The Effect of Tunnel Placement on Bone-Tendon Healing in Anterior Cruciate Ligament Reconstruction in a Goat Model

2009 ◽  
Vol 37 (8) ◽  
pp. 1522-1530 ◽  
Author(s):  
Max Ekdahl ◽  
Masahiro Nozaki ◽  
Mario Ferretti ◽  
Andrew Tsai ◽  
Patrick Smolinski ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Biomechanical Properties ◽  
Anterior Tibial Translation ◽  
Tunnel Placement ◽  
Anterior Tibial ◽  
Anterior Cruciate ◽  
Anterior Cruciate Ligament Surgery ◽  
Tibial Translation

Background Misplacement of the bone tunnels is one of the main causes of graft failure of anterior cruciate ligament surgery. Hypothesis Anatomic tunnel placement in anterior cruciate ligament surgery reconstruction will lead to improved outcomes, including biological ingrowth and biomechanical properties, when compared with nonanatomic tunnel placement. Study Design Controlled laboratory study. Methods Anterior cruciate ligament surgery reconstructions were performed on 3 different groups of goats (1 anatomic tunnel placement group and 2 different nonanatomic tunnel placement groups, with 10 goats in each group). For each group of 10 knees, 3 knees were used for histologic evaluation (bone tunnel enlargement, number of osteoclasts at the bone tendon interface, and revascularization of the graft) and 7 knees were used for biomechanical testing (anterior tibial translation, in situ force, cross-sectional area, and ultimate failure load). Animals were sacrificed at 12 weeks after surgery. Results The anatomic tunnel placement group showed less tunnel enlargement on the tibial side, fewer osteoclasts on both the tibial and femoral sides, and more vascularity in the femoral side when compared with the 2 nonanatomic reconstruction groups. Biomechanically, the anatomic tunnel placement group demonstrated less anterior tibial translation and greater in situ force than both nonanatomic tunnel placement groups. Conclusion Anatomic tunnel placement leads to superior biological healing and biomechanical properties compared with nonanatomic placement at 12 weeks after anterior cruciate ligament surgery reconstruction in a goat model. Clinical Relevance The findings of this study demonstrate the importance of anatomic tunnel placement in anterior cruciate ligament surgery reconstruction.

The Position of the Tibia during Graft Fixation Affects Knee Kinematics and Graft Forces for Anterior Cruciate Ligament Reconstruction

2001 ◽  
Vol 29 (6) ◽  
pp. 771-776 ◽  
Author(s):  
Jürgen Höher ◽  
Akihiro Kanamori ◽  
Jennifer Zeminski ◽  
Freddie H. Fu ◽  
Savio L-Y. Woo
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Knee Kinematics ◽  
Anterior Tibial Translation ◽  
Posterior Tibial ◽  
Anterior Tibial ◽  
Anterior Cruciate ◽  
Tibial Translation ◽  
Intact Knee

Ten cadaveric knees (donor ages, 36 to 66 years) were tested at full extension, 15°, 30°, and 90° of flexion under a 134-N anterior tibial load. In each knee, the kinematics as well as in situ force in the graft were compared when the graft was fixed with the tibia in four different positions: full knee extension while the surgeon applied a posterior tibial load (Position 1), 30° of flexion with the tibia at the neutral position of the intact knee (Position 2), 30° of flexion with a 67-N posterior tibial load (Position 3), and 30° of flexion with a 134-N posterior tibial load (Position 4). For Positions 1 and 2, the anterior tibial translation and the in situ forces were up to 60% greater and 36% smaller, respectively, than that of the intact knee. For Position 3, knee kinematics and in situ forces were closest to those observed in the intact knee. For Position 4, anterior tibial translation was significantly decreased by up to 2 mm and the in situ force increased up to 31 N. These results suggest that the position of the tibia during graft fixation is an important consideration for the biomechanical performance of an anterior cruciate ligament-reconstructed knee.

A Biomechanical Evaluation of Anterior Cruciate Ligament Reconstruction in Response to Rotational Loads

2000 ◽  
Author(s):  
Jennifer Zeminski ◽  
Akihiro Kanamori ◽  
Masayoshi Yagi ◽  
Richard E. Debski ◽  
Freddie H. Fu ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Complex Loading ◽  
Anterior Tibial Translation ◽  
Anterior Tibial ◽  
Biomechanical Evaluation ◽  
Anterior Cruciate ◽  
Tibial Translation

Abstract A successful reconstruction of the anterior cruciate ligament (ACL) after its injury should restore the kinematics of the intact knee, as well as reproduce the in-situ force in this ligament. While ACL reconstruction has been successful to limit anterior tibial translation under anterior loads applied to the tibia (1, 2), the same cannot be said about more complex loading conditions that include valgus and internal tibial torques.

The Effectiveness of Reconstruction of the Anterior Cruciate Ligament Using the Novel Knot/Press-Fit Technique

2005 ◽  
Vol 33 (6) ◽  
pp. 856-863 ◽  
Author(s):  
Robert H.P. Kilger ◽  
Maribeth Thomas ◽  
Scott Hanford ◽  
Dimosthenis A. Alaseirlis ◽  
Hans H. Paessler ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Knee Kinematics ◽  
Hamstring Tendon ◽  
Anterior Tibial Translation ◽  
Press Fit ◽  
Anterior Tibial ◽  
Tendon Grafts ◽  
Anterior Cruciate ◽  
Tibial Translation

Background A variety of fixation devices are used for anterior cruciate ligament reconstruction with hamstring tendon grafts. These devices increase costs and can present artifacts in magnetic resonance imaging as well as complications in revision surgery. Therefore, a novel knot/press-fit technique that requires no implantable devices has been introduced. Null Hypothesis The knot/press-fit technique restores knee kinematics as well as the more commonly used EndoButton CL fixation and has similar biomechanical properties as other devices published in the literature. Study Design Controlled laboratory study. Methods Eight fresh-frozen cadaveric knees (52 ± 7 years) were tested using a robotic/universal force-moment sensor testing system. The knee kinematics of the intact, anterior cruciate ligament-deficient, EndoButton-reconstructed, and knot/pressfit-reconstructed knee in response to both a 134-N anterior tibial load and a combined rotatory load at multiple knee flexion angles was determined. Differences between the 4 knee states were evaluated with a 2-factor repeated-measures analysis of variance (P <. 05). To determine the stiffness and strength of the knot/press-fit fixation, the femur-graft-tibia complex was tested in uniaxial tension. Results In response to an anterior tibial load, the anterior tibial translation for the knot/press-fit reconstruction was found to be not significantly different from that of the intact anterior cruciate ligament as well as that of the EndoButton reconstruction (P >. 05). In response to a combined rotatory load, neither reconstruction procedure could effectively reduce the coupled anterior tibial translation to that of the intact knee, and no significant difference between the 2 reconstructions could be detected (P >. 05). The stiffness of the knot/press-fit complex was found to be 37.8 ± 9.6 N/mm, and the load at failure was 540 ± 97.7 N, which is equal to other devices published in the literature. Clinical Relevance The experiment suggests that the knot/press-fit technique may be a reliable alternative for the femoral fixation of hamstring tendon grafts.

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