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Effects of graft pretensioning in anterior cruciate ligament reconstruction

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Graft pretensioning is used in anterior cruciate ligament (ACL) reconstruction to prevent secondary slackening. Its effects on collagen fibrillar ultrastructure are not known. In this study, we hypothesized that graft pretensioning in ACL reconstruction creates ultrastructural changes detectable in scanning electron microscopy (SEM).

Methods

A prospective comparative study was carried out on 38 ACL reconstructions using a 4-strand semitendinosus graft. Samples were harvested intra-operatively before and after pretensioning for 30 s, 2 or 5 min. The images produced in SEM were analyzed using an original semi-quantitative «CIP» score taking into account collagen cohesion, integrity, and parallelism. Intra- and inter-tester reliability for the CIP score were tested.

Results

The CIP scores decreased by 3.5 (1.6) points after pretensioning (P < 0.05). Significant differences were found in the 5, 2 min and 30 s subgroups for the global CIP score. Relative decrease (Delta CIP) was significantly higher in the 2 and 5 min subgroups after pretensioning in comparison with the 30 s subgroups. Intra- and inter-tester reliability for the CIP score were 0.85 and 0.92 (P < 0.05).

Conclusion

Pretensioning ACL grafts resulted in alteration of the collagen fibrillar ultrastructure, detectable using SEM. These results confirm the existence of collagen ultrastructural changes after pretensioning that may be related to its duration.

Level of evidence

Prospective comparative study, Level II.

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Acknowledgments

The authors wish to thank the staff of SCIAM (Common Service Imaging and Microscopic Analysis, Institute of Biology in Health, Angers University Hospital, Angers 49000, France), R. Filmon, and G. Mabilleau for their support in this research.

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Authors and Affiliations

  1. Orthopaedic Department, Nantes University Hospital, 44000, Nantes, France

    Claude Guillard, Francois Lintz, Guillaume Anthony Odri, Fabrice Colin, Sylvie Collon & François Gouin

  2. Inserm 922 Research Unit, Angers University Hospital, 49933, Angers, France

    Daniel Chappard

  3. Orthopaedic Department, Nord-Mayenne Hospital, 53100, Mayenne, France

    Denis Vogeli & Henri Robert

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  1. Claude Guillard
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  2. Francois Lintz
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Correspondence to Claude Guillard.

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Guillard, C., Lintz, F., Odri, G.A. et al. Effects of graft pretensioning in anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 20, 2208–2213 (2012). https://doi.org/10.1007/s00167-011-1833-1

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  • DOI: https://doi.org/10.1007/s00167-011-1833-1

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