Leland R (1988) Determination of graft tension before fixation in anterior cruciate ligament reconstruction. Arthroscopy 4(4):260–266
Ciccone WJ, Bratton DR, Weinstein DM, Elias JJ (2006) Viscoelasticity and temperature variations decrease tension and stiffness of hamstring tendon grafts following anterior cruciate ligament reconstruction. J Bone Joint Surg Am 88(5):1071–1078
Dargel J, Koebke J, Brüggemann G-P, Pennig D, Schmidt-Wiethoff R (2009) Tension degradation of anterior cruciate ligament grafts with dynamic flexion-extension loading: a biomechanical model in porcine knees. Arthroscopy 25(10):1115–1125
Eagar P, Hull ML, Howell SM (2004) 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. J Orthop Res 22(3):613–624
Elias JJ, Rai SP, Ciccone WJ (2008) In vitro comparison of tension and stiffness between hamstring tendon and patella tendon grafts. J Orthop Res 26(11):1506–1511
Fleming BC, Brady MF, Bradley MP, Banerjee R, Hulstyn MJ, Fadale PD (2008) Tibiofemoral compression force differences using laxity- and force-based initial graft tensioning techniques in the anterior cruciate ligament-reconstructed cadaveric knee. Arthroscopy 24(9):1052–1060
Fu S-C, Cheng W-H, Cheuk Y-C et al (2013) Effect of graft tensioning on mechanical restoration in a rat model of anterior cruciate ligament reconstruction using free tendon graft. Knee Surg Sports Traumatol Arthrosc
Graf BK, Vanderby R, Ulm MJ, Rogalski RP, Thielke RJ (1994) Effect of preconditioning on the viscoelastic response of primate patellar tendon. Arthroscopy 10(1):90–96
Herbort M, Lenschow S, Fu FH, Petersen W, Zantop T (2010) ACL mismatch reconstructions: influence of different tunnel placement strategies in single-bundle ACL reconstructions on the knee kinematics. Knee Surg Sports Traumatol Arthrosc 18(11):1551–1558
Höher J, Scheffler SU, Withrow JD et al (2000) Mechanical behavior of two hamstring graft constructs for reconstruction of the anterior cruciate ligament. J Orthop Res 18(3):456–461
Katsuragi R, Yasuda K, Tsujino J, Keira M, Kaneda K (2000) The effect of nonphysiologically high initial tension on the mechanical properties of in situ frozen anterior cruciate ligament in a canine model. Am J Sports Med 28(1):47–56
Kim S-G, Kurosawa H, Sakuraba K, Ikeda H, Takazawa S (2005) The effect of initial graft tension on postoperative clinical outcome in anterior cruciate ligament reconstruction with semitendinosus tendon. Arch Orthop Trauma Surg 126(4):260–264
Mae T, Shino K, Nakata K, Toritsuka Y, Otsubo H, Fujie H (2008) Optimization of graft fixation at the time of anterior cruciate ligament reconstruction. Part II: effect of knee flexion angle. Am J Sports Med 36(6):1094–1100
Mae T, Shino K, Nakata K, Toritsuka Y, Otsubo H, Fujie H (2008) Optimization of graft fixation at the time of anterior cruciate ligament reconstruction: part I: effect of initial tension. Am J Sports Med 36(6):1087–1093
Markolf KL, Hame S, Hunter DM et al (2002) Effects of femoral tunnel placement on knee laxity and forces in an anterior cruciate ligament graft. J Orthop Res 20(5):1016–1024
Nicholas SJ, D’Amato MJ, Mullaney MJ, Tyler TF, Kolstad K, McHugh MP (2004) A prospectively randomized double-blind study on the effect of initial graft tension on knee stability after anterior cruciate ligament reconstruction. Am J Sports Med 32(8):1881–1886
Scheffler SU, Südkamp NP, Göckenjan A, Hoffmann RFG, Weiler A (2002) Biomechanical comparison of hamstring and patellar tendon graft anterior cruciate ligament reconstruction techniques: the impact of fixation level and fixation method under cyclic loading. Arthroscopy 18(3):304–315
Sherman SL, Chalmers PN, Yanke AB et al (2012) Graft tensioning during knee ligament reconstruction: principles and practice. J Am Acad Orthop Surg 20(10):633–645
Stapleton TR, Curd DT, Baker CL (1999) Initial biomechanical properties of anterior cruciate ligament reconstruction autografts. J South Orthop Assoc 8(3):173–180; discussion 180
Tohyama H, Beynnon BD, Johnson RJ, Renström PA, Arms SW (1996) The effect of anterior cruciate ligament graft elongation at the time of implantation on the biomechanical behavior of the graft and knee. Am J Sports Med 24(5):608–614
Tohyama H, Yasuda K (1998) Significance of graft tension in anterior cruciate ligament reconstruction. Basic background and clinical outcome. Knee Surg Sports Traumatol Arthrosc 6(Suppl 1):S30–S37
van Kampen A, Wymenga AB, van der Heide HJ, Bakens HJ (1998) The effect of different graft tensioning in anterior cruciate ligament reconstruction: a prospective randomized study. Arthroscopy 14(8):845–850
Yamanaka M, Yasuda K, Tohyama H, Nakano H, Wada T (1999) The effect of cyclic displacement on the biomechanical characteristics of anterior cruciate ligament reconstructions. Am J Sports Med 27(6):772–777
Yasuda K, Tsujino J, Tanabe Y, Kaneda K (1997) Effects of initial graft tension on clinical outcome after anterior cruciate ligament reconstruction. Autogenous doubled hamstring tendons connected in series with polyester tapes. Am J Sports Med 25(1):99–106
Yoshiya S, Andrish JT, Manley MT, Bauer TW (1987) Graft tension in anterior cruciate ligament reconstruction. An in vivo study in dogs. Am J Sports Med 15(5):464–470
Yoshiya S, Kurosaka M, Ouchi K, Kuroda R, Mizuno K (2002) Graft tension and knee stability after anterior cruciate ligament reconstruction. Clin Orthop Relat Res 394:154–160
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2014 ESSKA
About this chapter
Cite this chapter
Scheffler, S.U. (2014). Tensioning of Grafts: Any Evidence?. In: Siebold, R., Dejour, D., Zaffagnini, S. (eds) Anterior Cruciate Ligament Reconstruction. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-45349-6_23
Download citation
DOI: https://doi.org/10.1007/978-3-642-45349-6_23
Published:
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-642-45348-9
Online ISBN: 978-3-642-45349-6
eBook Packages: MedicineMedicine (R0)