Effect of Initial Graft Tension During Calcaneofibular Ligament Reconstruction on Ankle Kinematics and Laxity

2018 ◽  
Vol 46 (12) ◽  
pp. 2935-2941 ◽  
Author(s):  
Yuzuru Sakakibara ◽  
Atsushi Teramoto ◽  
Tetsuya Takagi ◽  
Satoshi Yamakawa ◽  
Yohei Okada ◽  
...  
Keyword(s):  
Repeated Measures ◽  
Degrees Of Freedom ◽  
Ligament Reconstruction ◽  
External Rotation ◽  
Calcaneofibular Ligament ◽  
Initial Tension ◽  
3 Dimensional ◽  
Graft Tension ◽  
Intact Condition ◽  
Lateral Ankle Ligament

Background: Although a variety of surgical procedures for lateral ankle ligament reconstruction have frequently been reported, little is known about the effects of initial graft tension. Purpose/Hypothesis: The purpose was to investigate the effects of initial graft tension in calcaneofibular ligament (CFL) reconstruction. It was hypothesized that a high degree of initial graft tension would cause abnormal kinematics, laxity, and excessive graft tension. Study Design: Controlled laboratory study. Methods: Twelve cadaveric ankles were tested with a 6 degrees of freedom robotic system to apply passive plantarflexion-dorsiflexion motion and multidirectional loads. A repeated-measures experiment was designed with the CFL intact, CFL transected, and CFL reconstructed with 4 initial tension conditions (10, 30, 50, and 70 N). The 3-dimensional path and reconstructed graft tension were simultaneously recorded. Results: The calcaneus in CFL reconstruction with an initial tension of 70 N had the most eversion relative to the intact condition (mean eversion translations of 1.2, 3.0, 5.0, and 6.2 mm were observed at initial tensions of 10, 30, 50, and 70 N, respectively). The calcaneus also moved more posteriorly with external rotation as the initial tension increased. The reconstructed graft tension tended to increase as the initial tension increased. Conclusion: Ankle kinematic patterns and laxity after CFL reconstruction tended to become more abnormal as the initial graft tension increased at the time of surgery. Moreover, excessive initial graft tension caused excessive tension on the reconstructed graft. Clinical Relevance: This study indicated the importance of initial graft tension during CFL reconstruction. Overtensioning during CFL reconstruction should be avoided to imitate a normal ankle.

Effect of Initial Graft Tension During Anterior Talofibular Ligament Reconstruction on Ankle Kinematics, Laxity, and In Situ Forces of the Reconstructed Graft

2020 ◽  
Vol 48 (4) ◽  
pp. 916-922
Author(s):  
Yuzuru Sakakibara ◽  
Atsushi Teramoto ◽  
Tetsuya Takagi ◽  
Satoshi Yamakawa ◽  
Hiroaki Shoji ◽  
...  
Keyword(s):  
Repeated Measures ◽  
Degrees Of Freedom ◽  
Anterior Talofibular Ligament ◽  
Principle Of Superposition ◽  
Initial Tension ◽  
Ankle Motion ◽  
Graft Tension ◽  
In Situ Force ◽  
Ankle Kinematics

Background: Although a variety of surgical procedures for anterior talofibular ligament (ATFL) reconstruction have been reported, the effect of initial graft tension during ATFL reconstruction remains unclear. Purpose/Hypothesis: This study investigated the effects of initial graft tension on ATFL reconstruction. We hypothesized that a high degree of initial graft tension would cause abnormal kinematics and laxity. Study Design: Controlled laboratory study. Methods: Twelve cadaveric ankles were tested with a robotic system with 6 degrees of freedom to apply passive plantarflexion and dorsiflexion motions and a multidirectional load. A repeated measures experiment was designed with the intact ATFL, transected ATFL, and reconstructed ATFL at initial tension conditions of 10, 30, 50, and 70 N. The 3-dimensional path and reconstructed graft tension were simultaneously recorded, and the in situ forces of the ATFL and reconstructed graft were calculated with the principle of superposition. Results: Initial tension of 10 N was sufficient to imitate normal ankle kinematics and laxity, which were not significantly different when compared with those of the intact ankles. The in situ force on the reconstructed graft tended to increase as the initial tension increased. In situ force on the reconstructed graft >30 N was significantly greater than that of intact ankles. The in situ force on the ATFL was 19 N at 30° of plantarflexion. In situ forces of 21.9, 30.4, 38.2, and 46.8 N were observed at initial tensions of 10, 30, 50, and 70 N, respectively, at 30° of plantarflexion. Conclusion: Approximate ankle kinematic patterns and sufficient laxity, even with an initial tension of 10 N, could be obtained immediately after ATFL reconstruction. Moreover, excessive initial graft tension during ATFL reconstruction caused excessive in situ force on the reconstructed graft. Clinical Relevance: This study revealed the effects of initial graft tension during ATFL reconstruction. These data suggest that excessive tension during ATFL reconstruction should be avoided to ensure restoration of normal ankle motion.

scholarly journals Investigation of the Effect of Initial Graft Tension During Anterior Talofibular Ligament Reconstruction on Ankle Kinematics, Laxity, and In-situ Force

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0041
Author(s):  
Yuzuru Sakakibara ◽  
Atsushi Teramoto ◽  
Tomoaki Kamiya ◽  
Kota Watanabe ◽  
Toshihiko Yamashita
Keyword(s):  
External Rotation ◽  
Anatomic Reconstruction ◽  
Anterior Talofibular Ligament ◽  
Ankle Sprains ◽  
Principle Of Superposition ◽  
Initial Tension ◽  
Graft Tension ◽  
In Situ Force ◽  
Ankle Kinematics

Category: Basic Sciences/Biologics Introduction/Purpose: Ankle sprains are the most common sports injuries, and anterior talofibular ligament (ATFL) injury comprised 85% of all ankle sprains. Most patients recover with conservative treatment, but 20% of them progress to chronic ankle instability. Some studies have reported that anatomic reconstruction using a tendon graft is one of the best procedures to restore the ankle to its condition before symptom development. However, the effect of initial graft tension during ATFL reconstruction is still unclear. Therefore, the objective of this study was to investigate the effect of the initial graft tension during ATFL reconstruction. Methods: Eight fresh-frozen cadaveric ankle specimens were subjected to passive plantarflexion (PF)-dorsiflexion (DF) movement from 15° DF to 30° PF using the 6-degree-freedom robotic system. In addition, 60 N of anterior-posterior load, 1.7 Nm of inversion-eversion (IV-EV) torque, and 1.7 Nm of internal-external rotation (IR-ER) torque were applied to the ankle. During testing, 3-dimensional paths of the ankle were recorded simultaneously. Furthermore, in-situ forces of the ATFL and reconstructed graft were calculated using the principle of superposition. A repeated experiment was designed with the intact condition (intact), ATFL transection, and ATFL reconstruction with four different initial graft tensions (10 N, 30 N, 50 N, and 70 N). Results: AP laxity, IV-EV laxity and IR-ER laxity with ATFL transection was significantly greater than those with intact. In ATFL transection, the talus was significantly translated anteriorly with inversion and internal rotations under passive PF-DF motion compared with intact. Kinematic patterns and laxity in ATFL reconstruction with initial tension of 10 N and 30 N almost imitated intact, but in ATFL reconstruction with initial tension 70 N, the talus was significantly translated with external rotation compared with intact. As the initial graft tension during ATFL reconstruction increased, in-situ force of the reconstructed graft tended to increase during PF-DF motion. In-situ force of the reconstructed graft tension was significantly greater with initial tensions of 50 N, and 70 N than with intact during PF-DF motion (Figure 1). Conclusion: ATFL deficiency altered ankle kinematics and laxity. Although the optimal initial graft tension during ATFL reconstruction might restore ankle kinematics and laxity, excessive initial graft tension caused abnormal kinematics and laxity. Furthermore, the reconstructed graft tension increased as the initial tension increased. Initial tension during ATFL reconstruction has the important effect of imitating the normal ankle condition. We suggest that over-tensioning during ATFL reconstruction should be avoided in order to imitate the conditions of a normal ankle.

The Effect of Initial Graft Tension in Anterior Cruciate Ligament Reconstruction on the Mechanical Behaviors of the Femur-Graft-Tibia Complex during Cyclic Loading

2002 ◽  
Vol 30 (6) ◽  
pp. 800-805 ◽  
Author(s):  
Hironori Numazaki ◽  
Harukazu Tohyama ◽  
Hideaki Nakano ◽  
Shinichi Kikuchi ◽  
Kazunori Yasuda
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Ligament Reconstruction ◽  
Flexor Tendon ◽  
Cruciate Ligament ◽  
Tendon Graft ◽  
Initial Tension ◽  
Graft Tension ◽  
Anterior Cruciate ◽  
Flexor Tendon Graft

Background Initial graft tension influences clinical results of anterior cruciate ligament reconstruction. Hypothesis Under repetitive loading conditions, the effect of initial graft tension on the biomechanical behavior of the femur-graft-tibia complex may depend on the graft and the fixation. Study Design Ex vivo biomechanical laboratory study. Methods After anterior cruciate ligament reconstruction, initial graft tension of 20, 80, or 140 N was applied to the complex for 2 minutes. Then, a cyclic force-relaxation test was performed for 5000 cycles so that the graft was stretched by 2 mm. Results In a patellar tendon graft with interference screws, the average peak load values at the 5000th cycle were 105, 157, and 205 N for the complexes with initial tension of 20, 80, and 140 N, respectively. In a flexor tendon graft with interference screws, the values were 27, 41, and 39 N. In a flexor tendon graft with Endobutton fixation, the values were 17, 40, and 77 N. Conclusions Considering the tension of the normal anterior cruciate ligament (16 to 87 N), an initial tension of 20 N appears to be high enough for a patellar tendon graft. For a flexor tendon graft with interference screws, an increase in initial tension above 80 N has no biomechanical advantages.

Effect of initial graft tension at calcaneofibular ligament reconstruction for ankle stability

2017 ◽  
Vol 23 ◽  
pp. 13
Author(s):  
Y. Sakakibara ◽  
A. Teramoto ◽  
Y. Okada ◽  
S. Hiroaki ◽  
T. Kobayashi ◽  
...  
Keyword(s):  
Ligament Reconstruction ◽  
Calcaneofibular Ligament ◽  
Graft Tension ◽  
Ankle Stability

scholarly journals Augmented Ligament Reconstruction Partially Restores Hindfoot and Midfoot Kinematics After Lateral Ligament Ruptures

2019 ◽  
Vol 47 (8) ◽  
pp. 1921-1930
Author(s):  
Hannelore Boey ◽  
Stefaan Verfaillie ◽  
Tassos Natsakis ◽  
Jos Vander Sloten ◽  
Ilse Jonkers
Keyword(s):  
Ligament Reconstruction ◽  
Ankle Instability ◽  
External Rotation ◽  
Lateral Ligament ◽  
Osteochondral Lesions ◽  
Anterior Talofibular Ligament ◽  
Calcaneofibular Ligament ◽  
Talocalcaneal Joint ◽  
Fresh Frozen ◽  
Suture Tape

Background: Altered kinematics and persisting ankle instability have been associated with degenerative changes and osteochondral lesions. Purpose: To study the effect of ligament reconstruction surgery with suture tape augmentation (isolated anterior talofibular ligament [ATFL] vs combined ATFL and calcaneofibular ligament [CFL]) after lateral ligament ruptures (combined ATFL and CFL) on foot-ankle kinematics during simulated gait. Study Design: Controlled laboratory study. Methods: Five fresh-frozen cadaveric specimens were tested in a custom-built gait simulator in 5 different conditions: intact, ATFL rupture, ATFL-CFL rupture, ATFL-CFL reconstruction, and ATFL reconstruction. For each condition, range of motion (ROM) and the average angle (AA) in the hindfoot and midfoot joints were calculated during the stance phase of normal and inverted gait. Results: Ligament ruptures mainly changed ROM in the hindfoot and the AA in the hindfoot and midfoot and influenced the kinematics in all 3 movement directions. Combined ligament reconstruction was able to restore ROM in inversion-eversion in 4 of the 5 joints and ROM in internal-external rotation and dorsiflexion-plantarflexion in 3 of the 5 joints. It was also able to restore the AA in inversion-eversion in 2 of the 5 joints, the AA in internal-external rotation in all joints, and the AA in dorsiflexion-plantarflexion in 1 of the joints. Isolated ATFL reconstruction was able to restore ROM in inversion-eversion and internal-external rotation in 3 of the 5 joints and ROM in dorsiflexion-plantarflexion in 2 of the 5 joints. Isolated reconstruction was also able to restore the AA in inversion-eversion and dorsiflexion-plantarflexion in 2 of the joints and the AA in internal-external rotation in 3 of the joints. Both isolated reconstruction and combined reconstruction were most successful in restoring motion in the tibiocalcaneal and talonavicular joints and least successful in restoring motion in the talocalcaneal joint. However, combined reconstruction was still better at restoring motion in the talocalcaneal joint than isolated reconstruction (1/3 for ROM and 1/3 for the AA with isolated reconstruction compared to 1/3 for ROM and 2/3 for the AA with combined reconstruction). Conclusion: Combined ATFL-CFL reconstruction showed better restored motion immediately after surgery than isolated ATFL reconstruction after a combined ATFL-CFL rupture. Clinical Relevance: This study shows that ligament reconstruction with suture tape augmentation is able to partially restore kinematics in the hindfoot and midfoot at the time of surgery. In clinical applications, where the classic Broström-Gould technique is followed by augmentation with suture tape, this procedure may protect the repaired ligament during healing by limiting excessive ROM after a ligament rupture.

scholarly journals Improving Shoulder Kinematics in Individuals With Paraplegia: Comparison Across Circuit Resistance Training Exercises and Modifications in Hand Position

2016 ◽  
Vol 96 (7) ◽  
pp. 1006-1017 ◽  
Author(s):  
Linda M. Riek ◽  
Joshua Tome ◽  
Paula M. Ludewig ◽  
Deborah A. Nawoczenski
Keyword(s):  
Resistance Training ◽  
Repeated Measures ◽  
External Rotation ◽  
Tracking System ◽  
Hand Position ◽  
Orientation Data ◽  
3 Dimensional ◽  
Scapular Kinematics ◽  
Circuit Resistance Training ◽  
Circuit Resistance

Abstract Background Circuit resistance training (CRT) should promote favorable kinematics (scapular posterior tilt, upward rotation, glenohumeral or scapular external rotation) to protect the shoulder from mechanical impingement following paraplegia. Understanding kinematics during CRT may provide a biomechanical rationale for exercise positions and exercise selection promoting healthy shoulders. Objective The purposes of this study were: (1) to determine whether altering hand position during CRT favorably modifies glenohumeral and scapular kinematics and (2) to compare 3-dimensional glenohumeral and scapular kinematics during CRT exercises. Hypotheses The hypotheses that were tested were: (1) modified versus traditional hand positions during exercises improve kinematics over comparable humerothoracic elevation angles, and (2) the downward press demonstrates the least favorable kinematics. Design This was a cross-sectional observational study. Methods The participants were 18 individuals (14 men, 4 women; 25–76 years of age) with paraplegia. An electromagnetic tracking system acquired 3-dimensional position and orientation data from the trunk, scapula, and humerus during overhead press, chest press, overhead pulldown, row, and downward press exercises. Participants performed exercises in traditional and modified hand positions. Descriptive statistics and 2-way repeated-measures analysis of variance were used to evaluate the effect of modifications and exercises on kinematics. Results The modified position improved kinematics for downward press (glenohumeral external rotation increased 4.5° [P=.016; 95% CI=0.7, 8.3] and scapular external rotation increased 4.4° [P<.001; 95% CI=2.5, 6.3]), row (scapular upward rotation increased 4.6° [P<.001; 95% CI=2.3, 6.9]), and overhead pulldown (glenohumeral external rotation increased 18.2° [P<.001, 95% CI=16, 21.4]). The traditional position improved kinematics for overhead press (glenohumeral external rotation increased 9.1° [P=.001; 95% CI=4.1, 14.1], and scapular external rotation increased 5.5° [P=.004; 95% CI=1.8, 9.2]). No difference existed between chest press positions. Downward press (traditional or modified) demonstrated the least favorable kinematics. Limitations It is unknown whether faulty kinematics causes impingement or whether pre-existing impingement causes altered kinematics. Three-dimensional modeling is needed to verify whether “favorable” kinematics increase the subacromial space. Conclusions Hand position alters kinematics during CRT and should be selected to emphasize healthy shoulder mechanics.

Biomechanical Analysis of an Isolated Fibular (Lateral) Collateral Ligament Reconstruction Using an Autogenous Semitendinosus Graft

2007 ◽  
Vol 35 (9) ◽  
pp. 1521-1527 ◽  
Author(s):  
Benjamin R. Coobs ◽  
Robert F. LaPrade ◽  
Chad J. Griffith ◽  
Bradley J. Nelson
Keyword(s):  
Internal Rotation ◽  
Knee Flexion ◽  
Ligament Reconstruction ◽  
External Rotation ◽  
Anatomic Reconstruction ◽  
Ligament Injury ◽  
Collateral Ligament ◽  
Fibular Collateral Ligament ◽  
Normal Stability ◽  
Semitendinosus Graft

Background The fibular collateral ligament is the primary stabilizer to varus instability of the knee. Untreated fibular collateral ligament injuries can lead to residual knee instability and can increase the risk of concurrent cruciate ligament reconstruction graft failures. Anatomic reconstructions of the fibular collateral ligament have not been biomechanically validated. Purpose To describe an anatomic fibular collateral ligament reconstruction using an autogenous semitendinosus graft and to test the hypothesis that using this reconstruction technique to treat an isolated fibular collateral ligament injury will restore the knee to near normal stability. Study Design Controlled laboratory study. Methods Ten nonpaired, fresh-frozen cadaveric knees were biomechanically subjected to a 10 N·m varus moment and 5 N·m external and internal rotation torques at 0°, 15°, 30°, 60°, and 90° of knee flexion. Testing was performed with an intact and sectioned fibular collateral ligament, and also after an anatomic reconstruction of the fibular collateral ligament with an autogenous semitendinosus graft. Motion changes were assessed with a 6 degree of freedom electromagnetic motion analysis system. Results After sectioning, we found significant increases in varus rotation at 0°, 15°, 30°, 60°, and 90°, external rotation at 60° and 90°, and internal rotation at 0°, 15°, 30°, 60°, and 90° of knee flexion. After reconstruction, there were significant decreases in motion in varus rotation at 0°, 15°, 30°, 60°, and 90°, external rotation at 60° and 90°, and internal rotation at 0°, 15°, and 30° of knee flexion. In addition, we observed a full recovery of knee stability in varus rotation at 0°, 60°, and 90°, external rotation at 60° and 90°, and internal rotation at 0° and 30° of knee flexion. Conclusion An anatomic fibular collateral ligament reconstruction restores varus, external, and internal rotation to near normal stability in a knee with an isolated fibular collateral ligament injury. Clinical Significance An anatomic reconstruction of the fibular collateral ligament with an autogenous semitendinosus graft is a viable option to treat nonrepairable acute or chronic fibular collateral ligament tears in patients with varus instability.

Sign in / Sign up

Export Citation Format

Share Document