In vivo tensile behavior of a four-bundle hamstring graft as a replacement for the anterior cruciate ligament

The purpose of this study was to measure the in vivo tensile behavior of a double-looped semitendinosus and gracilis graft used to reconstruct a torn anterior cruciate ligament in the human knee. In 14 subjects, intraoperative tension was measured for each of the four graft bundles during passive motion from 0 to 90 degrees of flexion. Two hypotheses were tested: (a) the peak tension carried by each of the four bundles was equal during passive motion, and (b) the mechanics of the bundles mimicked the functional bands of the native anterior cruciate ligament. The total tension was also calculated and used to determine strength requirements for fixation devices. The peak tensions of the four bundles during passive motion were not equal; however, enough tension was present in each bundle that load-sharing occurred between bundles. The pattern of tension between the anterior and posterior bundles mimicked the reciprocating load-sharing behavior of the functional bands of the native anterior cruciate ligament. Reciprocal tensile behavior was consistently achieved with the use of a single femoral tunnel centered on the most isometric line without the need for two separate femoral sockets. The maximum total tension was 296 N; this was nearly equal to the strength of one commonly used fixation device.