Abstract
Purpose
This study aimed to clarify the effect of initial graft tension on the ensuing tibiofemoral
relationship and on 2-year clinical outcomes after anatomic triple-bundle anterior
cruciate ligament (ACL) reconstruction.
Methods
A total of 31 patients with primary unilateral ACL rupture (mean age, 25.1 years)
were enrolled. Anatomic triple-bundle ACL reconstruction was performed using semitendinosus
tendon autografts, and patients were grouped according to the total initial tension
at graft fixation: 20 N for 16 patients between January 2012 and December 2012 and
10 N for 15 patients between January 2013 and December 2013. Three-dimensional computed
tomography scans were performed preoperatively and at 3 weeks and 6 months postoperatively.
The side-to-side difference of the 3-dimensional tibial position relative to the femur
was compared at each time point. The side-to-side difference in anterior laxity was
sequentially compared preoperatively, immediately after surgery, and at 6 months and
2 years postoperatively. Clinical outcomes at 2 years were likewise compared.
Results
One patient in each group was excluded because of secondary ACL injury. At 3 weeks
postoperatively, 2.5 ± 1.3 and 1.0 ± 1.3 mm of posterior tibial displacement and 3.8°
± 2.4° and 2.0° ± 1.7° of external rotation were observed in the 20- and 10-N initial
tension groups, respectively, with significant differences (P = .006 and .033). At 6 months postoperatively, anterior displacement was 0.1/0.1
mm and external rotation was 0.8°/0.4° in both groups, without any significant differences.
The 2-year clinical outcomes were satisfactory, including mean side-to-side difference
in anterior knee laxity of 0.5 mm in both groups.
Conclusion
The tibiofemoral relationship 3 weeks after anatomic triple-bundle ACL reconstruction
with 10 N of initial tension is less constrained than that with 20 N. Six-month tibiofemoral
relationship and 2-year clinical outcomes are satisfactory in both groups.
Level of Evidence
III, retrospective comparative trial
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Article info
Publication history
Published online: December 25, 2021
Accepted:
December 16,
2021
Received:
May 25,
2021
Footnotes
See commentary on page 2242
The authors report the following potential conflicts of interest or sources of funding: K.N. reports grants and personal fees, Smith & Nephew; grants, Stryker, Arthrex. K.S. reports grants and personal fees, Smith & Nephew; personal fees, Meira; grants, Stryker. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
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© 2021 by the Arthroscopy Association of North America
