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First published on November 23, 2004, doi:10.1177/0363546504265924
This version was published on December 1, 2004
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The American Journal of Sports Medicine 32:1881-1886 (2004)
© 2004 American Orthopaedic Society for Sports Medicine

A Prospectively Randomized Double-Blind Study on the Effect of Initial Graft Tension on Knee Stability After Anterior Cruciate Ligament Reconstruction

Stephen J. Nicholas, MD*, Michael J. D’Amato, MD, Michael J. Mullaney, MPT, Timothy F. Tyler, PT, ATC, Kirsten Kolstad, PA and Malachy P. McHugh, PhD

From the Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, New York

* Address correspondence to Stephen J. Nicholas, MD, Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, 130 East 77th Street, New York, NY 10021.

Background: No consensus exists on the amount of tension that should be applied to anterior cruciate ligament grafts to best facilitate graft incorporation and re-create normal knee mechanics.

Hypothesis: Differences in initial graft tension will affect postoperative knee stability.

Study Design: Prospective, randomized, double-blind clinical trial.

Methods: Forty-nine patients undergoing bone–patellar tendon–bone autograft anterior cruciate ligament reconstruction by a single surgeon were randomized into high-tension (n = 27) and low-tension (n = 22) groups. Grafts were set at 90 N or 45 N. Arthrometric measurements (KT-1000 arthrometer manual maximum) of anterior tibial displacement and knee range of motion were made before surgery and at 1 week and an average of 20 months after surgery. Knee outcome scores were collected before and after surgery, and a single-leg hop test was also performed at final follow-up.

Results: After anterior cruciate ligament reconstruction, anterior tibial displacement was significantly greater in the patients in the low-tension group (P < .05). The side-to-side difference in anterior tibial displacement in the high-tension and low-tension groups was 1.1 ± 1.7 mm versus 2.4 ± 2.4 mm 1 week after surgery and 2.2 ± 1.6 mm versus 3.0 ± 2.2 mm at follow-up. Five patients had abnormal anterior tibial displacement (>5 mm side-to-side difference), and all were in the low-tension group (P <.05). Knee outcome scores improved with surgery (P <.01), with similar results for low-tension and high-tension groups. Hop test deficits were not different between groups.

Conclusions: Initial graft tension affects the restoration of knee stability. A graft tension of 45 N was not sufficient for restoring knee stability.

Key Words: KT-1000 • anterior tibial displacement • arthroscopy • arthrometer




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