Table 1.
Included studies’ characteristics separated by theme. All the conclusions described on the table are based on a p value < 0.05
| Author | Study type | N | Results |
|---|---|---|---|
| Regarding the graft tension | |||
| Yasuda et al. [11] (1997) | Clinical trial | 70 | Initial relative high stress in the graft (about 80 N) decreases laxity |
| Bylski-Austrow et al. [12] (1990) | Experimental (biomechanical) | 6 | Stress magnitude is less influencing than fixation angle; there is no correct position or tension |
| Gertel et al. [14] (1993) | Experimental (biomechanical) | 10 | Graft strength and joint mobility unchanged by tension magnitude |
| Sherman et al. [1] (2012) | Review article | 69 | 20–80 N of tension is recommended, depending on the graft, if flexion of 30°; 90 N of tension if in extension |
| Brady et al. [15] (2006) | Experimental (biomechanical) | 12 | Tension in extension generated greater compressive forces in the knee (90 N in extension = 3.5 x normal) |
| Austin et al. [16] (2007) | Experimental (biomechanical) | 10 | Graft tension did not change knee extension |
| Kim et al. [17] (2018) | Clinical trial | 60 | It is most appropriate to maintain a 20 -lb. (90 N) tension for graft fixation |
| Noyes et al. [18] (2019) | Experimental (biomechanical) | Current tensioning protocols are insufficient; suggests 40 flexion-extension cycles at 90 N for proper graft conditioning | |
| Regarding the knee-flexion angle when fixing the graft | |||
| Debandi et al. [5] (2016) | Experimental (biomechanical) | 12 | Anatomical reconstruction with fixation at 30° of knee flexion was superior (rotational stability) |
| Bylski-Austrow et al. [12] (1990) | Experimental (biomechanical) | 6 | Tension at 30° leads to greater stress in the graft than in extension; there is no correct position or tension |
| Gertel et al. [14] (1993) | Experimental (biomechanical) | 10 | Graft stress can be avoided with tensioning in extension |
| Brady et al. [15] (2006) | Experimental (biomechanical) | 12 | Stresses (15 N) applied at 20° of flexion or extension minimized rotational and axial forces on the knee; tension (90 N) in extension led to greater compressive forces |
| Austin et al. [16] (2007) | Experimental (biomechanical) | 10 | Knee flexion at 30° is associated with loss of extension |
| Mae et al. [19] (2008) | Experimental (biomechanical) | 6 | Knee flexion at 20° is closely associated to a normal knee |
| Kim et al. [17] (2018) | Clinical trial | 60 | Graft length shown to be longer with knee extended and loose in flexion |
| Miura et al. [20] (2006) | Experimental (biomechanical) | 10 | Dual band fixation (anteromedial/posterolateral bundles): PM bundle overloaded when fixed at 30°/30° and AM bundle overloaded when fixed at 60°/full extension |
| Höher et al. [21] (2001) | Experimental (biomechanical) | 10 | Fixing the graft at 30° of flexion better restored in situ forces and the kinematics of the knee when compared to the extension position |
| Asahina et al. [22] (1996) | Clinical trial | 44 | Superior stability and arthroscopic appearance in the group with the graft fixed at 30 ° of flexion; greater number of extension deficits when compared to fixation in extension |
| Regarding the knee-implant types | |||
| Speziali et al. [23] (2014) | Systematic review | 19 | Clinical outcomes were good or excellent in 2/3 of patients regardless of implants |
| Steiner et al. [24] (1994) | Experimental (biomechanical) | 36 | If properly fixed, implants/tendons showed similar strength. Patellar tendon with interference screws showed increased rigidity |
| Scheffler et al. [25] (2002) | Experimental (biomechanical) | 40 | Bonding materials should be avoided. Use of bone block fixation or hybrid fixation may decrease chance of failure |
| Brand et al. [26] (2000) | Review article | 98 | Interference screws in bone-to-bone fixation seems superior; metallic and bioabsorbable screws with similar results |
| Eguchi et al. [27] (2014) | Experimental (biomechanical) | 4 | Fixed-length suspensory devices have a greater mechanical clamping force than those of an adjustable length |
| Benedetto et al. [28] (2000) | Clinical trial | 113 | Bioabsorbable polygluconate screws with similar results when compared to metallic screws |
| Drogset et al. [29] (2005) | Clinical trial | 41 | Metallic screws showed better results than bioabsorbable screws |
| Arama et al. [30] (2015) | Clinical trial | 40 | There are no clinical differences in the use of titanium screws and bioabsorbable screws with hydroxyapatite |
| Ma et al. [31] | Clinical trial | 30 | Fixation with interference screws shows no difference in outcomes when compared to suspensory fixation |
| Carulli et al. [32] | Clinical trial | 90 | Good and similar results when comparing combined fixation with interference screws/sheath versus interference screw/staple |
| Weiss et al. [33] | Experimental (biomechanical) | 54 | Hybrid fixation has biomechanical advantages over simple fixation |
| Teo et al. [34] | Clinical trial | 64 | Supplementary tibial-graft fixation did not benefit ACL reconstruction |
Legend: ACL anterior cruciate ligament, AM anteromedial, PM posteromedial