The Effects of Graft Size and Insertion Site Location During Anterior Cruciate Ligament Reconstruction on Intercondylar Notch Impingement

2016 ◽  
Author(s):  
Hamid Nayeb Hashemi ◽  
Alexander D. Orsi ◽  
Ashkan Vaziri ◽  
Masoud Olia
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Insertion Site ◽  
Maximum Size ◽  
Intercondylar Notch ◽  
Site Location ◽  
Graft Size ◽  
Femoral Insertion ◽  
Acl Graft ◽  
Anterior Cruciate

Intercondylar notch impingement is detrimental to the anterior cruciate ligament (ACL). Notchplasty is a preventative remodeling procedure performed on the intercondylar notch during ACL reconstruction (ACLR). This study investigates how ACL graft geometry and both tibial and femoral insertion site location affect ACL-intercondylar notch interactions post ACLR. A range of ACL graft sizes are reported during ACLR, from 6mm–11mm in diameter. Minor variability of up to 3mm in ACL insertion site locations is reported during ACLR. Several 3D finite element (FE) knee joint models were constructed using three ACL graft sizes and polar arrays of tibial and femoral insertion site locations. Each knee model was subjected to flexion, tibial external rotation, and valgus motion. Impingement force and contact area between the ACL and the intercondylar notch compared well with published cadaver study results. A 3mm shift in the antero-lateral direction of the tibial insertion site of the average and maximum size ACL increased impingement force by 155.4% and 242.9% respectively. A 3mm shift in the anterior-proximal direction of the femoral insertion site of the average and maximum size ACL increased impingement by 292.6%, and 346.2% respectively. Simulated notchplasties of 4mm and 5mm reduced graft impingement force by 89.4% and 100% respectively for the simulations with greatest impingement. For the kinematics applied, the results show that small differences in graft size and insertion site location may lead to large increases in impingement force and contact area. The study aims to improve ACLR success rates by understanding how minor variations in graft size and insertion site location affect intercondylar notch impingement. Because minor variations in insertion site location during ACLR are a known occurrence, the results of this study may support the argument for performing notchplasty during ACLR.

scholarly journals Ribbon like appearance of the midsubstance fibres of the anterior cruciate ligament close to its femoral insertion site: a cadaveric study including 111 knees

2014 ◽  
Vol 23 (11) ◽  
pp. 3143-3150 ◽  
Author(s):  
Robert Śmigielski ◽  
Urszula Zdanowicz ◽  
Michał Drwięga ◽  
Bogdan Ciszek ◽  
Beata Ciszkowska-Łysoń ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Insertion Site ◽  
Cadaveric Study ◽  
Femoral Insertion ◽  
Anterior Cruciate

Area of the tibial insertion site of the anterior cruciate ligament as a predictor for graft size

2016 ◽  
Vol 25 (5) ◽  
pp. 1576-1582 ◽  
Author(s):  
Daniel Guenther ◽  
Sebastian Irarrázaval ◽  
Marcio Albers ◽  
Cara Vernacchia ◽  
James J. Irrgang ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Insertion Site ◽  
Graft Size ◽  
Tibial Insertion ◽  
Anterior Cruciate

Evaluating the tibial and femoral insertion site of the anterior cruciate ligament using an objective coordinate system: A cadaver study

Injury ◽  
2012 ◽  
Vol 43 (10) ◽  
pp. 1771-1775 ◽  
Author(s):  
Patrick Sadoghi ◽  
Paul Borbas ◽  
Jörg Friesenbichler ◽  
Susanne Scheipl ◽  
Norbert Kastner ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Coordinate System ◽  
Cruciate Ligament ◽  
Insertion Site ◽  
Cadaver Study ◽  
Femoral Insertion ◽  
System A ◽  
Anterior Cruciate

scholarly journals Failure load of the femoral insertion site of the anterior cruciate ligament in a porcine model: comparison of different portions and knee flexion angles

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Shohei Yamauchi ◽  
Kyohei Ishibashi ◽  
Eiji Sasaki ◽  
Shizuka Sasaki ◽  
Yuka Kimura ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Knee Flexion ◽  
Failure Load ◽  
Cruciate Ligament ◽  
Insertion Site ◽  
Posterolateral Bundle ◽  
Anteromedial Bundle ◽  
Femoral Insertion ◽  
Significant Difference ◽  
Anterior Cruciate

Abstract Background This study compared the failure load of the femoral insertion site of the anterior cruciate ligament between different portions and knee flexion angles. Methods In total, 87 fresh-frozen, porcine knees were used in this study. Three knees were used for histological evaluation; the remaining 84 knees were randomly divided into 4 groups: anterior anteromedial bundle, posterior anteromedial bundle, anterior posterolateral bundle, and posterior posterolateral bundle groups (n=21 per group). The anterior cruciate ligament femoral insertion site was divided into these four areas and excised, leaving a 3-mm square attachment in the center of each bundle. Tibia-anterior cruciate ligament-femur complexes were placed in a material testing machine at 30°, 120°, and 150° of knee flexion (n=7), and the failure load for each portion was measured under anterior tibial loading (0.33 mm/s). Results Histological study showed that the anterior cruciate ligament femoral insertion site consisted of direct and indirect insertions. Comparison of the failure load between the knee flexion angles revealed that all the failure loads decreased with knee flexion; significant decreases were observed in the failure load between 30 and 150° knee flexion in the posterior anteromedial bundle and posterior posterolateral bundle groups. Comparison of the failure load according to different portions revealed a significant difference between the anteromedial and posterolateral bundle groups at 150° of knee flexion, but no significant difference among the groups at 30° of flexion. Conclusions Although the failure load of the posterior portion decreased significantly in the knee flexion position, it (mainly consisting of indirect insertion) plays a significant role against anterior tibial load in the knee extension position; this appears to be related to the characteristics of the insertion site. Reflecting the complex structure and function of the ACL, this study showed that the failure load of the femoral insertion site varies with differences in positions and knee flexion angles.

Diagnostic of Injury Risk in the Anterior Cruciate Ligament Based On Shape Context Description of the Intercondylar Notch Curvature

2021 ◽  
Author(s):  
Joao Paulo Dias ◽  
Ariful Bhuiyan ◽  
Nabila Shamim
Keyword(s):  
Anterior Cruciate Ligament ◽  
Injury Risk ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
False Positives ◽  
Intercondylar Notch ◽  
Mr Images ◽  
Shape Context ◽  
Similarity Factor ◽  
Anterior Cruciate

Abstract An estimated number of 300,000 new anterior cruciate ligament (ACL) injuries occur each year in the United States. Although several magnetic resonance (MR) imaging-based ACL diagnostics methods have already been proposed in the literature, most of them are based on machine learning or deep learning strategies, which are computationally expensive. In this paper, we propose a diagnostics framework for the risk of injury in the anterior cruciate ligament (ACL) based on the application of the inner-distance shape context (IDSC) to describe the curvature of the intercondylar notch from MR images. First, the contours of the intercondylar notch curvature from 91 MR images of the distal end of the femur (70 healthy and 21 with confirmed ACL injury) were extracted manually using standard image processing tools. Next, the IDSC was applied to calculate the similarity factor between the extracted contours and reference standard curvatures. Finally, probability density functions of the similarity factor data were obtained through parametric statistical inference, and the accuracy of the ACL injury risk diagnostics framework was assessed using receiver operating characteristic analysis (ROC). The overall results for the area under the curve (AUC) showed that method reached a maximum accuracy of about 66%. Furthermore, the sensitivity and specificity results showed that an optimum discrimination threshold value for the similarity factor can be pursued that minimizes the incidence of false positives and false positives simultaneously.

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