Graft tensioning practices in anterior cruciate ligament reconstruction amongst orthopaedic surgeons in Australia

a national survey

Garry W Kirwan, Michael G Bourke, Lucinda Chipchase, Philip A Dalton, Trevor G Russell

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

PURPOSE: The application of graft tension during anterior cruciate ligament reconstruction is considered an important feature of ACLR. However, wide variation exists in relation to graft tensioning practice limiting the ability to determine the best approach. Thus, the primary aim of this study was to describe current clinical practice amongst Australian orthopaedic surgeons with respect to graft tensioning and explore influencing factors.

MATERIALS AND METHODS: A survey was developed to address the aims of the study and pilot testing was completed to confirm validity and reliability. The survey population was defined as Australian orthopaedic surgeons, associated with the Australian Orthopaedic Association sub-specialty of knee to target surgeons likely to perform ACLR. The final sampling frame consisted of 192 surgeons.

RESULTS: Manual tensioning was the most common method (80.5 %), with a maximum one-handed pull the most frequent description and estimated tension ranged between 41 and 60 N with the knee positioned near full extension. Surgeons using a tensioning device tended to use a higher tension (mean 81.85 N), with the knee positioned at 30° flexion (40 %). Sixteen percent reported individualising tension on viscoelasticity of the graft, graft diameter, patient anthropometry and age. Patient outcomes and available evidence were the primary factors influencing tensioning protocol.

CONCLUSION: Tensioning practices appear to consist of three main approaches, (1) manual tension using a sustained maximum one-handed pull, with tension estimated as 41-60 N, applied near full extension, (2) tensioning device, mean tension of 81.85 N, at 30° knee flexion, (3) individual approach based on size and viscoelastic properties of the graft, patient anthropometry, contralateral comparison to the other knee and age of the patient.

Original languageEnglish
Pages (from-to)1733-41
Number of pages9
JournalArchives of Orthopaedic and Trauma Surgery
Volume135
Issue number12
DOIs
Publication statusPublished - Dec 2015
Externally publishedYes

Fingerprint

Anterior Cruciate Ligament Reconstruction
Knee
Transplants
Anthropometry
Equipment and Supplies
Reproducibility of Results
Orthopedics
Orthopedic Surgeons
Surveys and Questionnaires
Population
Surgeons

Cite this

Kirwan, Garry W ; Bourke, Michael G ; Chipchase, Lucinda ; Dalton, Philip A ; Russell, Trevor G. / Graft tensioning practices in anterior cruciate ligament reconstruction amongst orthopaedic surgeons in Australia : a national survey. In: Archives of Orthopaedic and Trauma Surgery. 2015 ; Vol. 135, No. 12. pp. 1733-41.
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abstract = "PURPOSE: The application of graft tension during anterior cruciate ligament reconstruction is considered an important feature of ACLR. However, wide variation exists in relation to graft tensioning practice limiting the ability to determine the best approach. Thus, the primary aim of this study was to describe current clinical practice amongst Australian orthopaedic surgeons with respect to graft tensioning and explore influencing factors.MATERIALS AND METHODS: A survey was developed to address the aims of the study and pilot testing was completed to confirm validity and reliability. The survey population was defined as Australian orthopaedic surgeons, associated with the Australian Orthopaedic Association sub-specialty of knee to target surgeons likely to perform ACLR. The final sampling frame consisted of 192 surgeons.RESULTS: Manual tensioning was the most common method (80.5 {\%}), with a maximum one-handed pull the most frequent description and estimated tension ranged between 41 and 60 N with the knee positioned near full extension. Surgeons using a tensioning device tended to use a higher tension (mean 81.85 N), with the knee positioned at 30° flexion (40 {\%}). Sixteen percent reported individualising tension on viscoelasticity of the graft, graft diameter, patient anthropometry and age. Patient outcomes and available evidence were the primary factors influencing tensioning protocol.CONCLUSION: Tensioning practices appear to consist of three main approaches, (1) manual tension using a sustained maximum one-handed pull, with tension estimated as 41-60 N, applied near full extension, (2) tensioning device, mean tension of 81.85 N, at 30° knee flexion, (3) individual approach based on size and viscoelastic properties of the graft, patient anthropometry, contralateral comparison to the other knee and age of the patient.",
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Graft tensioning practices in anterior cruciate ligament reconstruction amongst orthopaedic surgeons in Australia : a national survey. / Kirwan, Garry W; Bourke, Michael G; Chipchase, Lucinda; Dalton, Philip A; Russell, Trevor G.

In: Archives of Orthopaedic and Trauma Surgery, Vol. 135, No. 12, 12.2015, p. 1733-41.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Graft tensioning practices in anterior cruciate ligament reconstruction amongst orthopaedic surgeons in Australia

T2 - a national survey

AU - Kirwan, Garry W

AU - Bourke, Michael G

AU - Chipchase, Lucinda

AU - Dalton, Philip A

AU - Russell, Trevor G

PY - 2015/12

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N2 - PURPOSE: The application of graft tension during anterior cruciate ligament reconstruction is considered an important feature of ACLR. However, wide variation exists in relation to graft tensioning practice limiting the ability to determine the best approach. Thus, the primary aim of this study was to describe current clinical practice amongst Australian orthopaedic surgeons with respect to graft tensioning and explore influencing factors.MATERIALS AND METHODS: A survey was developed to address the aims of the study and pilot testing was completed to confirm validity and reliability. The survey population was defined as Australian orthopaedic surgeons, associated with the Australian Orthopaedic Association sub-specialty of knee to target surgeons likely to perform ACLR. The final sampling frame consisted of 192 surgeons.RESULTS: Manual tensioning was the most common method (80.5 %), with a maximum one-handed pull the most frequent description and estimated tension ranged between 41 and 60 N with the knee positioned near full extension. Surgeons using a tensioning device tended to use a higher tension (mean 81.85 N), with the knee positioned at 30° flexion (40 %). Sixteen percent reported individualising tension on viscoelasticity of the graft, graft diameter, patient anthropometry and age. Patient outcomes and available evidence were the primary factors influencing tensioning protocol.CONCLUSION: Tensioning practices appear to consist of three main approaches, (1) manual tension using a sustained maximum one-handed pull, with tension estimated as 41-60 N, applied near full extension, (2) tensioning device, mean tension of 81.85 N, at 30° knee flexion, (3) individual approach based on size and viscoelastic properties of the graft, patient anthropometry, contralateral comparison to the other knee and age of the patient.

AB - PURPOSE: The application of graft tension during anterior cruciate ligament reconstruction is considered an important feature of ACLR. However, wide variation exists in relation to graft tensioning practice limiting the ability to determine the best approach. Thus, the primary aim of this study was to describe current clinical practice amongst Australian orthopaedic surgeons with respect to graft tensioning and explore influencing factors.MATERIALS AND METHODS: A survey was developed to address the aims of the study and pilot testing was completed to confirm validity and reliability. The survey population was defined as Australian orthopaedic surgeons, associated with the Australian Orthopaedic Association sub-specialty of knee to target surgeons likely to perform ACLR. The final sampling frame consisted of 192 surgeons.RESULTS: Manual tensioning was the most common method (80.5 %), with a maximum one-handed pull the most frequent description and estimated tension ranged between 41 and 60 N with the knee positioned near full extension. Surgeons using a tensioning device tended to use a higher tension (mean 81.85 N), with the knee positioned at 30° flexion (40 %). Sixteen percent reported individualising tension on viscoelasticity of the graft, graft diameter, patient anthropometry and age. Patient outcomes and available evidence were the primary factors influencing tensioning protocol.CONCLUSION: Tensioning practices appear to consist of three main approaches, (1) manual tension using a sustained maximum one-handed pull, with tension estimated as 41-60 N, applied near full extension, (2) tensioning device, mean tension of 81.85 N, at 30° knee flexion, (3) individual approach based on size and viscoelastic properties of the graft, patient anthropometry, contralateral comparison to the other knee and age of the patient.

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KW - Anterior Cruciate Ligament Reconstruction

KW - Australia

KW - Biomechanical Phenomena

KW - Cadaver

KW - Clinical Competence

KW - Female

KW - Humans

KW - Knee Injuries

KW - Male

KW - Orthopedics

KW - Pilot Projects

KW - Range of Motion, Articular

KW - Reproducibility of Results

KW - Surgeons

KW - Surveys and Questionnaires

KW - Journal Article

KW - Multicenter Study

U2 - 10.1007/s00402-015-2335-2

DO - 10.1007/s00402-015-2335-2

M3 - Article

VL - 135

SP - 1733

EP - 1741

JO - Archiv fur orthopadische und Unfall-Chirurgie

JF - Archiv fur orthopadische und Unfall-Chirurgie

SN - 0344-8444

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