The Journal of Bone and Joint Surgery (American). 2007;89:1565-1574.
doi:10.2106/JBJS.F.00370
© 2007 The Journal of Bone and Joint Surgery, Inc.
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Loss of Knee Extension After Anterior Cruciate Ligament Reconstruction: Effects of Knee Position and Graft Tensioning

John C. Austin, MD1, Chanakarn Phornphutkul, MD1 and Edward M. Wojtys, MD1

1 Department of Orthopaedic Surgery, University of Michigan, 24 Frank Lloyd Wright Drive, Ann Arbor, MI 48106-0391. E-mail address for J.C. Austin: jgnaustin{at}yahoo.com. E-mail address for C. Phornphutkul: berkbann{at}aol.com. E-mail address for E.M. Wojtys: edwojtys{at}med.umich.edu

Investigation performed at the Orthopaedic Research Laboratories, Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan

Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families 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, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

Background: Loss of knee extension has been reported by many authors to be the most common complication following anterior cruciate ligament reconstruction. The objective of this in vitro study was to determine the effect, on loss of knee extension, of the knee flexion angle and the tension of the bone-patellar tendon-bone graft during graft fixation in a reconstruction of an anterior cruciate ligament.

Methods: The anterior cruciate ligament was reconstructed with use of tibial and femoral bone tunnels placed in the footprint of the native anterior cruciate ligament in ten cadavers. The graft was secured with an initial tension of either 44 N (10 lb) or 89 N (20 lb) applied with the knee at 0° or 30° of flexion. The knee flexion angle was measured with use of digital images following graft fixation.

Results: Tensioning of the graft at 30° of knee flexion was associated with loss of knee extension in this cadaver model. Graft tension did not affect knee extension under the conditions tested.

Conclusions: The results suggest that one of the common causes of the loss of full knee extension may be diminished if the graft is secured in full knee extension when the tibial and femoral tunnels are placed in the footprint of the native anterior cruciate ligament. More importantly, even when the femoral and tibial tunnels are placed in the femoral and tibial footprints of the native anterior cruciate ligament, fixing a graft in knee flexion can result in the loss of knee extension.


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M. L. Busam, M. T. Provencher, and B. R. Bach Jr
Complications of Anterior Cruciate Ligament Reconstruction With Bone-Patellar Tendon-Bone Constructs: Care and Prevention
Am. J. Sports Med., February 1, 2008; 36(2): 379 - 394.
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