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J Knee Surg 2021; 34(07): 777-783
DOI: 10.1055/s-0039-3402046
Original Article

Evaluation of Graft Tensioning Effects in Anterior Cruciate Ligament Reconstruction between Hamstring and Bone–Patellar Tendon Bone Autografts

Steven F. DeFroda
1   Department of Orthopedic Surgery, Brown University, Providence, Rhode Island
,
Naga Padmini Karamchedu
1   Department of Orthopedic Surgery, Brown University, Providence, Rhode Island
,
Ross Budacki
1   Department of Orthopedic Surgery, Brown University, Providence, Rhode Island
,
Taylor Wiley
1   Department of Orthopedic Surgery, Brown University, Providence, Rhode Island
,
Paul D. Fadale
1   Department of Orthopedic Surgery, Brown University, Providence, Rhode Island
,
Michael J. Hulstyn
1   Department of Orthopedic Surgery, Brown University, Providence, Rhode Island
,
Robert M. Shalvoy
1   Department of Orthopedic Surgery, Brown University, Providence, Rhode Island
,
Gary J. Badger
2   Department Medical Biostatistics, University of Vermont, Burlington, Vermont
,
Braden C. Fleming
1   Department of Orthopedic Surgery, Brown University, Providence, Rhode Island
,
Brett D. Owens
1   Department of Orthopedic Surgery, Brown University, Providence, Rhode Island
› Author Affiliations Funding The research reported in this publication was supported by the National Institute of Health (2R01-AR047910, 1R01-AR074973, and 5P30-122732), the Lucy Lippitt Endowment, and the RIH Orthopaedic Foundation. The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health.
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Abstract

This article investigates the clinical, functional, and radiographic outcomes in anterior cruciate ligament (ACL) reconstruction patients over 7 years to determine the effects of initial graft tension on outcomes when using patellar tendon (bone–tendon–bone [BTB]) and hamstring tendon (HS) autografts. Ninety patients, reconstructed with BTB or HS, were randomized using two initial graft tension protocols: (1) normal anteroposterior (AP) laxity (“low-tension”; n = 46) and (2) AP laxity overconstrained by 2 mm (“high-tension”; n = 44). Seventy-two patients had data available at 7 years, with 9 excluded for graft failure. Outcomes included the Knee Injury and Osteoarthritis Outcome Score, Short-Form-36 (SF-36), and Tegner activity scale. Clinical outcomes included KT-1000S and International Knee Documentation Committee examination score; and functional outcomes included 1-leg hop distance and peak knee extensor torque. Imaging outcomes included medial joint space width, Osteoarthritis Research Society International radiographic score, and Whole-Organ Magnetic Resonance Score. There were significantly improved outcomes in the high-tension compared with the low-tension HS group for SF-36 subset scores for bodily pain (p = 0.012), social functioning (p = 0.004), and mental health (p = 0.014) 84 months postsurgery. No significant differences in any outcome were found within the BTB groups. Tegner activity scores were also significantly higher for the high-tension HS group compared with the low-tension (6.0 vs. 3.8, p = 0.016). Patients with HS autografts placed in high tension had better outcomes relative to low tension for Tegner activity score and SF-36 subset scores for bodily pain, social functioning, and mental health. For this reason, we recommend that graft fixation be performed with the knee at 30-degree flexion (“high-tension” condition) when reconstructing the ACL with HS autograft.

Keywords

ACL - graft selection - graft tensioning


Publication History

Received: 30 May 2019

Accepted: 10 November 2019

Article published online:
21 January 2020

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  • References

  • 1 Ajuied A, Wong F, Smith C. et al. Anterior cruciate ligament injury and radiologic progression of knee osteoarthritis: a systematic review and meta-analysis. Am J Sports Med 2014; 42 (09) 2242-2252
    CrossrefPubMedSearch in Google Scholar
  • 2 Brady MF, Bradley MP, Fleming BC, Fadale PD, Hulstyn MJ, Banerjee R. Effects of initial graft tension on the tibiofemoral compressive forces and joint position after anterior cruciate ligament reconstruction. Am J Sports Med 2007; 35 (03) 395-403
    CrossrefPubMedSearch in Google Scholar
  • 3 Fleming BC, Fadale PD, Hulstyn MJ. et al. The effect of initial graft tension after anterior cruciate ligament reconstruction: a randomized clinical trial with 36-month follow-up. Am J Sports Med 2013; 41 (01) 25-34
    CrossrefPubMedSearch in Google Scholar
  • 4 Akelman MR, Fadale PD, Hulstyn MJ. et al. Effect of matching or overconstraining knee laxity during anterior cruciate ligament reconstruction on knee osteoarthritis and clinical outcomes: a randomized controlled trial with 84-month follow-up. Am J Sports Med 2016; 44 (07) 1660-1670
    CrossrefPubMedSearch in Google Scholar
  • 5 Fleming BC, Brady MF, Bradley MP, Banerjee R, Hulstyn MJ, Fadale PD. Tibiofemoral compression force differences using laxity- and force-based initial graft tensioning techniques in the anterior cruciate ligament-reconstructed cadaveric knee. Arthroscopy 2008; 24 (09) 1052-1060
    CrossrefPubMedSearch in Google Scholar
  • 6 Beynnon BD, Uh BS, Johnson RJ. et al. Rehabilitation after anterior cruciate ligament reconstruction: a prospective, randomized, double-blind comparison of programs administered over 2 different time intervals. Am J Sports Med 2005; 33 (03) 347-359
    CrossrefPubMedSearch in Google Scholar
  • 7 Roos EM, Roos HP, Lohmander LS, Ekdahl C, Beynnon BD. Knee Injury and Osteoarthritis Outcome Score (KOOS)--development of a self-administered outcome measure. J Orthop Sports Phys Ther 1998; 28 (02) 88-96
    CrossrefPubMedSearch in Google Scholar
  • 8 Ware Jr JE, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 1992; 30 (06) 473-483
    CrossrefPubMedSearch in Google Scholar
  • 9 Tegner Y, Lysholm J. Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 1985; (198) 43-49
    PubMedSearch in Google Scholar
  • 10 Daniel DM, Malcom LL, Losse G, Stone ML, Sachs R, Burks R. Instrumented measurement of anterior laxity of the knee. J Bone Joint Surg Am 1985; 67 (05) 720-726
    CrossrefPubMedSearch in Google Scholar
  • 11 Irrgang JJ, Ho H, Harner CD, Fu FH. Use of the International Knee Documentation Committee guidelines to assess outcome following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 1998; 6 (02) 107-114
    CrossrefPubMedSearch in Google Scholar
  • 12 Reinke EK, Spindler KP, Lorring D. et al. Hop tests correlate with IKDC and KOOS at minimum of 2 years after primary ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2011; 19 (11) 1806-1816
    CrossrefPubMedSearch in Google Scholar
  • 13 Patel RR, Hurwitz DE, Bush-Joseph CA, Bach Jr BR, Andriacchi TP. Comparison of clinical and dynamic knee function in patients with anterior cruciate ligament deficiency. Am J Sports Med 2003; 31 (01) 68-74
    CrossrefPubMedSearch in Google Scholar
  • 14 Buckland-Wright JC, Wolfe F, Ward RJ, Flowers N, Hayne C. Substantial superiority of semiflexed (MTP) views in knee osteoarthritis: a comparative radiographic study, without fluoroscopy, of standing extended, semiflexed (MTP), and schuss views. J Rheumatol 1999; 26 (12) 2664-2674
    PubMedSearch in Google Scholar
  • 15 Altman RD, Gold GE. Atlas of individual radiographic features in osteoarthritis, revised. Osteoarthr Cartil 2007; 15 (Suppl. 01) 1-56
    CrossrefPubMedSearch in Google Scholar
  • 16 Peterfy CG, Guermazi A, Zaim S. et al. Whole-Organ Magnetic Resonance Imaging Score (WORMS) of the knee in osteoarthritis. Osteoarthritis Cartilage 2004; 12 (03) 177-190
    CrossrefPubMedSearch in Google Scholar
  • 17 Sajovic M, Stropnik D, Skaza K. Long-term comparison of semitendinosus and gracilis tendon versus patellar tendon autografts for anterior cruciate ligament reconstruction: a 17-year follow-up of a randomized controlled trial. Am J Sports Med 2018; 46 (08) 1800-1808
    CrossrefPubMedSearch in Google Scholar
  • 18 Poehling-Monaghan KL, Salem H, Ross KE. et al. Long-term outcomes in anterior cruciate ligament reconstruction: a systematic review of patellar tendon versus hamstring autografts. Orthop J Sport Med 2017; 5 (06) 2325967117709735
    CrossrefPubMedSearch in Google Scholar
  • 19 Thompson SM, Salmon LJ, Waller A, Linklater J, Roe JP, Pinczewski LA. Twenty-year outcome of a longitudinal prospective evaluation of isolated endoscopic anterior cruciate ligament reconstruction with patellar tendon or hamstring autograft. Am J Sports Med 2016; 44 (12) 3083-3094
    CrossrefPubMedSearch in Google Scholar
  • 20 Webster KE, Feller JA, Hartnett N, Leigh WB, Richmond AK. Comparison of patellar tendon and hamstring tendon anterior cruciate ligament reconstruction: a 15-year follow-up of a randomized controlled trial. Am J Sports Med 2016; 44 (01) 83-90
    CrossrefPubMedSearch in Google Scholar
  • 21 Yasuda K, Tsujino J, Tanabe Y, Kaneda K. 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 1997; 25 (01) 99-106
    CrossrefPubMedSearch in Google Scholar
  • 22 Kim SG, Kurosawa H, Sakuraba K, Ikeda H, Takazawa S. The effect of initial graft tension on postoperative clinical outcome in anterior cruciate ligament reconstruction with semitendinosus tendon. Arch Orthop Trauma Surg 2006; 126 (04) 260-264
    CrossrefPubMedSearch in Google Scholar
  • 23 Nicholas SJ, D'Amato MJ, Mullaney MJ, Tyler TF, Kolstad K, McHugh MP. 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 2004; 32 (08) 1881-1886
    CrossrefPubMedSearch in Google Scholar
  • 24 Yoshiya S, Kurosaka M, Ouchi K, Kuroda R, Mizuno K. Graft tension and knee stability after anterior cruciate ligament reconstruction. Clin Orthop Relat Res 2002; (394) 154-160
    CrossrefPubMedSearch in Google Scholar
  • 25 van Kampen A, Wymenga AB, van der Heide HJ, Bakens HJ. The effect of different graft tensioning in anterior cruciate ligament reconstruction: a prospective randomized study. Arthroscopy 1998; 14 (08) 845-850
    CrossrefPubMedSearch in Google Scholar
  • 26 Kirwan GW, Bourke MG, Chipchase L, Dalton PA, Russell TG. Initial graft tension and the effect on postoperative patient functional outcomes in anterior cruciate ligament reconstruction. Arthroscopy 2013; 29 (05) 934-941
    CrossrefPubMedSearch in Google Scholar