Residual graft tension after graft fixation in anterior cruciate ligament reconstruction: Manual vs tensioning boot techniques |
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| Institution: | 1. Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita-city, Osaka, 565-0871, Japan;2. Center of Sports Orthopaedic Surgery, Yukioka Hospital, 2-2-3, Ukita, Kita-ku, Osaka, 530-0021, Japan;1. Department of Dentistry and Oral Surgery, Shinshu University School of Medicine, 3-1-1, Asahi, Matsumoto, 390-8621, Japan;2. Department of Clinical Oral Oncology, Unit of Translational Medicine, Course of Medical and Dental Sciences, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8588, Japan;3. Department of Oral Maxillofacial Surgery, Kakogawa Central City Hospital, 439, Honmachi, Kakogawa-cho, Kakogawa, 675-8611, Japan;4. Department of Oral and Maxillofacial Surgery, Matsubara Tokushukai Hospital, 7-13-26, Amamihigashi, Matsubara, 580-0032, Japan;5. Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan;6. Department of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine, 89-1 Enyacho, Izumo, 693-8501, Japan;7. Department of Science of Physical Function, Division of Oral Medicine, Kyushu Dental University, 2-6-1, Manazuru, Kokura-kita, Kitakyushu, 803-8580, Japan;8. Department of Medicine of Sensory and Motor Organs, Division of Oral and Maxillofacial Surgery, Faculty of Medicine, Tottori University, 36-1 Nishi-cho, Yonago, 683-8504, Japan;9. Dentistry, Oral and Maxillofacial Surgery, Amagasaki Chuo Hospital, 1-12-1, Shioe, Amagasaki, 661-0976, Japan;10. Hokuryu established by the town dentist''s office, 2-17, Azayawara, Hokuryu, 078-2512, Japan;11. Department of Oral and Maxillofacial Surgery II, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka Suita, Osaka, 565-0871, Japan;12. Department of Science of Physical Functions, Division of Oral and Maxillofacial Surgery, Kyushu Dental University, 2-6-1, Manazuru, Kokura-kita, Kitakyushu, 803-8580, Japan;1. Tokyo Dental College Ichikawa General Hospital, Department of Orthopaedic Surgery, 5-11-13 Sugano, Ichikawa, Chiba, Japan;2. Shiraishi Spine Clinic, 1-5-1 Marunouchi, Chiyodaku, Tokyo, Japan;3. Murayama Medical Center, Department of Orthopaedic Surgery, 2-37-1 Gakuen, Musashi-Murayama, Tokyo, Japan;4. Saiseikai Yokohamashi Tobu Hospital, Department of Orthopedic Surgery, 3-6-1 Shimosueyosi, Tsurumiku, Yokohama, Kanagawa, Japan;5. Kawasaki Municipal Hospital, Department of Orthopedic Surgery, 12-1 Shinkawadori, Kawasakiku, Kawasaki, Kanagawa, Japan;1. Department of Orthopaedic Surgery, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi, Tokyo, 173-8605, Japan;2. Department of Anesthesia, Teikyo University School of Medicine, 2-11-1, Kaga, Itabashi, Tokyo, 173-8605, Japan;1. Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan;2. Department of Orthopaedic Surgery, Tokyo Medical and Dental University Hospital of Medicine (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan;3. Center for Stem Cell and Regenerative Medicine, Tokyo Medical and Dental University (TMDU), Tokyo, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan |
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| Abstract: | BackgroundGraft fixation at quantitative tension using a manual tensioner was advocated in ACL reconstruction, while the measured tension that is based on the surgeon's hand with the tensioner decreases after graft fixation. Therefore, our purpose is to elucidate how effectively the pre-determined graft tension maintained after final fixation of the graft to the tibia using a tensioning boot system fixed to the calf with a bandage, while monitoring the graft tension based on tibia.MethodsEight cadaveric legs (mean age: 83; 3 males and 5 females) underwent an anatomic double-bundle anterior cruciate ligament (ACL) reconstruction with hamstring tendon grafts. Two tension-adjustable force gauges were installed on the lateral femoral cortex beside the femoral tunnel. Then #5 strong suture wires through the loop end of grafts were tied to the force gauges using Endo-Buttons. After manual maximum load was repeatedly applied to each graft for 3 min, the grafts were fixed to the tibia with 10 N or 20 N at 20 degree of flexion with the following tensioning techniques using double spike plate system: (1) Manually tensioning technique (MT); (2) Tensioning boot technique with flexion-extension motion (TB-FE); and (3) Tensioning boot technique with repetitive pull (TB-RP). The residual tension at 20 was measured 3 min after grafts fixation, and also after 10 and 50 times of repeated flexion-extension motion. One-way repeated measures ANOVA was used for statistical analysis among the three techniques.ResultsThere were significant differences among three techniques fixing grafts with 10/20 N of initial tension in the residual tension 3 min after graft fixation and after 10 and 50 times of repeated flexion-extension motion. Among them, the residual tension in TB-RP was the greatest in most conditions.ConclusionTB-RP is the most secure procedure to maintain the graft tension closer to the intended initial tension in ACL reconstruction. |
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