Initial graft tension and the effect on postoperative patient functional outcomes in anterior cruciate ligament reconstruction

Garry W Kirwan, Michael G Bourke, Lucy CHIPCHASE, Philip A Dalton, Trevor G Russell

Research output: Contribution to journalReview article

13 Citations (Scopus)

Abstract

PURPOSE: The aim of this review was to investigate the effect of initial graft tension on patient-specific functional outcomes after anterior cruciate ligament reconstruction and determine whether a particular tension is associated with superior functional outcome. METHODS: We performed a systematic review of prospective randomized trials with a National Health and Medical Research Council Australia level of evidence of III or higher published between 1950 and July 2012. Studies using a semitendinosus-gracilis or bone-patellar tendon-bone autograft that reported graft tension and postoperative functional outcomes were included. Quantitative analysis was performed on available data by calculating effect size (ES) both at various time points and across tensions (in Newtons).

RESULTS: Initial search strategies returned 457 original publications, of which 5 articles fulfilled all exclusion and inclusion criteria. The mean score for quality was 5.8 (SD, 1.3), with 12 being the highest possible score. When compared with the preoperative side-to-side difference in anterior tibial displacement, 80 N and 78.9 N of tension recorded the largest effect at 2 weeks or less (ES, -2.98 [range, -3.82 to -2.14]) and 12 months or more (ES, -2.45 [range, -3.40 to -1.51]) postoperatively, respectively. When we compared tensions, the largest effect was toward 80 N when compared with 20 N at 2 weeks or less after surgery (ES, 0.76 [range, 0.17 to 1.35]).

CONCLUSIONS: The objective of this review was to systematically assess the literature to determine whether a particular initial graft tension results in superior outcomes after anterior cruciate ligament reconstruction. From the review, there is a trend toward an initial graft tension of 78.5 to 90 N resulting in a reduced side-to-side difference in anterior laxity. However, there is insufficient evidence to conclude whether patient-specific function is improved at any specific tension.


Original languageEnglish
Pages (from-to)934-941
Number of pages8
JournalArthroscopy: The Journal of Arthroscopy and Related Surgery
Volume29
Issue number5
DOIs
Publication statusPublished - May 2013
Externally publishedYes

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Anterior Cruciate Ligament Reconstruction
Transplants
Bone and Bones
Patellar Ligament
Autografts
Publications
Biomedical Research
Health

Cite this

Kirwan, Garry W ; Bourke, Michael G ; CHIPCHASE, Lucy ; Dalton, Philip A ; Russell, Trevor G. / Initial graft tension and the effect on postoperative patient functional outcomes in anterior cruciate ligament reconstruction. In: Arthroscopy: The Journal of Arthroscopy and Related Surgery. 2013 ; Vol. 29, No. 5. pp. 934-941.
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abstract = "PURPOSE: The aim of this review was to investigate the effect of initial graft tension on patient-specific functional outcomes after anterior cruciate ligament reconstruction and determine whether a particular tension is associated with superior functional outcome. METHODS: We performed a systematic review of prospective randomized trials with a National Health and Medical Research Council Australia level of evidence of III or higher published between 1950 and July 2012. Studies using a semitendinosus-gracilis or bone-patellar tendon-bone autograft that reported graft tension and postoperative functional outcomes were included. Quantitative analysis was performed on available data by calculating effect size (ES) both at various time points and across tensions (in Newtons).RESULTS: Initial search strategies returned 457 original publications, of which 5 articles fulfilled all exclusion and inclusion criteria. The mean score for quality was 5.8 (SD, 1.3), with 12 being the highest possible score. When compared with the preoperative side-to-side difference in anterior tibial displacement, 80 N and 78.9 N of tension recorded the largest effect at 2 weeks or less (ES, -2.98 [range, -3.82 to -2.14]) and 12 months or more (ES, -2.45 [range, -3.40 to -1.51]) postoperatively, respectively. When we compared tensions, the largest effect was toward 80 N when compared with 20 N at 2 weeks or less after surgery (ES, 0.76 [range, 0.17 to 1.35]).CONCLUSIONS: The objective of this review was to systematically assess the literature to determine whether a particular initial graft tension results in superior outcomes after anterior cruciate ligament reconstruction. From the review, there is a trend toward an initial graft tension of 78.5 to 90 N resulting in a reduced side-to-side difference in anterior laxity. However, there is insufficient evidence to conclude whether patient-specific function is improved at any specific tension.",
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Initial graft tension and the effect on postoperative patient functional outcomes in anterior cruciate ligament reconstruction. / Kirwan, Garry W; Bourke, Michael G; CHIPCHASE, Lucy; Dalton, Philip A; Russell, Trevor G.

In: Arthroscopy: The Journal of Arthroscopy and Related Surgery, Vol. 29, No. 5, 05.2013, p. 934-941.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Initial graft tension and the effect on postoperative patient functional outcomes in anterior cruciate ligament reconstruction

AU - Kirwan, Garry W

AU - Bourke, Michael G

AU - CHIPCHASE, Lucy

AU - Dalton, Philip A

AU - Russell, Trevor G

N1 - Copyright © 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

PY - 2013/5

Y1 - 2013/5

N2 - PURPOSE: The aim of this review was to investigate the effect of initial graft tension on patient-specific functional outcomes after anterior cruciate ligament reconstruction and determine whether a particular tension is associated with superior functional outcome. METHODS: We performed a systematic review of prospective randomized trials with a National Health and Medical Research Council Australia level of evidence of III or higher published between 1950 and July 2012. Studies using a semitendinosus-gracilis or bone-patellar tendon-bone autograft that reported graft tension and postoperative functional outcomes were included. Quantitative analysis was performed on available data by calculating effect size (ES) both at various time points and across tensions (in Newtons).RESULTS: Initial search strategies returned 457 original publications, of which 5 articles fulfilled all exclusion and inclusion criteria. The mean score for quality was 5.8 (SD, 1.3), with 12 being the highest possible score. When compared with the preoperative side-to-side difference in anterior tibial displacement, 80 N and 78.9 N of tension recorded the largest effect at 2 weeks or less (ES, -2.98 [range, -3.82 to -2.14]) and 12 months or more (ES, -2.45 [range, -3.40 to -1.51]) postoperatively, respectively. When we compared tensions, the largest effect was toward 80 N when compared with 20 N at 2 weeks or less after surgery (ES, 0.76 [range, 0.17 to 1.35]).CONCLUSIONS: The objective of this review was to systematically assess the literature to determine whether a particular initial graft tension results in superior outcomes after anterior cruciate ligament reconstruction. From the review, there is a trend toward an initial graft tension of 78.5 to 90 N resulting in a reduced side-to-side difference in anterior laxity. However, there is insufficient evidence to conclude whether patient-specific function is improved at any specific tension.

AB - PURPOSE: The aim of this review was to investigate the effect of initial graft tension on patient-specific functional outcomes after anterior cruciate ligament reconstruction and determine whether a particular tension is associated with superior functional outcome. METHODS: We performed a systematic review of prospective randomized trials with a National Health and Medical Research Council Australia level of evidence of III or higher published between 1950 and July 2012. Studies using a semitendinosus-gracilis or bone-patellar tendon-bone autograft that reported graft tension and postoperative functional outcomes were included. Quantitative analysis was performed on available data by calculating effect size (ES) both at various time points and across tensions (in Newtons).RESULTS: Initial search strategies returned 457 original publications, of which 5 articles fulfilled all exclusion and inclusion criteria. The mean score for quality was 5.8 (SD, 1.3), with 12 being the highest possible score. When compared with the preoperative side-to-side difference in anterior tibial displacement, 80 N and 78.9 N of tension recorded the largest effect at 2 weeks or less (ES, -2.98 [range, -3.82 to -2.14]) and 12 months or more (ES, -2.45 [range, -3.40 to -1.51]) postoperatively, respectively. When we compared tensions, the largest effect was toward 80 N when compared with 20 N at 2 weeks or less after surgery (ES, 0.76 [range, 0.17 to 1.35]).CONCLUSIONS: The objective of this review was to systematically assess the literature to determine whether a particular initial graft tension results in superior outcomes after anterior cruciate ligament reconstruction. From the review, there is a trend toward an initial graft tension of 78.5 to 90 N resulting in a reduced side-to-side difference in anterior laxity. However, there is insufficient evidence to conclude whether patient-specific function is improved at any specific tension.

KW - Adult

KW - Anterior Cruciate Ligament

KW - Anterior Cruciate Ligament Reconstruction

KW - Biomechanical Phenomena

KW - Female

KW - Humans

KW - Male

KW - Randomized Controlled Trials as Topic

KW - Recovery of Function

KW - Treatment Outcome

KW - Young Adult

KW - Journal Article

KW - Review

U2 - 10.1016/j.arthro.2013.01.021

DO - 10.1016/j.arthro.2013.01.021

M3 - Review article

VL - 29

SP - 934

EP - 941

JO - Arthroscopy - Journal of Arthroscopic and Related Surgery

JF - Arthroscopy - Journal of Arthroscopic and Related Surgery

SN - 0749-8063

IS - 5

ER -