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Open Access Short Report

Anterior cruciate ligament graft tensioning. Is the maximal sustained one-handed pull technique reproducible?

Barry J O'Neill12*, Fergus J Byrne12, Kieran M Hirpara12, William F Brennan2, Peter E McHugh2 and William Curtin1

Author Affiliations

1 Department of Orthopaedic & Trauma Surgery, Galway Regional Hospitals, Galway, Ireland

2 The National Centre for Biomedical Engineering, National University of Ireland, Galway, Ireland

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BMC Research Notes 2011, 4:244  doi:10.1186/1756-0500-4-244

Published: 20 July 2011



Tensioning of anterior cruciate ligament (ACL) reconstruction grafts affects the clinical outcome of the procedure. As yet, no consensus has been reached regarding the optimum initial tension in an ACL graft. Most surgeons rely on the maximal sustained one-handed pull technique for graft tension. We aim to determine if this technique is reproducible from patient to patient.


We created a device to simulate ACL reconstruction surgery using Ilizarov components and porcine flexor tendons. Six experienced ACL reconstruction surgeons volunteered to tension porcine grafts using the device to see if they could produce a consistent tension. None of the surgeons involved were able to accurately reproduce graft tension over a series of repeat trials.


We conclude that the maximal sustained one-handed pull technique of ACL graft tensioning is not reproducible from trial to trial. We also conclude that the initial tension placed on an ACL graft varies from surgeon to surgeon.