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Effect of graft tensioning on mechanical restoration in a rat model of anterior cruciate ligament reconstruction using free tendon graft

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

Abstract

Purpose

Initial graft tensioning is important in anterior cruciate ligament reconstruction (ACLR), but its effect on graft healing is still not clear. Since all previous animal studies on graft tensioning used bone–patellar tendon–bone, this study aimed to investigate the effect of initial graft tensioning on ACLR using tendon graft.

Methods

Fifty-five Sprague–Dawley rats underwent ACLR using flexor digitorum longus tendon graft. A constant force of 2 or 4 N was applied during graft fixation. At 0, 2, and 6 weeks, knee samples were harvested (n = 6) for static knee laxity test and graft pull-out test. Histological examination was performed at 2 and 6 weeks post-injury (n = 4).

Results

At time zero, knee laxity was restored by ACLR with 2 or 4 N tensioning as compared to ACL-deficient group (p < 0.001), and the 4 N group exhibited a better restoration as compared to 2 N group (p = 0.031). At week 2 post-operation, the 4 N group still exhibited a better restoration in knee laxity (p = 0.001) and knee stiffness (p = 0.002) than the 2 N group; the graft pull-out force (p = 0.032) and stiffness (p = 0.010) were also higher. At week 6 post-operation, there was no significant difference between the 2 and 4 N group in knee laxity and graft pull-out strength. Histological examination showed that the beneficial effect of higher initial graft tension may be contributed by maintenance of graft integrity at mid-substance and reduction in adverse peri-graft bone changes in the femoral tunnel region.

Conclusions

A higher initial graft tension favours the restoration of knee laxity and promotes graft healing in ACLR using free tendon graft in the rat model.

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Acknowledgments

This study was supported by the Innovation and Technology Fund (Ref: ITS/444/09) from the Innovation and Technology Commission of the government of Hong Kong SAR.

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Authors and Affiliations

  1. Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China

    Sai-Chuen Fu, Wai-Hang Cheng, Yau-Chuk Cheuk, Tsui-Yu Mok, Shu-Hang Yung & Kai-Ming Chan

  2. The Hong Kong Jockey Club Sports Medicine and Health Sciences Centre, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China

    Sai-Chuen Fu, Wai-Hang Cheng, Yau-Chuk Cheuk, Tsui-Yu Mok, Shu-Hang Yung & Kai-Ming Chan

  3. Department of Orthopaedic Surgery, Huddinge University Hospital, CLINTEC, Karolinska Institutet, Stockholm, Sweden

    Christer G. Rolf

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  1. Sai-Chuen Fu
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  2. Wai-Hang Cheng
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Correspondence to Sai-Chuen Fu or Kai-Ming Chan.

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Fu, SC., Cheng, WH., Cheuk, YC. et al. 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 21, 1226–1233 (2013). https://doi.org/10.1007/s00167-012-1974-x

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  • DOI: https://doi.org/10.1007/s00167-012-1974-x

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