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Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 26, Issue 12, pp 3690–3698 | Cite as

Device-assisted tensioning is associated with lower rates of graft failure when compared to manual tensioning in ACL reconstruction

  • Laura Morrison
  • Chloe Haldane
  • Darren de SA
  • Fawaz Findakli
  • Nicole Simunovic
  • Olufemi R. Ayeni
Knee

Abstract

Purpose

To describe (1) the current graft tensioning practices in ACL reconstruction (ACLR) and, (2) the failure rates with the use of manual tensioning, or device-assisted tensioning at the time of graft fixation.

Methods

The electronic databases MEDLINE, EMBASE, and PubMed were searched independently by two reviewers from database inception to search date on January 21, 2017. Inclusion criteria were studies reporting graft tensioning method and rate of graft failure. The definition of graft failure used was: (1) side-to-side instrumented laxity > 5 mm, (2) Lachman 2 +, (3) positive pivot-shift testing, (4) MRI-confirmed graft rupture or, (5) need for revision surgery.

Results

A total of 3379 patients and 3380 knees were treated with ACL reconstruction and followed for an average of 41.7 months (range 4–145 months). ACLR with manual tensioning was performed on 1518 (51.9%) patients and device-assisted tensioning was performed on 1802 (48.1%) patients. The average knee position reported was 29.2° in single-bundle ACLR and 22.9° in double-bundle ACLR. The median amount of tension used in manual tensioning was ‘maximum manual tension’ and 50 N in device-assisted tensioning. Overall, the failure rate in studies reporting manual tensioning was 8.9% compared to 4.3% in device-assisted tensioning.

Conclusion

Both manual tensioning and device-assisted tensioning are associated with low overall failure rates (< 10%) in ACLR; however, there is a higher rate of reported failure with manual tensioning compared to device-assisted tensioning. These findings highlight the need to investigate variations in graft tensioning practice, such as specific tension devices and their parameters, with high-quality, randomized controlled trials to elucidate details of their clinical impact.

Level of evidence

Level IV, systematic review of level I–IV studies.

Keywords

Anterior cruciate ligament (ACL) Reconstruction Graft Tension Manual Device 

Notes

Funding

None.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

This is a systematic review of the literature and no ethics approval is required.

Informed consent

For this type of study informed consent is not required.

Supplementary material

167_2018_4951_MOESM1_ESM.docx (19 kb)
Supplementary material 1 (DOCX 19 KB)
167_2018_4951_MOESM2_ESM.docx (28 kb)
Supplementary material 2 (DOCX 28 KB)

References

  1. 1.
    Arneja S, McConkey MO, Mulpuri K, Chin P, Gilbart MK, Regan WD, Leith JM (2009) Graft tensioning in anterior cruciate ligament reconstruction: a systematic review of randomized controlled trials. Arthroscopy 25(2):200–207CrossRefGoogle Scholar
  2. 2.
    Austin JC, Phornphutkul C, Wojtys EM (2007) Loss of knee extension after anterior cruciate ligament reconstruction: effects of knee position and graft tensioning. J Bone Jt Surg Am 89(7):1565–1574Google Scholar
  3. 3.
    Burks RT, Leland R (1988) Determination of graft tension before fixation in anterior cruciate ligament reconstruction. Arthroscopy 4(4):260–266CrossRefGoogle Scholar
  4. 4.
    Bylski-Austrow DI, Grood ES, Hefzy MS, Holden JP, Butler DL (1990) Anterior cruciate ligament replacements: a mechanical study of femoral attachment location, flexion angle at tensioning, and initial tension. J Orthop Res 8(4):522–531CrossRefGoogle Scholar
  5. 5.
    Cuomo P, Rama KR, Bull AM, Amis AA (2007) The effects of different tensioning strategies on knee laxity and graft tension after double-bundle anterior cruciate ligament reconstruction. Am J Sports Med 35(12):2083–2090CrossRefGoogle Scholar
  6. 6.
    Dargel J, Gotter M, Mader K, Pennig D, Koebke J, Schmidt-Wiethoff R (2007) Biomechanics of the anterior cruciate ligament and implications for surgical reconstruction. Strateg Trauma Limb Reconstr 2(1):1–12CrossRefGoogle Scholar
  7. 7.
    Fleming B, Beynnon B, Howe J, McLeod W, Pope M (1992) Effect of tension and placement of a prosthetic anterior cruciate ligament on the anteroposterior laxity of the knee. J Orthop Res 10(2):177–186CrossRefGoogle Scholar
  8. 8.
    Gertel TH, Lew WD, Lewis JL, Stewart NJ, Hunter RE (1993) Effect of anterior cruciate ligament graft tensioning direction, magnitude, and flexion angle on knee biomechanics. Am J Sports Med 21(4):572–581CrossRefGoogle Scholar
  9. 9.
    Grunau PD, Arneja S, Leith JM (2016) A randomized clinical trial to assess the clinical effectiveness of a measured objective tensioning decide in hamstring anterior cruciate ligament reconstruction. Am J Sports Med 44(6):1482–1486CrossRefGoogle Scholar
  10. 10.
    Jisa KA, Williams BT, Jaglowski JR, Turnbull TL, LaPrade RF, Wijdicks CA (2016) Lack of consensus regarding pretensioning and preconditioning protocols for soft tissue graft reconstruction of the anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc 24(9):2884–2891CrossRefGoogle Scholar
  11. 11.
    Kirwan GW, Bourke MG, Chipchase L, Dalton PA, Russel TG (2013) Initial graft tension and the effect on postoperative patient functional outcomes in anterior cruciate ligament reconstruction. Arthroscopy 29(5):934–941CrossRefGoogle Scholar
  12. 12.
    Koga H, Muneta T, Yagishita K, Watanabe T, Mochizuki T, Horie M, Nakamura T, Otabe K, Sekiya I (2015) Effect of initial graft tension on knee stability and graft tension pattern in double-bundle anterior cruciate ligament reconstruction. Arthroscopy 31(9):1756–1763CrossRefGoogle Scholar
  13. 13.
    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. Am J Sports Med 36(6):1087–1093CrossRefGoogle Scholar
  14. 14.
    Nicholas SJ, D’Amato MJ, Mullaney MR, 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):1881–1886CrossRefGoogle Scholar
  15. 15.
    Nishizawa Y, Hoshino Y, Nagamune K, Araki D, Nagai K, Kurosaka M, Kuroda R (2017) Comparison between intra- and extra-articular tension of the graft during fixation in anterior cruciate ligament reconstruction. Arthroscopy 33(6):1204–1210CrossRefGoogle Scholar
  16. 16.
    O’Neill BJ, Byrne FJ, Hirpara KM, Brennan WF, McHugh PE, Curtin W (2011) Anterior cruciate ligament graft tensioning. Is the maximal sustained one-handed pull technique reproducible? BMC Res Notes 4:244CrossRefGoogle Scholar
  17. 17.
    Samitier G, Marcano AI, Alentorn-Geli E, Cugat R, Farmer KW, Moser MW (2015) Failure of anterior cruciate ligament reconstruction. Arch Bone Jt Surg 3(4):220–240PubMedPubMedCentralGoogle Scholar
  18. 18.
    Sasaki Y, Chang SS, Fujii M, Araki D, Zhu J, Marshall B, Linde-Rosen M, Smolinski P, Fu FH (2015) Effect of fixation angle and graft tension in double-bundle anterior cruciate ligament reconstruction on knee biomechanics. Knee Surg Sports Traumatol Arthrosc 24(9):2892–2898CrossRefGoogle Scholar
  19. 19.
    Sherman SL, Chalmers PN, Yanke AB, Bush-Joseph CA, Verma NN, Cole BJ, Bach BR Jr (2012) Graft tensioning during knee ligament reconstruction: principles and practice. J Am Acad Orthop Surg 20(10):633–645PubMedGoogle Scholar
  20. 20.
    Shino K, Mae T, Tachibana Y (2015) Anatomic ACL reconstruction: rectangular tunnel/bone–patellar tendon–bone or triple-bundle/semitendinosus tendon grafting. J Orthop Sci 20(3):457–468CrossRefGoogle Scholar
  21. 21.
    Thompson DM, Hull ML, Howell SM (2006) Does a tensioning device pinned to the tibia improve knee anterior–posterior load-displacement compared to manual tensioning of the graft following anterior cruciate ligament reconstruction? A cadaveric study of two tibial fixation devices. J Orthop Res 24(9):1832–1841CrossRefGoogle Scholar
  22. 22.
    Woo SLY, Wu C, Dede O, Vercillo F, Noorani S (2006) Biomechanics and anterior cruciate ligament reconstruction. J Orthop Surg 1:2CrossRefGoogle Scholar
  23. 23.
    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):99–106CrossRefGoogle Scholar
  24. 24.
    Yoshiya S, Kurosaka M, Ouchi K, Kuroda R, Kosaku M (2002) Graft tension and knee stability after anterior cruciate ligament reconstruction. Clin Orthop Relat Res 394:154–160CrossRefGoogle Scholar

Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2018

Authors and Affiliations

  • Laura Morrison
    • 1
  • Chloe Haldane
    • 1
  • Darren de SA
    • 2
  • Fawaz Findakli
    • 3
  • Nicole Simunovic
    • 3
  • Olufemi R. Ayeni
    • 4
  1. 1.Michael G. DeGroote School of MedicineHamiltonCanada
  2. 2.UPMC Center for Sports MedicinePittsburghUSA
  3. 3.Department of Health Research Methods, Evidence and ImpactMcMaster UniversityHamiltonCanada
  4. 4.Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical CentreMcMaster UniversityHamiltonCanada

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