Potential risk of cartilage damage in double bundle ACL reconstruction: impact of knee flexion angle and portal location on the femoral PL bundle tunnel

Background: It is unclear how each bundle of the posterior cruciate ligament contributes to posterior knee stability. Hypothesis: Changes in bundle orientation and length occur such that neither bundle dominates in restraining posterior tibial motion throughout knee flexion and extension. Study Design: Controlled laboratory study. Methods: Six fresh-frozen cadaveric knees were studied in a joint-testing rig with individual quadriceps and hamstring muscle loading. Kinematic data for the tibia and femur were obtained at knee flexion angles from 0° to 120°. The joint was then disarticulated, and the insertions of the two bundles on the tibia and femur were digitized. Results: Length of the anterolateral bundle increased with increasing knee flexion angle from 10° to 120°. Length of the posteromedial bundle decreased with increasing knee flexion angle from 0° to 45° and increased slightly from 60° to 120°. Length of the anteromedial bundle was significantly less than that of the posteromedial at 0°, 10°, and 20° of knee flexion. The anterolateral bundle was significantly more horizontal at flexion angles of 0°, 10°, 20°, 30°, and 45° (P < 0.05). The posteromedial bundle was more horizontal at 120°. Conclusions: Changes in orientation take place such that neither bundle dominates in restraining posterior tibial motion throughout knee flexion and extension. Clinical Relevance: Double-bundle reconstructions achieve more physiologic knee function.

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Effect of Knee Flexion Angle on Tunnel Length and Articular Cartilage Damage During Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction (SS-54)

Arthroscopy The Journal of Arthroscopic and Related Surgery ◽

10.1016/j.arthro.2008.04.054 ◽

2008 ◽

Vol 24 (6) ◽

pp. e31 ◽

Cited By ~ 9

Author(s):

Geoffrey S. Baer ◽

Freddie H. Fu ◽

Wei Shen ◽

Max Ekdahl ◽

Masahiro Nozaki ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Knee Flexion ◽

Ligament Reconstruction ◽

Cruciate Ligament ◽

Cartilage Damage ◽

Double Bundle ◽

Knee Flexion Angle ◽

Tunnel Length ◽

Cruciate Ligament Reconstruction ◽

Anterior Cruciate

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A high degree of knee flexion after TKA promotes the ability to perform high-flexion activities and patient satisfaction in Asian population

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04369-4 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Hyuk-Soo Han ◽

Jong Seop Kim ◽

Bora Lee ◽

Sungho Won ◽

Myung Chul Lee

Keyword(s):

Quality Of Life ◽

Patient Satisfaction ◽

Clinical Data ◽

Knee Flexion ◽

Male Gender ◽

Flexion Angle ◽

Knee Flexion Angle ◽

High Flexion ◽

Standing Up

Abstract Background This study investigated whether achieving a higher degree of knee flexion after TKA promoted the ability to perform high-flexion activities, as well as patient satisfaction and quality of life. Methods Clinical data on 912 consecutive primary TKA cases involving a single high-flexion posterior stabilized fixed-bearing prosthesis were retrospectively analyzed. Demographic and clinical data were collected, including knee flexion angle, the ability to perform high-flexion activities, and patient satisfaction and quality of life. Results Of the cases, 619 (68%) achieved > 130° of knee flexion after TKA (high flexion group). Knee flexion angle and clinical scores showed significant annual changes, with the maximum improvement seen at 5 years and slight deterioration observed at 10 years postoperatively. In the high flexion group, more than 50% of the patients could not kneel or squat, and 35% could not stand up from on the floor. Multivariate analysis revealed that > 130° of knee flexion, the ability to perform high-flexion activities (sitting cross-legged and standing up from the floor), male gender, and bilateral TKA were significantly associated with patient satisfaction after TKA, while the ability to perform high-flexion activities (sitting cross-legged and standing up from the floor), male gender, and bilateral TKA were significantly associated with patient quality of life after TKA. Conclusions High knee flexion angle (> 130°) after TKA increased the ease of high-flexion activities and patient satisfaction. The ease of high-flexion activities also increased quality of life after TKA in our Asian patients, who frequently engage in these activities in daily life.

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