title: Graft tensioning in anterior cruciate ligament reconstruction: a systematic review of randomized controlled trials.
abstract: OBJECTIVE
  The purposes of this study were to (1) perform a systematic review of randomized controlled trials evaluating graft tensioning in anterior cruciate ligament (ACL) reconstruction, and (2) determine the scientific quality of published randomized controlled trials evaluating graft tensioning in ACL reconstruction.
  
  
  METHODS
  The search strategy included a computerized literature search, a citation search, and a manual search of key journals and conference proceedings. Eligible studies were randomized controlled trials evaluating the effect of graft tensioning on the outcomes of ACL reconstruction. Two reviewers independently performed the literature searches. The validity of the trials was scored using the Detsky quality scale. Consensus was achieved by a study committee of 3 investigators.
  
  
  RESULTS
  Five randomized controlled trials met the inclusion criteria. The mean standardized Detsky score was 61.3 +/- 15.2%. Only 2 of the studies scored >or=75%. All trials consisted of autogenous graft sources, with 3 involving a bone-patellar tendon-bone graft, 1 involving a 5-strand semitendinosus-polyester (5STP) graft, and 1 involving a semitendinosus-gracilis-polyester (STGP) graft.
  
  
  CONCLUSIONS
  Based on the evidence in this systematic review, there is a trend that suggests that 80 N of tension is the most effective amount of tension to apply during ACL reconstruction using hamstring-polyester graft sources. For ACL reconstruction using semitendinosus-gracilis or patellar tendon graft sources, there is no clear trend in terms of statistically significant or clinically relevant differences in terms of the amount of applied tension to apply to the graft during graft fixation. We are unable to provide recommendations as to the amount of tension to apply to 4-strand semitendinosus-gracilis autografts without polyester augmentation because there has been no randomized clinical trial conducted to determine the most effective amount of tension to apply when using this graft source.
authors.affiliation: Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada. shal.arneja@hotmail.com
authors.forename: Shalinder
authors.initials: S
authors.lastname: Arneja
authors.forename: Mark O
authors.initials: MO
authors.lastname: McConkey
authors.forename: Kishore
authors.initials: K
authors.lastname: Mulpuri
authors.forename: Patrick
authors.initials: P
authors.lastname: Chin
authors.forename: Michael K
authors.initials: MK
authors.lastname: Gilbart
authors.forename: William D
authors.initials: WD
authors.lastname: Regan
authors.forename: Jordan M
authors.initials: JM
authors.lastname: Leith
mesh_terms: D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D001182:Arthroscopy / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D016025:Bone Transplantation / Q000379:methods; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000517:prevention & control / Q000601:surgery; D008297:Male; D008592:Menisci, Tibial / Q000601:surgery; D017063:Outcome Assessment, Health Care; D017847:Patellar Ligament / Q000637:transplantation; D011091:Polyesters; D019736:Prostheses and Implants; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D013314:Stress, Mechanical; D013710:Tendons / Q000637:transplantation; D000070600:Tibial Meniscus Injuries; D014182:Transplantation, Autologous; D055815:Young Adult
chemical_list: D011091:Polyesters