Biomechanical Comparison of Anatomic Single- and Double-Bundle Anterior Cruciate Ligament Reconstructions: An In Vitro Study (original) (raw)
Related papers
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2011
Purpose: To evaluate in vivo the differences in tibial rotation between single-and double-bundle anterior cruciate ligament (ACL)-reconstructed knees under combined loading conditions. Methods: An 8-camera optoelectronic system and a force plate were used to collect kinematic and kinetic data from 14 patients with double-bundle ACL reconstruction, 14 patients with single-bundle reconstruction, 12 ACL-deficient subjects, and 12 healthy control individuals while performing 2 tasks. The first included walking, 60°pivoting, and stair ascending, and the second included stair descending, 60°p
Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association, 2012
To investigate the effect of coronal-and sagittal-plane anterior cruciate ligament (ACL) graft obliquity on tibial rotation (TR) range of motion (ROM) during dynamic pivoting activities after ACL reconstruction with bone-patellar tendon-bone (BPTB) autograft. Methods: We evaluated 19 ACL-reconstructed patients (mean age, 29 years; age range, 18 to 38 years; mean time interval postoperatively, 19.9 months) and 19 matched control subjects (mean age, 30.6 years; age range, 24 to 37 years) using motion analysis during (1) descending a stairway and pivoting and (2) landing from a jump and pivoting. Magnetic resonance imaging was used to measure the coronal and sagittal ACL graft angle. The dependent variables were TR ROM during pivoting and the side-to-side difference (SSD) in TR ROM between the reconstructed knee and the contralateral intact knee. Results: TR ROM of the ACL-reconstructed knee was significantly increased compared with both the contralateral intact knee and the healthy control knee (P Ͻ .05). A significant positive correlation was observed between TR ROM and coronal ACL graft angle (r ϭ 0.727, P ϭ .0006 for descending and pivoting; r ϭ 0.795, P ϭ .0001 for landing and pivoting) as well as between SSD of TR ROM and coronal ACL graft angle (r ϭ 0.789, P Ͻ .0001 for descending and pivoting; r ϭ 0.799, P Ͻ .0001 for landing and pivoting). No correlation was found with the sagittal ACL graft angle. Conclusions: After ACL reconstruction with a BPTB graft, patients' knees showed higher TR values than their uninjured knees and the knees of uninjured control volunteers during dynamic pivoting activities. The findings of this study show that TR was better restored in ACL-reconstructed patients with a more oblique graft in the coronal plane. A similar relation was not observed for graft orientation in the sagittal plane. Although these data do not imply a cause-and-effect relation between the 2 variables, they may indicate that a more oblique placement of a single BPTB ACL graft in the coronal plane is correlated with better control of TR. Level of Evidence: Level IV, case series.
The Anterior Cruciate Ligament injury in the human knee joint has long been a debilitating injury, particularly amongst professional athletes, often requiring a reconstruction and an extensive rehabilitation period. Surgeons commonly use the single bundle reconstructions to replicate the biomechanical restraint and stability the ligament structure provides to the knee joint against anterior translation and excessive internal rotation of the tibia with respect to the femur. However after follow up of these patients during high demanding tasks, such as single legged landing there is still presentation of increased internal rotation at the knee and osteoarthritis 5-10 years following surgery. This suggests that the surgical technique may not restore all the biomechanical support the natural ACL provides to the knee joint. The work presented here covers musculoskeletal computational modeling utilizing inverse kinematics predictions of knee rotation to calculate the internal rotation of the tibia. Using the model, gait analysis of ACL reconstructed subjects are compared with control healthy subjects to understand whether Internal Tibial Rotation (ITR) is fully restored in ACL single bundle reconstructions during a dynamic hop movement.
The Kinematic Basis of Anterior Cruciate Ligament Reconstruction
Operative Techniques in Sports Medicine, 2008
The goals of anterior cruciate ligament (ACL) reconstruction are to restore knee stability and function and to preserve joint health. Static tests for antero-posterior laxity (e.g. Lachman test or KT-1000 arthrometer) have typically shown restoration of normal or near-normal laxity with a variety of modern ACL reconstruction techniques. However, ACL reconstruction has failed to prevent early onset of osteoarthritis, and there is growing evidence that traditional single-bundle ACL reconstruction does not restore normal knee mechanics under functional loading conditions. ACL reconstruction may fail to restore normal rotational stability during the pivot shift. Abnormal internalexternal rotation and ab/adduction have been reported after ACL reconstruction during normal daily activities like walking and running. Recently, cadaveric studies have shown the potential superiority of ACL double bundle (DB) reconstruction for restoring anatomy and mechanical function. However, clinical data demonstrating the clear superiority of DB reconstruction is lacking, due to the absence of well-controlled clinical studies. Additionally, dynamic knee function after anatomic DB ACL has yet to be assessed comprehensively.
Anterior cruciate ligament repair versus reconstruction: A kinematic analysis
2019
Background: The purpose of this study was to compare the biomechanical properties of an anterior cruciate ligament (ACL) anatomic repair of a true femoral avulsion to an anatomic ACL reconstruction. It was hypothesized that the ACL repair and ACL reconstruction would have comparable biomechanical behavior when compared to the native knee. Methods: Ten paired fresh-frozen cadaveric knees (n = 20) were used to investigate knee kinematics when an anterior drawer force, varus, valgus, internal, and external rotational moment were applied at 0, 15, 30, 45, 60, and 90 degrees of flexion. Displacement and rotation were recorded in the following conditions: ACL-intact, ACL-deficient, and ACL-repaired vs reconstructed. Results: Sectioning of the ACL significantly increased anterior tibial translation (0°, 15°, 30° and 45°) compared to the intact state. The mean anterior displacement difference from intact was lower in the ACL-repaired knees compared to reconstructed knees at 30° and 90°. There were no significant differences between conditions in varus, valgus, internal, or external rotations. Conclusion: ACL repair and ACL reconstruction procedures restored knee anterior tibial translation in matched paired specimens. There were no differences in valgus, varus, internal, or external rotation. Although, ACL-repaired knees (avulsion model) demonstrated less anterior tibial translation when compared to ACL-reconstructed knees, this difference was less than one millimeter. Based on the findings of this study, repair and reconstruction procedures both restored anterior tibial translation in matched-pair specimens. This suggests that the initial functionality of both techniques is similar and that further clinical studies are needed to compare the long-term stability.
Arthroscopy-the Journal of Arthroscopic and Related Surgery, 2010
Purpose: The objective of this study was to analyze 2 different single-bundle anterior cruciate ligament (ACL) reconstruction procedures and compare their ability to reduce the pivot-shift phenomenon with an anatomic double-bundle (DB) technique. Methods: Twelve fresh-frozen cadaveric hip-to-toe lower extremity specimens were used. ACL reconstructions were performed by conventional single-bundle, anteromedial (AM) single-bundle, and DB techniques. Anterior tibial translation was measured in the intact knee, ACL-deficient knee, and the 3 ACL reconstructions in response to a Lachman test and a mechanized pivot-shift test. A surgical navigation system (Praxim Medivision, Grenoble, France) simultaneously tracked kinematics. Results: Intact knees were clinically graded as grade 0 (n ϭ 12). ACL-deficient knees were graded as grade 1 (n ϭ 10) and grade 2 (n ϭ 2). With a mechanized pivot-shift test, anterior tibial translation was 1.7 Ϯ 3.0 mm, 9.7 Ϯ 3.8 mm, 4.4 Ϯ 1.0 mm, 1.8 Ϯ 1.5 mm, and Ϫ1.7 Ϯ 3.3 mm for intact knees, ACL-deficient knees, conventional technique, AM technique, and DB technique, respectively. There was a significant difference between the DB technique and both single-bundle techniques tested (P Ͻ .05). Conclusions: The model used represents an isolated ACL injury without concomitant injury to the capsuloligamentous restraints or menisci. However, during the pivot shift, neither type of singlebundle ACL reconstruction stabilized the knee to the same degree as the DB ACL reconstruction. Clinical Relevance: In this cadaveric model a DB repair offers great anterior and rotational stability. Although this study suggests that the DB technique is biomechanically superior to a single-bundle technique using traditional transtibial tunnel positions, there appear to be minimal differences in knee kinematics during stability testing with the DB technique versus an AM graft position. Indeed, compared with the AM position alone, the DB technique "overconstrained" the kinematics of the knee during a pivoting maneuver at time zero in a cadaveric model with an isolated ACL injury.
Biomechanical analysis of an anatomic anterior cruciate ligament reconstruction
The American journal of sports medicine
The focus of most anterior cruciate ligament reconstructions has been on replacing the anteromedial bundle and not the posterolateral bundle. Anatomic two-bundle reconstruction restores knee kinematics more closely to normal than does single-bundle reconstruction. Controlled laboratory study. Ten cadaveric knees were subjected to external loading conditions: 1) a 134-N anterior tibial load and 2) a combined rotatory load of 5-N x m internal tibial torque and 10-N x m valgus torque. Resulting knee kinematics and in situ force in the anterior cruciate ligament or replacement graft were determined by using a robotic/universal force-moment sensor testing system for 1) intact, 2) anterior cruciate ligament deficient, 3) single-bundle reconstructed, and 4) anatomically reconstructed knees. Anterior tibial translation for the anatomic reconstruction was significantly closer to that of the intact knee than was the single-bundle reconstruction. The in situ force normalized to the intact ante...
Orthopaedic Journal of Sports Medicine
Background: Tibial rotation is an important topic in anterior cruciate ligament (ACL) surgery, and many efforts are being made to address rotational stability. The exact role of the ACL in controlling tibial rotation in clinical studies is unknown. Purpose: To quantify the effect of ACL reconstruction on the amount of tibial rotation based on the current available literature. Study Design: Systematic review; Level of evidence, 4. Methods: A literature search of the PubMed and EMBASE databases was performed in August 2019. Two independent reviewers reviewed titles and abstracts as well as full-text articles. A total of 2383 studies were screened for eligibility. After screening of titles and abstracts, 178 articles remained for full-text assessment. Ultimately, 13 studies were included for analysis. A quality assessment was performed by means of the RoB 2.0 (revised tool for Risk of Bias in randomized trials) and the ROBINS-I (Risk Of Bias In Non-randomized Studies–of Interventions) ...