Wc. Burns et al., THE EFFECT OF FEMORAL TUNNEL POSITION AND GRAFT TENSIONING TECHNIQUE ON POSTERIOR LAXITY OF THE POSTERIOR CRUCIATE LIGAMENT-RECONSTRUCTED KNEE, American journal of sports medicine, 23(4), 1995, pp. 424-430
We report the effects of femoral tunnel position and graft tensioning
technique on posterior laxity of the posterior cruciate ligament-recon
structed knee. An isometric femoral tunnel site was located using a sp
ecially designed alignment jig. Additional femoral tunnel positions we
re located 5 mm proximal and distal to the isometric femoral tunnel. W
ith the graft in the proximal femoral tunnel, graft tension decreased
as the knee flexed; with the graft in the distal femoral tunnel, graft
tension increased as the knee flexed. When the graft was placed in th
e isometric femoral tunnel, a nearly isometric graft tension was maint
ained between 0 degrees and 90 degrees of knee flexion. One technique
tested was tensioning the graft at 90 degrees of knee flexion while ap
plying an anterior drawer force of 156 N to the tibia. This technique
restored statistically normal posterior stability to the posterior cru
ciate ligament-deficient knee between 0 degrees and 90 degrees for the
distal femoral tunnel position, between 0 degrees and 75 degrees for
the isometric tunnel position, and between 0 degrees and 45 degrees fo
r the proximal tunnel position. When the graft was tensioned with the
knee in full extension and without the application of an anterior draw
er force, posterior translation of the reconstructed knee was signific
antly different from that of the intact knee between 15 degrees and 90
degrees for all femoral tunnel positions.