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Departments of Musculoskeletal Research, Orthopaedic Surgery, and Pathology, Cleveland Clinic Foundation, Cleveland, Ohio
Departments of Musculoskeletal Research, Orthopaedic Surgery, and Pathology, Cleveland Clinic Foundation, Cleveland, Ohio
Departments of Musculoskeletal Research, Orthopaedic Surgery, and Pathology, Cleveland Clinic Foundation, Cleveland, Ohio
Departments of Musculoskeletal Research, Orthopaedic Surgery, and Pathology, Cleveland Clinic Foundation, Cleveland, Ohio
The purpose of this study was to examine the effect of initial tensioning on the outcome of reconstruction of the ACL.
The ACLs of 15 adult mongrel dogs were excised and reconstructed. In the first five dogs, the ACLs of both knees were reconstructed using the medial one- third of the patellar tendon. The graft was fixed under a tension of 1 N (0.22 pounds) in one knee and 39 N (8.8 pounds) in the opposite knee. In the remainder of the dogs, the reconstructions were augmented with Dacron prostheses. Tensioning of both graft compo nents in the augmented reconstructions was either with 1 N in one knee and 39 N in the contralateral knee or disproportionate tensions of 1 N and 39 N applied to the autogenous material and to the prosthesis. Sacrifice was 3 months postsurgery and results were examined with microangiography/histology and mechanical test ing.
In the reconstructions with the patellar tendon alone, the biologic study showed poor vascularity and focal myxoid degeneration within the graft pretensioned with a load of 39 N. In the augmented reconstructions, the knees in which both graft materials were fixed with 1 N tension showed the strongest and stiffest reconstruc tion at 3 months. The study suggests that minimal tension should be applied to the graft materials during surgical reconstruction of the ACL.
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B. K. Graf, J. Henry, M. Rothenberg, and R. Vanderby Anterior Cruciate Ligament Reconstruction with Patellar Tendon: An Ex Vivo Study of Wear-related Damage and Failure at the Femoral Tunnel Am. J. Sports Med., January 1, 1994; 22(1): 131 - 135. [Abstract] [PDF]
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T. H. Gertel, W. D. Lew, J. L. Lewis, N. J. Stewart, and R. E. Hunter Effect of anterior cruciate ligament graft tensioning direction, magnitude, and flexion angle on knee biomechanics Am. J. Sports Med., July 1, 1993; 21(4): 572 - 581. [Abstract] [PDF]
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B. Fleming, B. D. Beynnon, R. J. Johnson, W. D. McLeod, and M. H. Pope Isometric versus tension measurements Am. J. Sports Med., January 1, 1993; 21(1): 82 - 88. [Abstract] [PDF]
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B. K. Graf, K. Fujisaki, R. Vanderby JR, and A. C. Vailas The effect of in situ freezing on rabbit patellar tendon: A histologic, biochemical, and biomechanical analysis Am. J. Sports Med., July 1, 1992; 20(4): 401 - 405. [Abstract] [PDF]
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J. G. Howe, R. J. Johnson, M. J. Kaplan, B. Fleming, and M. Jarvinen Anterior cruciate ligament reconstruction using quadriceps patellar tendon graft: Part I. Long-term followup Am. J. Sports Med., September 1, 1991; 19(5): 447 - 457. [Abstract] [PDF]
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S. L.-Y. Woo, J. M. Hollis, D. J. Adams, R. M. Lyon, and S. Takai Tensile properties of the human femur-anterior cruciate ligament-tibia complex: The effects of specimen age and orientation Am. J. Sports Med., June 1, 1991; 19(3): 217 - 225. [Abstract] [PDF]
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J. A. McCarthy, J. R. Steadman, J. Dunlap, R. Shively, and S. Stonebrook A nonparallel, nonisometric synthetic graft augmentation of a patellar tendon anterior cruciate ligament reconstruction: A model for assessment of stress shielding Am. J. Sports Med., January 1, 1990; 18(1): 43 - 49. [Abstract] [PDF]
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