Differential pretensions of a flexor tendon graft for anterior cruciate ligament reconstruction

A biomechanical comparison in a porcine knee model

Chian Her Lee, Guo Shu Huang, Kuo Hua Chao, Shing Sheng Wu, Qian Chen

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Purpose: The best way to apply the pretension force to the soft tissue graft during anterior cruciate ligament (ACL) reconstruction remains controversial. We compared manual, intra-, and extra-articular pretension techniques and determined the magnitude of displacement of the femur-graft-tibia complex in response to repetitive loading. Type of Study: A biomechanical-controlled study. Methods: Fresh porcine knees and profundus digital flexor tendons of hind limbs were used. Specimens were divided into 3 groups. Group A (manual pretension, n = 9) consisted of grafts that were pretensioned only by a maximal manual pull before final fixation on the tibial side. Group B (extra-articular pretension, n = 9) consisted of grafts that were pretensioned using a commercial tensiometer at 89 N for 15 minutes on the tendon preparation board, followed by pulling using maximal manual force before final fixation. Group C (intra-articular pretension, n = 9) consisted of grafts that were fastened on the femoral side first and then underwent application of a pretension force at 89 N for 5 minutes before final fixation on the tibial side. These femur-graft-tibia complexes from the 3 groups were loaded from 0 to 150 N at a frequency of 1 Hz for 1,000 cycles and then underwent a tensile load-to-failure test at a rate of 150 mm/min. Results: The displacement of the femur-graft-tibial complex in response to cyclic loading for group C (5.4 ± 0.3 mm) was significantly lower than those for groups A (12.5 ± 1.1 mm) and B (8.8 ± 0.8 mm) (P <.001). The fixation stiffness of group C (47.9 ± 17.6 N/mm) was significantly greater than that of group A (32.5 ± 9.7 N/mm) (P <.05) but not significantly different from that of group B (53.1 ± 9.1 N/mm). The ultimate failure load in each group was not significantly different. Conclusion: Intra-articular pretension of the graft before final fixation can significantly minimize graft elongation at time 0 compared with manual and extra-articular pretension. Clinical Relevance: Intra-articular or in vivo pretension of the graft using instruments may minimize the graft elongation in the early period of rehabilitation after ACL reconstruction.

Original languageEnglish
Pages (from-to)540-546
Number of pages7
JournalArthroscopy - Journal of Arthroscopic and Related Surgery
Volume21
Issue number5
DOIs
Publication statusPublished - May 2005
Externally publishedYes

Fingerprint

Anterior Cruciate Ligament Reconstruction
Tendons
Knee
Swine
Transplants
Joints
Femur
Tibia
Thigh
Rehabilitation
Extremities

Keywords

  • ACL reconstruction
  • Pretension
  • Tendon graft

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Surgery

Cite this

Differential pretensions of a flexor tendon graft for anterior cruciate ligament reconstruction : A biomechanical comparison in a porcine knee model. / Lee, Chian Her; Huang, Guo Shu; Chao, Kuo Hua; Wu, Shing Sheng; Chen, Qian.

In: Arthroscopy - Journal of Arthroscopic and Related Surgery, Vol. 21, No. 5, 05.2005, p. 540-546.

Research output: Contribution to journalArticle

@article{c073fdc110174318b3bb44e1270c9ce1,
title = "Differential pretensions of a flexor tendon graft for anterior cruciate ligament reconstruction: A biomechanical comparison in a porcine knee model",
abstract = "Purpose: The best way to apply the pretension force to the soft tissue graft during anterior cruciate ligament (ACL) reconstruction remains controversial. We compared manual, intra-, and extra-articular pretension techniques and determined the magnitude of displacement of the femur-graft-tibia complex in response to repetitive loading. Type of Study: A biomechanical-controlled study. Methods: Fresh porcine knees and profundus digital flexor tendons of hind limbs were used. Specimens were divided into 3 groups. Group A (manual pretension, n = 9) consisted of grafts that were pretensioned only by a maximal manual pull before final fixation on the tibial side. Group B (extra-articular pretension, n = 9) consisted of grafts that were pretensioned using a commercial tensiometer at 89 N for 15 minutes on the tendon preparation board, followed by pulling using maximal manual force before final fixation. Group C (intra-articular pretension, n = 9) consisted of grafts that were fastened on the femoral side first and then underwent application of a pretension force at 89 N for 5 minutes before final fixation on the tibial side. These femur-graft-tibia complexes from the 3 groups were loaded from 0 to 150 N at a frequency of 1 Hz for 1,000 cycles and then underwent a tensile load-to-failure test at a rate of 150 mm/min. Results: The displacement of the femur-graft-tibial complex in response to cyclic loading for group C (5.4 ± 0.3 mm) was significantly lower than those for groups A (12.5 ± 1.1 mm) and B (8.8 ± 0.8 mm) (P <.001). The fixation stiffness of group C (47.9 ± 17.6 N/mm) was significantly greater than that of group A (32.5 ± 9.7 N/mm) (P <.05) but not significantly different from that of group B (53.1 ± 9.1 N/mm). The ultimate failure load in each group was not significantly different. Conclusion: Intra-articular pretension of the graft before final fixation can significantly minimize graft elongation at time 0 compared with manual and extra-articular pretension. Clinical Relevance: Intra-articular or in vivo pretension of the graft using instruments may minimize the graft elongation in the early period of rehabilitation after ACL reconstruction.",
keywords = "ACL reconstruction, Pretension, Tendon graft",
author = "Lee, {Chian Her} and Huang, {Guo Shu} and Chao, {Kuo Hua} and Wu, {Shing Sheng} and Qian Chen",
year = "2005",
month = "5",
doi = "10.1016/j.arthro.2005.01.013",
language = "English",
volume = "21",
pages = "540--546",
journal = "Arthroscopy - Journal of Arthroscopic and Related Surgery",
issn = "0749-8063",
publisher = "W.B. Saunders Ltd",
number = "5",

}

TY - JOUR

T1 - Differential pretensions of a flexor tendon graft for anterior cruciate ligament reconstruction

T2 - A biomechanical comparison in a porcine knee model

AU - Lee, Chian Her

AU - Huang, Guo Shu

AU - Chao, Kuo Hua

AU - Wu, Shing Sheng

AU - Chen, Qian

PY - 2005/5

Y1 - 2005/5

N2 - Purpose: The best way to apply the pretension force to the soft tissue graft during anterior cruciate ligament (ACL) reconstruction remains controversial. We compared manual, intra-, and extra-articular pretension techniques and determined the magnitude of displacement of the femur-graft-tibia complex in response to repetitive loading. Type of Study: A biomechanical-controlled study. Methods: Fresh porcine knees and profundus digital flexor tendons of hind limbs were used. Specimens were divided into 3 groups. Group A (manual pretension, n = 9) consisted of grafts that were pretensioned only by a maximal manual pull before final fixation on the tibial side. Group B (extra-articular pretension, n = 9) consisted of grafts that were pretensioned using a commercial tensiometer at 89 N for 15 minutes on the tendon preparation board, followed by pulling using maximal manual force before final fixation. Group C (intra-articular pretension, n = 9) consisted of grafts that were fastened on the femoral side first and then underwent application of a pretension force at 89 N for 5 minutes before final fixation on the tibial side. These femur-graft-tibia complexes from the 3 groups were loaded from 0 to 150 N at a frequency of 1 Hz for 1,000 cycles and then underwent a tensile load-to-failure test at a rate of 150 mm/min. Results: The displacement of the femur-graft-tibial complex in response to cyclic loading for group C (5.4 ± 0.3 mm) was significantly lower than those for groups A (12.5 ± 1.1 mm) and B (8.8 ± 0.8 mm) (P <.001). The fixation stiffness of group C (47.9 ± 17.6 N/mm) was significantly greater than that of group A (32.5 ± 9.7 N/mm) (P <.05) but not significantly different from that of group B (53.1 ± 9.1 N/mm). The ultimate failure load in each group was not significantly different. Conclusion: Intra-articular pretension of the graft before final fixation can significantly minimize graft elongation at time 0 compared with manual and extra-articular pretension. Clinical Relevance: Intra-articular or in vivo pretension of the graft using instruments may minimize the graft elongation in the early period of rehabilitation after ACL reconstruction.

AB - Purpose: The best way to apply the pretension force to the soft tissue graft during anterior cruciate ligament (ACL) reconstruction remains controversial. We compared manual, intra-, and extra-articular pretension techniques and determined the magnitude of displacement of the femur-graft-tibia complex in response to repetitive loading. Type of Study: A biomechanical-controlled study. Methods: Fresh porcine knees and profundus digital flexor tendons of hind limbs were used. Specimens were divided into 3 groups. Group A (manual pretension, n = 9) consisted of grafts that were pretensioned only by a maximal manual pull before final fixation on the tibial side. Group B (extra-articular pretension, n = 9) consisted of grafts that were pretensioned using a commercial tensiometer at 89 N for 15 minutes on the tendon preparation board, followed by pulling using maximal manual force before final fixation. Group C (intra-articular pretension, n = 9) consisted of grafts that were fastened on the femoral side first and then underwent application of a pretension force at 89 N for 5 minutes before final fixation on the tibial side. These femur-graft-tibia complexes from the 3 groups were loaded from 0 to 150 N at a frequency of 1 Hz for 1,000 cycles and then underwent a tensile load-to-failure test at a rate of 150 mm/min. Results: The displacement of the femur-graft-tibial complex in response to cyclic loading for group C (5.4 ± 0.3 mm) was significantly lower than those for groups A (12.5 ± 1.1 mm) and B (8.8 ± 0.8 mm) (P <.001). The fixation stiffness of group C (47.9 ± 17.6 N/mm) was significantly greater than that of group A (32.5 ± 9.7 N/mm) (P <.05) but not significantly different from that of group B (53.1 ± 9.1 N/mm). The ultimate failure load in each group was not significantly different. Conclusion: Intra-articular pretension of the graft before final fixation can significantly minimize graft elongation at time 0 compared with manual and extra-articular pretension. Clinical Relevance: Intra-articular or in vivo pretension of the graft using instruments may minimize the graft elongation in the early period of rehabilitation after ACL reconstruction.

KW - ACL reconstruction

KW - Pretension

KW - Tendon graft

UR - http://www.scopus.com/inward/record.url?scp=19044376270&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=19044376270&partnerID=8YFLogxK

U2 - 10.1016/j.arthro.2005.01.013

DO - 10.1016/j.arthro.2005.01.013

M3 - Article

VL - 21

SP - 540

EP - 546

JO - Arthroscopy - Journal of Arthroscopic and Related Surgery

JF - Arthroscopy - Journal of Arthroscopic and Related Surgery

SN - 0749-8063

IS - 5

ER -