title: In vivo graft tension in anatomic double-bundle anterior cruciate ligament reconstruction during active leg-raising motion with the knee splinted.
abstract: OBJECTIVE
  The purpose of this study was to measure the in vivo graft tension in anatomic 2-bundle anterior cruciate ligament (ACL) reconstruction during active leg-raising exercise with the knee immobilized.
  
  
  METHODS
  Anatomic double-bundle ACL reconstruction was performed with autogenous semitendinosus tendons in 7 patients while under general anesthesia. Two grafts were fixed with 2 EndoButton-CL devices (Smith & Nephew Endoscopy, Andover, MA) on the femur and were temporarily fixed to 2 tension-adjustable force gauges on the anterior tibial cortex. Then, a knee brace in semi-flexion was put around the knee, and 10 N of initial tension was applied to each graft at 20° of flexion. The tension on the anteromedial (AM) and posterolateral (PL) grafts was continuously measured during active leg-raising motion with the knee immobilized after patients had awoken from anesthesia. Then, the tension measurement was repeated during active leg-raising motion with the knee immobilized while a 2-kg weight was fitted around the ankle.
  
  
  RESULTS
  In situ graft tension during active leg-raising motion with a knee brace was 10.9 ± 4.0 N for the AM graft and 8.6 ± 5.1 N for the PL graft, whereas the tension with a 2-kg weight around the ankle was 10.9 ± 3.4 N for the AM graft and 9.9 ± 3.6 N for the PL graft. There was no significant difference between each graft in the 2 motions with a paired t test.
  
  
  CONCLUSIONS
  Graft tension with the knee immobilized with a semi-flexed knee brace during active leg-raising motion was 19.5 N with no weight and 20.8 N with additional weight, both of which were almost equal to the initial graft tension at the time of fixation at 20°. Thus the leg-raising exercise can be recommended as safe when a semi-flexed knee brace is worn after ACL reconstruction.
  
  
  CONCLUSIONS
  These findings will help to plan postoperative rehabilitation programs with security.
authors.affiliation: Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan; Department of Sports Medicine, Osaka Kousei-Nenkin Hospital, Osaka, Japan. ta-mae@umin.ac.jp
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Mae
authors.forename: Konsei
authors.initials: K
authors.lastname: Shino
authors.forename: Norinao
authors.initials: N
authors.lastname: Matsumoto
authors.forename: Ken
authors.initials: K
authors.lastname: Nakata
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Kinugasa
authors.forename: Hideki
authors.initials: H
authors.lastname: Yoshikawa
authors.forename: Minoru
authors.initials: M
authors.lastname: Yoneda
mesh_terms: D000293:Adolescent; D000328:Adult; D000842:Ankle / Q000502:physiology; D016118:Anterior Cruciate Ligament / Q000502:physiology / Q000601:surgery; D000070598:Anterior Cruciate Ligament Injuries; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods / Q000534:rehabilitation*; D001915:Braces; D015444:Exercise / Q000502:physiology*; D005260:Female; D006801:Humans; D007717:Knee / Q000502:physiology* / Q000601:surgery; D007718:Knee Injuries / Q000534:rehabilitation / Q000601:surgery*; D007866:Leg / Q000502:physiology*; D008297:Male; D013710:Tendons / Q000502:physiology / Q000637:transplantation*; D016896:Treatment Outcome; D016474:Weight-Bearing; D055815:Young Adult