A survey of the tension applied to a doubled hamstring tendon graft for reconstruction of the anterior cruciate ligament

Purpose: Currently there is no consensus regarding the amount of tension to apply to a graft when reconstructing the anterior cruciate ligament (ACL). We undertook a study to determine whether sports trained orthopedic surgeons tension hamstring tendon grafts maximally during ACL reconstruction, and also whether surgeons tend to load their grafts within a narrow range of tensions. Type of Study: Cross-sectional study. Methods: One fresh-frozen cadaveric knee with appropriately placed femoral and tibial tunnels and five pairs of preconditioned semitendinosus and gracilis tendons were used. Custom-made computer software and a custom-made, load measurement device was employed. Thirteen orthopedic sports medicine physicians from our community took part in the study. Surgeons were asked to tension the graft as they would in surgery and were then asked to tension the graft maximally. Results: The mean and standard deviation of the normal tension (14.8 +/- 7.2 lb) was significantly less (P = .005) than the mean maximal tension (22.3 +/- 6.9 lb). Conclusions: This study shows that most ACL surgeons do not tension their graft maximally. Moreover, graft tensioning is highly variable among sports medicine orthopedists. These findings revisit the question as to whether tension should be more accurately measured and controlled for intraoperatively.