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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

Authors

  • 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

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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