title: The effect of cyclic loading on rotated bone-tendon-bone anterior cruciate ligament graft constructs.
abstract: BACKGROUND
  Single-incision anterior cruciate ligament reconstruction with a bone-patellar tendon-bone construct is commonly performed with 180 degrees rotation of the graft. It has been hypothesized that further rotation of the graft to 540 degrees can effectively shorten the graft to address graft length-tunnel mismatch. Initial biomechanical failure characteristics of rotated constructs have been reported, but cyclic loading of tendons has not been performed.
  
  
  OBJECTIVE
  Graft rotation affects the biomechanical properties of the construct.
  
  
  METHODS
  Controlled laboratory study.
  
  
  METHODS
  Thirty-five bone-patellar tendon-bone composite porcine right knee specimens were randomized into 3 groups and were externally rotated to 0 degrees , 180 degrees , or 540 degrees . Each group was then cyclically loaded in an artificial synovial fluid medium between 50 and 250 N for 5,000 cycles, loaded between 50 and 500 N for an additional 5,000 cycles, and finally subjected to load-to-failure testing.
  
  
  RESULTS
  Graft rotation shortened constructs by 1.7 +/- 0.8 mm at 180 degrees of rotation and 7.6 +/- 2.0 mm at 540 degrees of rotation (P < .01). There was a statistically significant increase in strain during cyclic loading at 540 degrees . No significant differences in maximum load, yield stress, yield strain, or modulus of elasticity were detected in single-cycle load-to-failure testing after cyclic loading.
  
  
  CONCLUSIONS
  Rotation of bone-patellar tendon-bone constructs to 540 degrees predictably shortens the effective graft length at the expense of increased strain with cyclic loading at stresses equivalent to walking and running.
  
  
  CONCLUSIONS
  Although rotation to 540 degrees potentially addresses graft length-tunnel mismatch, further clinical evaluation is required to evaluate the impact of increased strain on knee laxity and to determine the effects of physiologic loading of rotated bone-patellar tendon-bone constructs in vivo.
authors: Section of Sports Medicine, Department of Orthopaedic Surgery, Rush Medical College, Rush University Medical Center, Chicago, IL 60612, USA.
authors: Eric
authors: E
authors: Berkson
authors: Gregory H
authors: GH
authors: Lee
authors: Ashwin
authors: A
authors: Kumar
authors: Nikhil
authors: N
authors: Verma
authors: Bernard R
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authors: Bach
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