An in vitro study of anterior cruciate ligament graft placement and isometry.

Isometric positioning of the ACL graft or prosthesis is an important consideration in successful reconstruction of the ACL-deficient knee. This study documented the relationship between graft placement and intraarticular graft length changes and graft tension changes during knee passive range of motion. Fifteen fresh cadaveric knees were mounted in stabilizing rigs. The ACL was identified and cut in each specimen. Intraarticular reconstruction was then performed using a 6 mm polypropylene braid (3M LAD, St. Paul, MN). The following graft placements were evaluated: 1) over-the-top, 2) modified over-the-top with a femoral bone trough, 3) femoral drill hole positions, and 4) tibial drill hole positions. The proximal end of the graft was fixed to the lateral aspect of the femur with a screw and spiked washer. The distal end of the graft was attached to a turnbuckle attached to a load cell on the anterior aspect of the tibia. The knee was then extended passively from 90 degrees to 0 degrees. Two experiments were performed. In Experiment A, the turnbuckle was adjusted to keep graft tension constant and the graft length changes were recorded. In Experiment B, the graft fixation sites were not altered and tension changes with range of motion were recorded. A change in the graft distance between attachment sites with knee range of motion can be monitored either by ligament length or by tension change. With the over-the-top technique, in Experiment A, the graft distance between attachment sites increased as the knee was extended (means = 4.9 mm); in Experiment B, large tension increases were recorded with knee extension.(ABSTRACT TRUNCATED AT 250 WORDS)