Flexion deformity and laxity as a function of knee position at the time of tensioning of rigid anatomic hamstring ACL grafts

Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilitation and Technology
Peter J C McEwenMatthew P R Wilkinson

Abstract

Anatomic ACL grafts routinely display the anisometric length-tension behaviour seen in the native ligament with maximum length in full knee extension. Recent improvements in hamstring graft preparation and fixation have improved graft rigidity to the point where total graft lengthening after implantation may be less than 1 mm. Despite this it remains common practice to fix these grafts in a knee flexed position. Nineteen participants underwent all-inside ACL reconstruction with optimally preconditioned 4 strand semitendinosus grafts using bi-cortical adjustable suspensory loop fixation. Using a computer navigation system, baseline measures of anisometricity, extension range, and tibial rotation were made. The graft was tensioned and provisionally fixed with the knee flexed 5° beyond its anisometric point and extension range recorded. The graft was then definitively fixed with the knee fully extended and extension range and tibial rotation recorded again. Anterior laxity measurements were made pre-operatively and postoperatively using a manual arthrometer and compared to those from the contralateral limb. Fixing the graft with the knee flexed produced a mean FD of 10.9° (p < 0.0001) and fixing in extension restored full extensio...Continue Reading

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