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Muscle, Ligaments and Tendons Journal

The reproducibility of manual and fixed tensioning in anterior cruciate ligament reconstruction

Original Article, 172 - 177
doi: 10.11138/mltj/2018.8.2.172
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Abstract
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Introduction: Tensioning of anterior cruciate ligament grafts is required to restore knee stability.
No consensus has been achieved as to what is the best tension. Little work has been done as to whether the most common method of tensioning, by manually pulling, is reproducible.
Methods: A model was developed that allowed cycling & tensioning of a graft while measuring tension in it. Five surgeons were asked to repeatedly tension the graft as they would in theatre. The same was done using a fixed tensioning device.
The coefficient of variability (CV) was calculated for the final tensions.
Results: The average CV for the surgeons tensioning was 27% (19 to 41%). Fixed tensioning produced a CV of 9%. Welch ANOVA testing demonstrated a significant inter-surgeon variability (p<0.0001). Unpaired T-tests comparing each surgeon to the tensioner demonstrated a significant difference in tensions (p<0.05) in all results.
Conclusions: A CV less than 10% is considered evidence that a method is reliable & therefore this study provides further evidence that manual tensioning is not a reproducible way of applying tension to a graft. Fixed tensioning is reproducible but the clinical impact of this needs further study. Level of evidence: IIIb.

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