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Viscoelasticity and Temperature Variations Decrease Tension and Stiffness of Hamstring Tendon Grafts Following Anterior Cruciate Ligament Reconstruction
William J. CicconeII, MD1; Derek R. Bratton, BS1; David M. Weinstein, MD1; John J. Elias, PhD1
1 The Medical Education and Research Institute of Colorado, 3920 North Union Boulevard, Suite 210, Colorado Springs, CO 80907. E-mail address for J.J. Elias: elias@meric.info
View Disclosures and Other Information
In support of their research for or preparation of this manuscript, one or more of the authors received grants or outside funding from Stryker Endoscopy. None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
Investigation performed at the Medical Education and Research Institute of Colorado, Colorado Springs, Colorado

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2006 May 01;88(5):1071-1078. doi: 10.2106/JBJS.E.00576
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Background: Hamstring tendon grafts used for anterior cruciate ligament reconstruction are typically harvested early in the surgical procedure and are preconditioned prior to reimplantation. Postoperatively, the grafts undergo stress relaxation and warm from the temperature of the operating room to body temperature. The hypothesis of this study was that the tension within semitendinosus and gracilis tendon grafts and the stiffness of the grafts significantly decrease postoperatively because of both stress relaxation and an increase in temperature.

Methods: Double-strand grafts were created from six semitendinosus tendons and six gracilis tendons harvested from cadaver specimens. The grafts were loaded to 65 N while at operating-room temperature (20°C). After fifteen minutes of stress relaxation, graft tension was measured and the grafts were stretched by 0.1 mm to determine stiffness. The tension and stiffness measurements represented graft properties immediately following reconstruction. Additional tension and stiffness measurements were made following three hours of stress relaxation and after increasing the temperature to the body temperature at the knee (34°C). Both types of graft were examined for differences in stiffness and tension due to stress relaxation and the temperature increase.

Results: For both types of graft, the tension and stiffness decreased following stress relaxation to approximately 50% and 80%, respectively, of the value immediately after reconstruction. Increasing the temperature decreased the tension and stiffness further to approximately 40% and 70%, respectively, of the value after reconstruction for both types of graft. All changes in tension and stiffness were significant (p < 0.01).

Conclusions: Graft tension and stiffness achieved immediately following reconstruction are not maintained postoperatively because of stress relaxation and a temperature increase. This could lead to increased knee laxity.

Clinical Relevance: Keeping hamstring tendon grafts warm may prevent the decrease in stiffness and tension caused by a postoperative temperature increase. Grafts should be preconditioned to the extent possible, although postoperative stress relaxation cannot be eliminated.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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