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Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 12/2018

01-12-2018 | Knee

Device-assisted tensioning is associated with lower rates of graft failure when compared to manual tensioning in ACL reconstruction

Authors: Laura Morrison, Chloe Haldane, Darren de SA, Fawaz Findakli, Nicole Simunovic, Olufemi R. Ayeni

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 12/2018

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Abstract

Purpose

To describe (1) the current graft tensioning practices in ACL reconstruction (ACLR) and, (2) the failure rates with the use of manual tensioning, or device-assisted tensioning at the time of graft fixation.

Methods

The electronic databases MEDLINE, EMBASE, and PubMed were searched independently by two reviewers from database inception to search date on January 21, 2017. Inclusion criteria were studies reporting graft tensioning method and rate of graft failure. The definition of graft failure used was: (1) side-to-side instrumented laxity > 5 mm, (2) Lachman 2 +, (3) positive pivot-shift testing, (4) MRI-confirmed graft rupture or, (5) need for revision surgery.

Results

A total of 3379 patients and 3380 knees were treated with ACL reconstruction and followed for an average of 41.7 months (range 4–145 months). ACLR with manual tensioning was performed on 1518 (51.9%) patients and device-assisted tensioning was performed on 1802 (48.1%) patients. The average knee position reported was 29.2° in single-bundle ACLR and 22.9° in double-bundle ACLR. The median amount of tension used in manual tensioning was ‘maximum manual tension’ and 50 N in device-assisted tensioning. Overall, the failure rate in studies reporting manual tensioning was 8.9% compared to 4.3% in device-assisted tensioning.

Conclusion

Both manual tensioning and device-assisted tensioning are associated with low overall failure rates (< 10%) in ACLR; however, there is a higher rate of reported failure with manual tensioning compared to device-assisted tensioning. These findings highlight the need to investigate variations in graft tensioning practice, such as specific tension devices and their parameters, with high-quality, randomized controlled trials to elucidate details of their clinical impact.

Level of evidence

Level IV, systematic review of level I–IV studies.
Appendix
Available only for authorised users
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Metadata
Title
Device-assisted tensioning is associated with lower rates of graft failure when compared to manual tensioning in ACL reconstruction
Authors
Laura Morrison
Chloe Haldane
Darren de SA
Fawaz Findakli
Nicole Simunovic
Olufemi R. Ayeni
Publication date
01-12-2018
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 12/2018
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-018-4951-1

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