The remains of anterior cruciate ligament graft tension after cyclic knee motion

Background: There is sometimes a return of excess knee laxity after anterior cruciate ligament reconstruction. One of the contributing factors might be a loss in graft tension. It is unknown whether the tension imposed on an anterior cruciate ligament graft degrades with time and, if so, the effect of that loss of tension on knee laxity. Hypotheses: The pretension in the anterior cruciate ligament graft reduces significantly within the first 500 motion cycles, and this decrease in graft tension causes an increase in knee laxity. Study Design: Controlled laboratory study. Methods: This study measured the remains of bone-patellar tendon-bone graft pretension after cyclical flexion-extension and the effect of any tension loss on knee laxity, using 8 cadaveric knees. A tension transducer was inserted into the graft and calibrated in situ. The reconstruction tension was 40 N at 20 degrees of flexion. In test 1, the graft tension was measured under cyclical flexion-extension in a motorized rig up to 1500 cycles. Test 2, with a new graft, also included anteroposterior and internal-external rotational knee laxity measurements at 0, 500, and 1500 cycles. Results: The graft tension at 0 degrees of flexion dropped from 208 N, by 25% after 50 cycles, 41% by 500, and 46% by 1500 cycles. Anterior laxity increased from +1.4 to +2.8 mm by 500 cycles, and performing these laxity tests also caused significant tension losses. Clinical Relevance: These results provide one possible explanation for early slackening of anterior cruciate ligament reconstructions.