Fixation of the graft in reconstruction of the anterior cruciate ligament.

©2005 British Editorial Society of Bone and Joint Surgery doi:10.1302/0301-620X.87B5. 15803 $2.00 J Bone Joint Surg [Br] 2005;87-B:593-603. Methods of reconstruction of the anterior cruciate ligament (ACL) have developed considerably over the last 15 years. Primary repair and extra-articular procedures have failed to reproduce satisfactory stability of the knee 1 and the use of prosthetic ligaments has been abandoned. 2 These techniques have been superseded by reconstruction with an intra-articular graft. The current surgical approach is by anatomical reconstruction using a biological tissue autograft. The bone-patellar tendon-bone graft (B-PT-B) has given good clinical results, 3 but morbidity at the donor site 4,5 has prompted many surgeons to favour the four-strand hamstring graft usually using the tendons of semitendinosus and gracilis doubled. Reconstruction should aim to recreate the exact mechanical properties of the injured ligament and restore normal function to the knee. Currently, this cannot be achieved. Biomechanical testing of ligament reconstructions in the laboratory has been used widely in attempts to recreate these mechanical properties. The ultimate load to failure of the B-PT-B graft has been shown to be 2977 N 6