Effect of fixation angle and graft tension in double-bundle anterior cruciate ligament reconstruction on knee biomechanics View Full Text


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Article Info

DATE

2015-03-01

AUTHORS

Yusuke Sasaki, Shih-Sheng Chang, Masataka Fujii, Daisuke Araki, Junjun Zhu, Brandon Marshall, Monica Linde-Rosen, Patrick Smolinski, Freddie H. Fu

ABSTRACT

PurposeTo compare the effect of graft fixation angle and tension in double-bundle anterior cruciate ligament (ACL) reconstruction on knee biomechanics.MethodsFourteen cadaver knees were tested using a robotic system under two loadings: (1) an 89-N anterior tibial load (ATL) at full extension (FE), 15°, 30°, 45°, 60°, and 90°, and (2) combined 7 N m valgus and 5 N m internal tibial torques (simulated pivot-shift test) at FE, 15° and 30°. Four graft fixation angles and tensions were used for the anteromedial (AM) and posterolateral (PL) bundles, respectively: (Recon 1) 30°/20N and FE/20N, (Recon 2) 30°/30N and FE/10N, (Recon 3) 45°/20N and 15°/20N, and (Recon 4) 45°/30N and 15°/10N.ResultsAll fixation protocols closely restored the intact knee kinematics under ATL and simulated pivot-shift loading. For the AM bundle under ATL, the in situ force (ISF) with Recon 3 at the FE was significantly lower than that of the intact knee. For the PL bundle under ATL, the ISF with Recon 3 at the FE, 15° and 30° was significantly higher than that of the intact knee. In PL bundle under simulated pivot-shift loading, the ISF with Recon 1 and Recon 2 at FE was lower and the ISF of the PL bundle with Recon 3 at the 15° was higher than that of the intact knee.ConclusionThe AM-45°/30N and PL-15°/10N fixation most closely matched intact knee kinematics; however, stabilizing the knee during anterior tibial translation may risk an imbalance of the AM and the PL bundle loading. The results indicate that ACL bundle forces may not be restored even if the clinical assessment shows good results with the Lachman test and pivot-shift test. This may alter the loading on other structures of the knee. More... »

PAGES

2892-2898

References to SciGraph publications

  • 2011-07-28. Effects of different initial bundle tensioning strategies on the outcome of double-bundle ACL reconstruction: a cohort study in BMC SPORTS SCIENCE, MEDICINE AND REHABILITATION
  • 2010-08-24. A prospective randomised study of anatomical single-bundle versus double-bundle anterior cruciate ligament reconstruction: quantitative evaluation using an electromagnetic measurement system in INTERNATIONAL ORTHOPAEDICS
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  • 2005-09-28. The effect of initial graft tension on postoperative clinical outcome in anterior cruciate ligament reconstruction with semitendinosus tendon. in ARCHIVES OF ORTHOPAEDIC AND TRAUMA SURGERY
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  • Identifiers

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    http://scigraph.springernature.com/pub.10.1007/s00167-015-3552-5

    DOI

    http://dx.doi.org/10.1007/s00167-015-3552-5

    DIMENSIONS

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    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/25726160


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    29 schema:description PurposeTo compare the effect of graft fixation angle and tension in double-bundle anterior cruciate ligament (ACL) reconstruction on knee biomechanics.MethodsFourteen cadaver knees were tested using a robotic system under two loadings: (1) an 89-N anterior tibial load (ATL) at full extension (FE), 15°, 30°, 45°, 60°, and 90°, and (2) combined 7 N m valgus and 5 N m internal tibial torques (simulated pivot-shift test) at FE, 15° and 30°. Four graft fixation angles and tensions were used for the anteromedial (AM) and posterolateral (PL) bundles, respectively: (Recon 1) 30°/20N and FE/20N, (Recon 2) 30°/30N and FE/10N, (Recon 3) 45°/20N and 15°/20N, and (Recon 4) 45°/30N and 15°/10N.ResultsAll fixation protocols closely restored the intact knee kinematics under ATL and simulated pivot-shift loading. For the AM bundle under ATL, the in situ force (ISF) with Recon 3 at the FE was significantly lower than that of the intact knee. For the PL bundle under ATL, the ISF with Recon 3 at the FE, 15° and 30° was significantly higher than that of the intact knee. In PL bundle under simulated pivot-shift loading, the ISF with Recon 1 and Recon 2 at FE was lower and the ISF of the PL bundle with Recon 3 at the 15° was higher than that of the intact knee.ConclusionThe AM-45°/30N and PL-15°/10N fixation most closely matched intact knee kinematics; however, stabilizing the knee during anterior tibial translation may risk an imbalance of the AM and the PL bundle loading. The results indicate that ACL bundle forces may not be restored even if the clinical assessment shows good results with the Lachman test and pivot-shift test. This may alter the loading on other structures of the knee.
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    36 schema:keywords ACL bundle forces
    37 AM bundle
    38 AM-45
    39 ConclusionThe AM-45
    40 FE/10N
    41 FE/20N
    42 ISF
    43 Lachman test
    44 MethodsFourteen cadaver knees
    45 PL bundle
    46 PL bundle loading
    47 PL-15
    48 PurposeTo
    49 Recon 1
    50 Recon 2
    51 Recon 3
    52 angle
    53 anterior cruciate ligament reconstruction
    54 anterior tibial load
    55 anterior tibial translation
    56 anteromedial
    57 assessment
    58 biomechanics
    59 bundle forces
    60 bundle loading
    61 bundles
    62 cadaver knees
    63 clinical assessment
    64 cruciate ligament reconstruction
    65 double-bundle anterior cruciate ligament reconstruction
    66 effect
    67 extension
    68 fixation
    69 fixation angle
    70 force
    71 full extension
    72 good results
    73 graft fixation angles
    74 graft tension
    75 imbalance
    76 intact knee
    77 intact knee kinematics
    78 internal tibial torque
    79 kinematics
    80 knee
    81 knee biomechanics
    82 knee kinematics
    83 ligament reconstruction
    84 load
    85 loading
    86 pivot-shift loading
    87 pivot-shift test
    88 posterolateral bundle
    89 reconstruction
    90 results
    91 robotic system
    92 situ forces
    93 structure
    94 system
    95 tension
    96 test
    97 tibial load
    98 tibial torque
    99 tibial translation
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    103 schema:name Effect of fixation angle and graft tension in double-bundle anterior cruciate ligament reconstruction on knee biomechanics
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