scholarly journals Multiplanar Loading of the Knee and Its Influence on Anterior Cruciate Ligament and Medial Collateral Ligament Strain During Simulated Landings and Noncontact Tears

2019 ◽  
Vol 47 (8) ◽  
pp. 1844-1853 ◽  
Author(s):  
Nathaniel A. Bates ◽  
Nathan D. Schilaty ◽  
Christopher V. Nagelli ◽  
Aaron J. Krych ◽  
Timothy E. Hewett
Keyword(s):  
Cruciate Ligament ◽  
Frontal Plane ◽  
Tibial Rotation ◽  
Increased Risk ◽  
Acl Failure ◽  
Anterior Tibial ◽  
Knee Abduction ◽  
Internal Tibial Rotation ◽  
Risk Magnitude ◽  
Anterior Cruciate

Background:Anterior cruciate ligament (ACL) tears and concomitant medial collateral ligament (MCL) injuries are known to occur during dynamic athletic tasks that place combinatorial frontal and transverse plane loads on the knee. A mechanical impact simulator that produces clinical presentation of ACL injury allows for the quantification of individual loading contributors leading to ACL failure.Purpose/Hypothesis:The objective was to delineate the relationship between knee abduction moment, anterior tibial shear, and internal tibial rotation applied at the knee and ACL strain during physiologically defined simulations of impact at a knee flexion angle representative of initial contact landing from a jump. The hypothesis tested was that before ACL failure, abduction moment would induce greater change in ACL strain during landing than either anterior shear or internal rotation.Study Design:Controlled laboratory study.Methods:Nineteen cadaveric specimens were subjected to simulated landings in the mechanical impact simulator. During simulations, external knee abduction moment, internal tibial rotation moment, and anterior tibial shear loads were derived from a previously analyzed in vivo cohort and applied to the knee in varying magnitudes with respect to injury risk classification. Implanted strain gauges were used to track knee ligament displacement throughout simulation. Kruskal-Wallis tests were used to assess strain differences among loading factors, with Wilcoxon each pair post hoc tests used to assess differences of magnitude within each loading.Results:Each loading factor significantly increased ACL strain ( P < .005). Within factors, the high-risk magnitude of each factor significantly increased ACL strain relative to the baseline condition ( P≤ .002). However, relative to knee abduction moment specifically, ACL strain increased with each increased risk magnitude ( P≤ .015).Conclusion:Increased risk levels of each load factor contributed to increased levels of ACL strain during a simulated jump landing. The behavior of increased strain between levels of increased risk loading was most prevalent for changes in knee abduction moment. This behavior was observed in the ACL and MCL.Clinical Relevance:Knee abduction moment may be the predominant precursor to ACL injury and concomitant MCL injury. As knee abduction occurs within the frontal plane, primary preventative focus should incorporate reduction of frontal plane knee loading in landing and cutting tasks, but secondary reduction of transverse plane loading could further increase intervention efficacy. Constraint of motion in these planes should restrict peak ACL strain magnitudes during athletic performance.

A Novel Graft Fixation Technique for Anterior Cruciate Ligament Reconstruction Using Hamstring Tendon Grafts

2017 ◽  
Vol 12 (1) ◽  
Author(s):  
Guoan Li ◽  
Ali Hosseini ◽  
Hemanth Gadikota ◽  
Thomas Gill
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Reconstruction Technique ◽  
Tibial Rotation ◽  
Pullout Strength ◽  
Anterior Tibial ◽  
Anterior Cruciate ◽  
Tibial Translation ◽  
Intact Knee

This study evaluated the biomechanical efficacy of single-tunnel double-bundle anterior cruciate ligament (ACL) reconstruction technique. The graft construct is achieved using a novel fixation device that splits an ACL (SPACL) graft into two bundles, recreating the anteromedial (AM) and posterolateral (PL) bundles for ACL reconstruction. A pullout strength test of the SPACL was performed using a 7-mm bovine digital extensor tendon graft. The capability in restoration of knee kinematics after SPACL reconstruction was investigated using cadaveric human knees on a robotic testing system under an anterior tibial load of 134 N and a simulated quadriceps load of 400 N. The data indicated that the SPACL graft has a pullout strength of 823.7±172.3 N. Under the 134 N anterior tibial load, the anteroposterior joint laxity had increased constraint using the SPACL reconstruction but not significantly (p > 0.05) at all selected flexion angles. Under the 400 N quadriceps load, no significant differences were observed between the anterior tibial translation of intact knee and SPACL conditions at all selected flexion angles, but the SPACL graft induced a significant increase in external tibial rotation compared to the intact knee condition at all selected flexion angles with a maximal external rotation of −3.20 deg ±3.6 deg at 90 deg flexion. These data showed that the SPACL technique is equivalent or superior to existing ACL reconstruction techniques in restoration of knee laxity and kinematics. The new SPACL reconstruction technique could provide a valuable alternation to contemporary ACL reconstruction surgery by more closely recreating native ACL kinematics.

scholarly journals Dynamic Trunk Control Influence on Run-to-Cut Maneuver: A Risk Factor for ACL Rupture

2011 ◽  
Author(s):  
Steve T. Jamison ◽  
Xueliang Pan ◽  
Ajit M. W. Chaudhari
Keyword(s):  
Cruciate Ligament ◽  
Knee Injuries ◽  
Acl Rupture ◽  
Activity Levels ◽  
Trunk Control ◽  
Increased Risk ◽  
Knee Abduction ◽  
Short And Long Term ◽  
Anterior Cruciate

Anterior Cruciate Ligament (ACL) rupture is one of the most common serious knee injuries in field and court sports, with an estimated 70% of these injuries being non-contact in nature, often from sudden changes in direction or pivoting [3]. ACL injury results in both short- and long-term consequences for the athlete, which may include surgery, decreased activity levels, elevated pain levels during activities and increased risk of osteoarthritis. Previous studies have shown that knee abduction and tibial internal rotation moments independently strain the ACL, and that these moments have an interaction effect at physiologic load levels, creating strains approaching the reported range of ACL rupture [2, 6–8].

scholarly journals Determination of the Position of the Knee at the Time of an Anterior Cruciate Ligament Rupture for Male Versus Female Patients by an Analysis of Bone Bruises

2018 ◽  
Vol 46 (7) ◽  
pp. 1559-1565 ◽  
Author(s):  
Kwadwo A. Owusu-Akyaw ◽  
Sophia Y. Kim ◽  
Charles E. Spritzer ◽  
Amber T. Collins ◽  
Zoë A. Englander ◽  
...  
Keyword(s):  
Female Athletes ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Anterior Tibial Translation ◽  
Tibial Rotation ◽  
Male And Female ◽  
Mri Scans ◽  
Internal Tibial Rotation ◽  
Anterior Cruciate ◽  
Tibial Translation

Background: The incidence of anterior cruciate ligament (ACL) ruptures is 2 to 4 times higher in female athletes as compared with their male counterparts. As a result, a number of recent studies have addressed the hypothesis that female and male patients sustain ACL injuries via different mechanisms. The efficacy of prevention programs may be improved by a better understanding of whether there are differences in the injury mechanism between sexes. Hypothesis/Purpose: To compare knee positions at the time of a noncontact ACL injury between sexes. It was hypothesized that there would be no differences in the position of injury. Study Design: Controlled laboratory study. Methods: Clinical T2-weighted magnetic resonance imaging (MRI) scans from 30 participants (15 male and 15 female) with a noncontact ACL rupture were reviewed retrospectively. MRI scans were obtained within 1 month of injury. Participants had contusions associated with an ACL injury on both the medial and lateral articular surfaces of the femur and tibia. Three-dimensional models of the femur, tibia, and associated bone bruises were created via segmentation on MRI. The femur was positioned relative to the tibia to maximize bone bruise overlap, thereby predicting the bone positions near the time of the injury. Flexion, valgus, internal tibial rotation, and anterior tibial translation were measured in the predicted position of injury. Results: No statistically significant differences between male and female patients were detected in the position of injury with regard to knee flexion ( P = .66), valgus ( P = .87), internal tibial rotation ( P = .26), or anterior tibial translation ( P = .18). Conclusion: These findings suggest that a similar mechanism results in an ACL rupture in both male and female athletes with this pattern of bone bruising. Clinical Relevance: This study provides a novel comparison of male and female knee positions at the time of an ACL injury that may offer information to improve injury prevention strategies.

scholarly journals The Ratio of Tibial Slope and Meniscal Bone Angle for the Prediction of ACL Reconstruction Failure Risk

2018 ◽  
Vol 04 (03) ◽  
pp. e152-e159 ◽  
Author(s):  
Steffen Sauer ◽  
Robert English ◽  
Mark Clatworthy
Keyword(s):  
Anterior Cruciate Ligament ◽  
High Risk ◽  
Graft Failure ◽  
Cruciate Ligament ◽  
Tibial Slope ◽  
Acl Graft ◽  
Failure Risk ◽  
Increased Risk ◽  
Acl Failure ◽  
Anterior Cruciate

Background A growing body of research is indicating that the tibial slope and the geometry of the tibiofemoral meniscal–cartilage interface may affect the risk of anterior cruciate ligament reconstruction (ACLR) failure. Increased lateral tibial posterior slope (LTPS) and reduced meniscal bone angle (MBA) are associated with increased risk of anterior cruciate ligament (ACL) injury. The significance of a LTPS–MBA ratio regarding the prediction of ACL failure risk remains unknown. As LTPS and MBA may eventually potentiate or neutralize each other, it is expected that a low LTPS–MBA ratio is associated with high chance of ACL graft survival while a high LTPS–MBA ratio is associated with high risk of ACL failure. Material and Methods Out of 1,487 consecutive patients who underwent hamstring ACLR between August 2000 and May 2013, 54 ACLR failures with intact lateral menisci were included in this study and matched one-to-one with 54 control participants by age, sex, graft, surgical technique, and graft fixation method. Control participants had undergone ACLR without signs of lateral meniscal injury, graft failure, or insufficiency. MBA and LTPS were assessed on magnetic resonance imaging. Logistic regression was used to identify LTPS/MBA key cut-off ratios. Results In this cohort, a LTPS–MBA ratio under 0.27 was associated with a 28% risk of ACLR failure (36% of patients), while a ratio exceeding 0.42 was associated with an 82% risk of ACLR failure (31% of patients). The odds of ACL failure increased by 22.3% per reduction of 1 degree in MBA (odds ratio [OR], 1.22; 95% limits, 1.1–1.34). No significant association was found between LTPS and the risk of ACL graft failure in transtibial ACLR, while the odds of ACL failure increased by 34.9% per degree of increasing LTPS in transportal ACLR (OR, 1.34; 95% limits, 1.01–1.79). No significant correlation was found between MBA and LTPS (p = 0.5). Conclusion Reduced MBA was associated with significantly increased risk of ACL graft failure. A ratio of LTPS and MBA was found to be useful for the prediction of ACLR failure risk and may preoperatively help to identify patients at high risk of ACLR failure. This may have implications for patient counseling and the indication of additional extra-articular stabilizing procedures.

Preferred Hip Strategy During Landing Reduces Knee Abduction Moment in Collegiate Female Soccer Players

2018 ◽  
Vol 27 (3) ◽  
pp. 213-217 ◽  
Author(s):  
Anh-Dung Nguyen ◽  
Jeffrey B. Taylor ◽  
Taylor G. Wimbish ◽  
Jennifer L. Keith ◽  
Kevin R. Ford
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Frontal Plane ◽  
Soccer Players ◽  
Ligament Injuries ◽  
Anterior Cruciate Ligament Injuries ◽  
Hip Strategy ◽  
Knee Loading ◽  
Knee Abduction ◽  
Anterior Cruciate

Context: Hip-focused interventions are aimed to decrease frontal plane knee loading related to anterior cruciate ligament injuries. Whether a preferred hip landing strategy decreases frontal plane knee loading is unknown. Objective: To determine if a preferred hip landing strategy during a drop vertical jump (DVJ) is utilized during a single-leg landing (SLL) task and whether differences in frontal plane knee loading are consistent between a DVJ and an SLL task. Design: Descriptive laboratory study. Setting: Research laboratory. Participants: Twenty-three collegiate, female soccer players. Main Outcome Measures: Participants were dichotomized into a hip (HIP; n = 9) or knee/ankle (KA; n = 14) strategy group based on the percentage distribution of each lower extremity joint relative to the summated moment (% distribution) during the DVJ. Separate 1-way analysis of variances examined the differences in joint-specific % distribution and external knee abduction moment between the HIP and KA groups. Results: The HIP group had significantly greater % distribution of hip moment and less % distribution of knee moment compared with the KA group during the DVJ and SLL. External knee abduction moment was also significantly less in the HIP group compared with the KA group during the DVJ. Conclusions: Female soccer athletes who land with a preferred hip strategy during a DVJ also land with a preferred hip strategy during an SLL. The preferred hip strategy also resulted in less external knee abduction moments during the DVJ. Clinical Relevance: Targeting the neuromuscular control of the hip extensor may be useful in reducing risk of noncontact anterior cruciate ligament injuries.

scholarly journals The Function of the Human Anterior Cruciate Ligament and Analysis of Single- and Double-Bundle Graft Reconstructions

2009 ◽  
Vol 1 (1) ◽  
pp. 66-75 ◽  
Author(s):  
Frank R. Noyes
Keyword(s):  
Anterior Cruciate Ligament ◽  
Clinical Data ◽  
Cruciate Ligament ◽  
Double Bundle ◽  
Rotational Stability ◽  
Tibial Rotation ◽  
Graft Placement ◽  
Anterior Cruciate Ligament Graft ◽  
Anterior Tibial ◽  
Anterior Cruciate

Context: There exists controversy on the ability of a single or double anterior cruciate ligament graft technique to restore anterior cruciate ligament function. This article examines the published experimental and clinical data supporting these surgical procedures in the ability to restore knee stability. Evidence Acquisition: An analysis of anterior cruciate ligament function and single- and double-graft reconstructions defined by selected biomechanical, robotic, kinematic, anatomical, and clinical studies. Results: The anterior cruciate ligament resists the combined motions of anterior tibial translation and internal tibial rotation, which defines the concept of rotational stability. This function prevents anterior tibial subluxation of the lateral and medial tibiofemoral compartments that accounts for the pivot-shift phenomena. The placement of single anterior cruciate ligament grafts high and proximal at the femoral attachment and posterior at the tibial attachment results in a vertical graft orientation. This graft placement results in a limited ability to provide rotational stability and is inferior when compared to a double-bundle graft procedure. Studies show that a more oblique single-graft orientation, in the sagittal and coronal plane, achieved from a central anatomic femoral and tibial location provides rotational stability similar to a double-bundle anterior cruciate ligament graft. Conclusion: There exists insufficient experimental and clinical data to recommend the more complex double- bundle anterior cruciate ligament graft technique over a well-placed central anatomic single graft in terms of restoring knee rotational stability. Meticulous surgical technique for anterior cruciate ligament graft placement is necessary to avoid failure.

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