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Twist and its effect on ACL graft forces
M P Arnold1, L Blankevoort, A ten Ham
1Department of Orthopedic Surgery, University of Groningen, P.O. Box 30.001, NL-9700 RB Groningen, The Netherlands. m.arnold@orth.azg.nl
Summary
Twisting anterior cruciate ligament (ACL) grafts during surgery can unpredictably alter graft forces. While sometimes reducing tension, it can also significantly increase it, making individualized assessment crucial for optimal outcomes.
Area of Science:
- Orthopedic Surgery
- Biomechanical Engineering
- Sports Medicine
Background:
- Graft tension is critical for anterior cruciate ligament (ACL) reconstruction success, influencing graft healing and long-term stability.
- Previous research indicated graft twisting might modulate forces, but clinical data is lacking.
Purpose of the Study:
- To investigate the intraoperative effects of graft twisting on graft forces in patients undergoing ACL reconstruction.
- To determine if twisting bone-patellar tendon-bone grafts can predictably reduce peak forces.
Main Methods:
- A custom tension-measurement device was used to assess graft forces in 15 patients during ACL surgery.
- Graft forces were measured in neutral, externally twisted, and internally twisted positions (180 degrees).
- Surgical variables potentially affecting graft force patterns were quantified.
Main Results:
- External twisting reduced maximal graft force by up to 50% in 8 out of 15 knees.
- Internal or external twisting increased graft forces in extension by up to 300% in 5 knees.
- Femoral tunnel position was the only surgical variable consistently affecting graft force patterns.
Conclusions:
- The effect of graft twisting on ACL graft forces is unpredictable and varies significantly between patients.
- A general recommendation for graft twisting in ACL reconstruction cannot be made.
- Intraoperative assessment of graft twisting may be beneficial for individualizing graft tension modulation.