title: Graft tensioning practices in anterior cruciate ligament reconstruction amongst orthopaedic surgeons in Australia: a national survey.
abstract: OBJECTIVE
  The application of graft tension during anterior cruciate ligament reconstruction is considered an important feature of ACLR. However, wide variation exists in relation to graft tensioning practice limiting the ability to determine the best approach. Thus, the primary aim of this study was to describe current clinical practice amongst Australian orthopaedic surgeons with respect to graft tensioning and explore influencing factors.
  
  
  METHODS
  A survey was developed to address the aims of the study and pilot testing was completed to confirm validity and reliability. The survey population was defined as Australian orthopaedic surgeons, associated with the Australian Orthopaedic Association sub-specialty of knee to target surgeons likely to perform ACLR. The final sampling frame consisted of 192 surgeons.
  
  
  RESULTS
  Manual tensioning was the most common method (80.5 %), with a maximum one-handed pull the most frequent description and estimated tension ranged between 41 and 60 N with the knee positioned near full extension. Surgeons using a tensioning device tended to use a higher tension (mean 81.85 N), with the knee positioned at 30° flexion (40 %). Sixteen percent reported individualising tension on viscoelasticity of the graft, graft diameter, patient anthropometry and age. Patient outcomes and available evidence were the primary factors influencing tensioning protocol.
  
  
  CONCLUSIONS
  Tensioning practices appear to consist of three main approaches, (1) manual tension using a sustained maximum one-handed pull, with tension estimated as 41-60 N, applied near full extension, (2) tensioning device, mean tension of 81.85 N, at 30° knee flexion, (3) individual approach based on size and viscoelastic properties of the graft, patient anthropometry, contralateral comparison to the other knee and age of the patient.
authors.affiliation: Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia. g.kirwan@griffith.edu.au.|Division of Physiotherapy, School of Allied Health Sciences, Griffith University, Gold Coast Campus, Southport, QLD, 4222, Australia. g.kirwan@griffith.edu.au.
authors.forename: Garry W
authors.initials: GW
authors.lastname: Kirwan
authors.affiliation: Department of Physiotherapy, QEII Jubilee Hospital, Metro South Health, Queensland Government, Brisbane, QLD, Australia.|Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Bourke
authors.affiliation: Division of Physiotherapy, School of Science and Health, University of Western Sydney, Penrith, NSW, Australia.
authors.forename: Lucinda
authors.initials: L
authors.lastname: Chipchase
authors.affiliation: Department of Orthopaedic Surgery, QEII Jubilee Hospital, Metro South Health, Queensland Government, Brisbane, QLD, Australia.
authors.forename: Philip A
authors.initials: PA
authors.lastname: Dalton
authors.affiliation: Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia.
authors.forename: Trevor G
authors.initials: TG
authors.lastname: Russell
mesh_terms: D016118:Anterior Cruciate Ligament / Q000601:surgery*; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods*; D001315:Australia; D001696:Biomechanical Phenomena; D002102:Cadaver; D002983:Clinical Competence; D005260:Female; D006801:Humans; D007718:Knee Injuries / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D009985:Orthopedics; D010865:Pilot Projects; D016059:Range of Motion, Articular; D015203:Reproducibility of Results; D066231:Surgeons / Q000592:standards*; D011795:Surveys and Questionnaires
keywords: Anterior cruciate ligament; Clinical practice; Graft tension; Reconstruction