The Effects of Grade III Posterolateral Knee Complex Injuries on Anterior Cruciate Ligament Graft Force (original) (raw)
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To determine if untreated grade III injuries of the posterolateral structures contribute to increased force on an anterior cruciate ligament graft, we measured the force in the graft in cadaveric knees during joint loading after reconstruction with otherwise intact structures and in the same reconstructed knees after selected cutting of specific posterolateral knee structures. Tests were first performed on the knee with the posterolateral structures intact and then after sequential sectioning of the fibular collateral ligament, popliteofibular ligament, and popliteus tendon. The graft force was significantly higher after fibular collateral ligament transection during varus loading at both 0°and 30°of knee flexion than it was for the same loading of the joint with intact posterolateral structures. In addition, coupled loading of varus and internal rotation moments at 0°and 30°of flexion further increased graft force beyond that with varus force alone. The increase in graft force remained significant with additional sequential cutting of the popliteofibular ligament and popliteus tendon. We believe this study supports the clinical observation that untreated grade III posterolateral structure injuries contribute to anterior cruciate ligament graft failure by allowing higher forces to stress the graft.
The American journal of sports medicine
To determine whether untreated grade 3 posterolateral knee injuries contribute to a significant increase in force on a posterior cruciate ligament reconstruction graft, we measured the force on the graft during joint loading of a posterior cruciate ligament-reconstructed knee with otherwise intact structures and then selectively cut the popliteofibular ligament, popliteus tendon, and the fibular collateral ligament. A posterior cruciate ligament reconstruction was performed in eight fresh-frozen cadaveric knees. One end of the graft was fixed to a tensioning jig with a load cell used to measure force in the graft as loads were applied to the knee. The force on the graft was significantly higher with the posterolateral structures cut during varus loading at 30 degrees, 60 degrees, and 90 degrees of flexion than it was in the same joint under the same loading conditions but with the posterolateral structures intact. Additionally, coupled loading of posterior drawer force and external ...
Knee Surgery, Sports Traumatology, Arthroscopy, 2017
force of the ACL during external rotation loading and the anatomic PL augmentation did not restore the in situ tissue force of the ACL during IR loading. Furthermore, there were no differences in ATT, IR, ER, and in situ tissue force under anterior tibial loading, IR and ER loading between the two reconstruction groups. Conclusion There were no significant differences between anatomic and non-anatomic PL augmentation using the porcine knee model.
Mechanical Properties of the Posterolateral Structures of the Knee
The individual biomechanical strength properties of the fibular collateral ligament, popliteofibular ligament, and popliteus tendon have not been well elucidated by previous studies. To define the necessary strength requirements for a posterolateral knee reconstruction, these properties for the main individual structures of the posterolateral knee need to be defined.
Biomechanical and Anatomical Effects of an External Rotational Torque Applied to the Knee
American Journal of Sports Medicine, 2006
Isolated posterolateral instability of the knee is relatively uncommon. Posterolateral corner injuries occur more commonly in association with an injury to the anterior or posterior cruciate ligaments. 18,35 O'Brien et al 28 noted that graft failures of anterior cruciate ligament reconstructions might be the result of unrecognized and untreated posterolateral corner injuries of the knee. The anatomy and specific arrangement of the posterolateral corner of the knee has been described in detail. The principal anatomical structures of the posterolateral corner of the knee include the iliotibial band, lateral collateral ligament, the arcuate ligament, the popliteus tendon, the popliteofibular ligament, the short lateral ligament, the fabellofibular ligament, the lateral head of the gastrocnemius muscle, and the posterolateral part of the capsule. 6,23,29,32,35 The popliteofibular ligament has been rediscovered as a key element in posterolateral stability of the knee. 3,22,32 Reliable assessment of all knee ligament injuries at the time of presentation allows appropriate planning for surgical treatment. Recommended tests include posterolateral
Joints
Purpose The aim of this retrospective, multicenter study was to investigate the correlation between a high degree of rotatory instability, posterolateral tibial slope (PLTS), and anterolateral ligament (ALL) injury. Methods The study population consisted of 76 adults with isolated, complete noncontact anterior cruciate ligament (ACL) tear. The sample was divided into two groups according to the preoperative degree of rotator instability (group A: pivot-shift test grades 2 and 3; group B: pivot-shift test grade 1). Preoperative magnetic resonance imaging (MRI) assessment included angle of PLTS, posterior shift of the lateral femoral condyle (16 mm) on the tibial plateau, and the presence/absence of ALL injury. The two groups were compared for differences. Results There was a statistically significant association between pivot-shift test grades 2 and 3 (group A), PLTS slope angle > 9 degrees, and ALL injury (p 11 mm), which was, however, not statistically significant when evaluated...
Knee Surgery, Sports Traumatology, Arthroscopy, 2012
Purpose The structural properties of the healing ligament are the determining factor for the stability of the reconstruction before, during, and after osseous integration of anterior cruciate ligament grafts. Over the course of ligamentization, the stability of synovialized grafts seems lower than that of non-synovialized patellar tendon grafts. Methods In an animal study on 42 sheep, 21 nonsynovialized grafts (patellar tendon) and 21 synovialized grafts (flexor digitorum superficialis tendon) were performed to replace the anterior cruciate ligament. After 6, 12, and 24 weeks, 7 animals from each group were euthanized and investigated. Anteroposterior stability of the knee was assessed. After removal of all other soft tissues, the ACL was loaded to failure. Histology and histological analysis of the intra-articular graft region was then performed.