A Comparison of Ligament Tensions Between Intra- and Extra-Articular Measurement in Anterior Cruciate Ligament Reconstruction

Anterior cruciate ligament (ACL) reconstruction is one of the treatments of ACL injuries. In the surgery, the reconstructed ligament should be properly tensioned to provide a normal ligament behavior. However, the ligament tension has been measured with an extra-articular technique in past studies, while the intra-articular ligament tension is still unknown. The purpose of this study is to compare the ligament tensions between intra-and extra-articular measurements in the ACL reconstruction. Intra-articular measurement employs a micro-force sensor designed with a width and thickness same as those of the reconstructed ligament. This study performed two experiments (i.e., sensor accuracy and cadaveric study). In the sensor accuracy experiment, the accuracy of the sensor was about 3% until an applied force of 100 N. In the cadaveric study, the results of the intra-and extra-articular measurement tensions were 13.6 +/- 3.9 N and 18.7 +/- 1.3 N (n = 6), respectively. The significant difference in student t-test (p-value was 0.026) between the intra-and extra-articular measurements was observed. The bending angle and friction between the graft and bone tunnel, and the shape of the intra-articular edge of tibial bone tunnel affected the intra-articular measurement in ACL reconstruction.