Effect of Meniscal Ramp Lesion Repair on Knee Kinematics, Bony Contact Forces, and In Situ Forces in the Anterior Cruciate Ligament

2019 ◽  
Vol 47 (13) ◽  
pp. 3195-3202 ◽  
Author(s):  
Jan-Hendrik Naendrup ◽  
Thomas R. Pfeiffer ◽  
Calvin Chan ◽  
Kanto Nagai ◽  
João V. Novaretti ◽  
...  
Keyword(s):  
External Rotation ◽  
Cruciate Ligament ◽  
Knee Kinematics ◽  
Contact Forces ◽  
Full Extension ◽  
Compression Load ◽  
Ramp Lesion ◽  
Anterior Cruciate ◽  
Intact Knee

Background: Meniscal ramp lesions are possible concomitant injuries in cases of anterior cruciate ligament (ACL) deficiency. Although recent studies have investigated the influence of ramp lesions on knee kinematics, the effect on the ACL reconstruction graft remains unknown. Purpose/Hypothesis: The purpose was to determine the effects of ramp lesion and ramp lesion repair on knee kinematics, the in situ forces in the ACL, and bony contact forces. It was hypothesized that ramp lesions will significantly increase in situ forces in the native ACL and bony contact forces and that ramp lesion repair will restore these conditions comparably with those forces of the intact knee. Study Design: Controlled laboratory study. Methods: Investigators tested 9 human cadaveric knee specimens using a 6 degrees of freedom robotic testing system. The knee was continuously flexed from full extension to 90° while the following loads were applied: (1) 90-N anterior load, (2) 5 N·m of external-rotation torque, (3) 134-N anterior load + 200-N compression load, (4) 4 N·m of external-rotation torque + 200-N compression load, and (5) 4 N·m of internal-rotation torque + 200-N compression load. Loading conditions were applied to the intact knee, a knee with an arthroscopically induced 25-mm ramp lesion, and a knee with an all-inside repaired ramp lesion. In situ forces in the ACL, bony contact forces in the medial compartment, and bony contact forces in the lateral compartment were quantified. Results: In response to all loading conditions, no differences were found with respect to kinematics, in situ forces in the ACL, and bony contact forces between intact knees and knees with a ramp lesion. However, compared with intact knees, knees with a ramp lesion repair had significantly reduced anterior translation at flexion angles from full extension to 40° in response to a 90-N anterior load ( P < .05). In addition, a significant decrease in the in situ forces in the ACL after ramp repair was detected only for higher flexion angles when 4 N·m of external-rotation torque combined with a 200-N compression load ( P < .05) and 4 N·m of internal-rotation torque combined with a 200-N compression load were applied ( P < .05). Conclusion: In this biomechanical study, ramp lesions did not significantly affect knee biomechanics at the time of surgery. Clinical Relevance: From a biomechanical time-zero perspective, the indications for ramp lesion repair may be limited.

Effect of Meniscal Ramp Lesion Repair on Knee Kinematics, Bony Contact Forces, and In Situ Forces in the Anterior Cruciate Ligament: Letter to Editor

2020 ◽  
Vol 48 (2) ◽  
pp. NP23-NP25
Author(s):  
Thais Dutra Vieira ◽  
William G. Blakeney ◽  
Sergio Canuto ◽  
Etienne Cavaignac ◽  
Steven Claes ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Knee Kinematics ◽  
Contact Forces ◽  
Ramp Lesion ◽  
Anterior Cruciate

Effect of Meniscal Ramp Lesion Repair on Knee Kinematics, Bony Contact Forces, and In Situ Forces in the Anterior Cruciate Ligament: Response

2020 ◽  
Vol 48 (2) ◽  
pp. NP25-NP27
Author(s):  
Jan-Hendrik Naendrup ◽  
Thomas R. Pfeiffer ◽  
Calvin Chan ◽  
Kanto Nagai ◽  
João V. Novaretti ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Knee Kinematics ◽  
Contact Forces ◽  
Ramp Lesion ◽  
Anterior Cruciate

scholarly journals Effect of Meniscal Ramp Lesion Repair on Knee Kinematics, ACL In-Situ Forces and Bony Contact Forces – A Biomechanical Study

2019 ◽  
Vol 7 (6_suppl4) ◽  
pp. 2325967119S0023
Author(s):  
Thomas Pfeiffer ◽  
Jan-Hendrik Naendrup ◽  
Kanto Nagai ◽  
Joao Novaretti ◽  
Calvin Chan ◽  
...  
Keyword(s):  
External Rotation ◽  
Knee Kinematics ◽  
Biomechanical Study ◽  
Contact Forces ◽  
Testing System ◽  
Loading Conditions ◽  
Compression Force ◽  
Full Extension ◽  
Ramp Lesion

Aims and Objectives: While recent studies showed that all inside meniscal ramp repair is able to restore knee kinematics, the effects of ramp repairs on ACL in-situ forces and bony contact forces is still unclear. Therefore, the purpose of this study is to determine the effect of ramp lesion repair on knee kinematics, the ACL-ISF and bony contact forces using a 6-degree-of-freedom (DOF) robotic testing system. It was hypothesized that ramp repair will restore kinematics, ACL-ISF and bony contact forces comparably to the forces of the intact knee. Materials and Methods: Nine fresh-frozen human cadaveric knee specimens were tested using a 6-degree-of-freedom robotic testing system (FRS2010) to continuously flex the knee from full extension to 90° and apply continuous loading conditions: 1) 90 N of anterior force, 2) 5 Nm of external rotation torque, 3) 134 N anterior force + 200 N compression force, 4) 4 Nm external rotation torque + 200 N compression force, 5) 4 Nm internal rotation torque + 200 N compression force. Loading conditions were applied to the intact knee, a knee with an arthroscopically induced 25 mm ramp lesion, and a knee with an all-inside repaired ramp lesion. ACL in-situ forces, medial compartment bony contact forces and lateral compartment bony contact forces were quantified. Repeated measure ANOVAs were performed to compare knee states at each flexion angle (p<0.05). Results: In response to all loading conditions, no differences with respect to kinematics, ACL in-situ forces, and bony contact forces between the intact state and the ramp lesion state were detected. However, compared to the intact state, ramp lesion repair significantly reduced anterior translation in flexion angles from full extension to 40° in response to 5 N anterior force (p < 0.05). In addition, a significant decrease in the ACL in-situ forces after ramp repair was detected only for higher flexion angles when 4 Nm external rotation torque combined with 200 N compression force (p < 0.05) and when 4 Nm internal rotation torque combined with 200 N compression force were applied (p < 0.05). Conclusion: In this biomechanical study, ramp lesions did not significantly affect knee biomechanics. Care must be taken to avoid potential overconstraint when performing all-inside ramp lesion repairs. From biomechanical time-zero perspective, it is debatable if stable ramp lesions need to be addressed surgically. As stable ramp lesions do not significantly change knee biomechanics, the indications for ramp lesion repair may be limited.

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.

scholarly journals Effect of Meniscal Ramp Repair on Knee Kinematics, ACL In Situ Force and Bony Contact Forces - A Biomechanical Study

2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0015 ◽  
Author(s):  
Thomas Rudolf Pfeiffer ◽  
Jan Hendrik Naendrup ◽  
Calvin Chan ◽  
Kanto Nagai ◽  
João V. Novaretti ◽  
...  
Keyword(s):  
Knee Kinematics ◽  
Contact Forces ◽  
Testing System ◽  
Loading Conditions ◽  
Ramp Lesion ◽  
Robotic Testing ◽  
Deficient Knee ◽  
Robotic Testing System ◽  
Intact Knee

Objectives: While recent studies showed that all inside meniscal ramp repair is able to restore knee kinematics, the effects of ramp repairs on ACL in-situ forces (ISF) and bony contact forces is still unclear. Therefore, the purpose of this study is to determine the effect of ramp lesion repair on knee kinematics, the ACL-ISF and bony contact forces using a 6-degree-of-freedom (DOF) robotic testing system. It was hypothesized that ramp repair will restore kinematics, ACL-ISF and bony contact forces comparably to the forces of the intact knee. Methods: 5 fresh-frozen human cadaveric knee specimens were tested using a 6-DOF robotic testing system (FRS2010) to continuously flex the knee from 0° to 90° and apply continuous loading conditions: 134 N anterior load + 200 N compressive load (CL), 4 Nm internal torque + 200 N CL, 4 Nm external torque + 200 N CL. Loading conditions were applied to the: 1) Intact knee 2) Arthroscopically induced 25 mm ramp lesion via posteromedial portal 3) All inside ramp repair 4) ACL deficient knee + ramp repair 5) soft tissue removal 6) Transection of the lateral condyle. To mimic an ideal ACL reconstruction the native ACL was kept intact. By replaying kinematics, ACL-ISF and bony contact forces were determined. Repeated measure ANOVAs were performed to compare knee states at each flexion angle (p<0.05). Results: Ramp repair significantly reduced anterior translation compared to the ramp deficient knee in high flexion under anterior load and CL (mean diff. -0.8 mm, range 0.6-0.9 mm) and at all flexions angles while applying internal torque and CL (mean diff. -2.3 mm, range 1.8-3.3 mm). Increased medial translation and valgus position were observed in all loading conditions at all flexion angles. Both ACL-ISF and medial bony contact forces were not significantly altered by the ramp lesion and repair under any applied loading and flexion angle. In contrast, ramp repair significantly increased lateral bony contact forces by under external torque and CL at 60° and 70° flexion compared to the ramp deficient knee, 32 N and 37 N respectively. No significant differences between intact and ramp deficient knee were detected with respect to kinematics, ACL-ISF and bony contact forces. Conclusion: In this study ramp repair decreased anterior translation, increased valgus rotation, and increased bony contact forces in the lateral compartment, disproving the hypothesis under study. The data from this study puts into question potential overconstraint when repairing ramp lesions utilizing all inside devices in 10 degrees of knee flexion. Contrasting previous literature that showed the restoration of the intact state, the results might be attributable to added CL forces and missing influence of the ACL reconstructions. The findings of this study also imply that untreated ramp lesion might not affect ACL-ISF. Future research is needed to better understand the influence of different techniques for repair of ramp lesions and the effect of chronicity on ramp lesions in patients.

scholarly journals Different anterolateral procedures have variable impact on knee kinematics and stability when performed in combination with anterior cruciate ligament reconstruction

2020 ◽  
pp. jisakos-2019-000360
Author(s):  
Thomas Neri ◽  
Danè Dabirrahmani ◽  
Aaron Beach ◽  
Samuel Grasso ◽  
Sven Putnis ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Knee Kinematics ◽  
Rotational Laxity ◽  
Level Of Evidence ◽  
Cruciate Ligament Reconstruction ◽  
Anterior Cruciate ◽  
Deficient Knee ◽  
Intact Knee

ObjectiveThe optimal anterolateral procedure to control anterolateral rotational laxity of the knee is still unknown. The objective was to compare the ability of five anterolateral procedures performed in combination with anterior cruciate ligament reconstruction (ACLR) to restore native knee kinematics in the setting of a deficient anterior cruciate ligament (ACL) and anterolateral structures.MethodsA controlled laboratory study was performed using 10 fresh-frozen cadaveric whole lower limbs with intact iliotibial band. Kinematics from 0° to 90° of flexion were recorded using a motion analysis three-dimensional (3D) optoelectronic system, allowing assessment of internal rotation (IR) and anteroposterior (AP) tibial translation at 30° and 90° of flexion. Joint centres and bony landmarks were calculated from 3D bone models obtained from CT scans. Intact knee kinematics were assessed initially, followed by sequential section of the ACL and anterolateral structures (anterolateral ligament, anterolateral capsule and Kaplan fibres). After ACLR, five anterolateral procedures were performed consecutively on the same knee: ALLR, modified Ellison, deep Lemaire, superficial Lemaire and modified MacIntosh. The last three procedures were randomised. For each procedure, the graft was fixed in neutral rotation at 30° of flexion and with a tension of 20 N.ResultsIsolated ACLR did not restore normal overall knee kinematics in a combined ACL plus anterolateral-deficient knee, leaving a residual tibial rotational laxity (p=0.034). Only the ALLR (p=0.661) and modified Ellison procedure (p=0.641) restored overall IR kinematics to the normal intact state. Superficial and deep Lemaire and modified MacIntosh tenodeses overconstrained IR, leading to shifted and different kinematics compared with the intact condition (p=0.004, p=0.001 and p=0.045, respectively). Compared with ACLR state, addition of an anterolateral procedure did not induce any additional control on AP translation at 30° and 90° of flexion (all p>0.05), except for the superficial Lemaire procedure at 90° (p=0.032).ConclusionIn biomechanical in vitro setting, a comparison of five anterolateral procedures revealed that addition of either ALLR or modified Ellison procedure restored overall native knee kinematics in a combined ACL plus anterolateral-deficient knee. Superficial and deep Lemaire and modified MacIntosh tenodeses achieved excellent rotational control but overconstrained IR, leading to a change from intact knee kinematics.Level of evidenceThe level-of-evidence statement does not apply for this laboratory experiments study.

The Effects of a Popliteus Muscle Load on In Situ Forces in the Posterior Cruciate Ligament and on Knee Kinematics

1998 ◽  
Vol 26 (5) ◽  
pp. 669-673 ◽  
Author(s):  
Christopher D. Harner ◽  
Jürgen Höher ◽  
Tracy M. Vogrin ◽  
Gregory J. Carlin ◽  
Savio L-Y. Woo
Keyword(s):  
Posterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Knee Kinematics ◽  
Tibial Rotation ◽  
Posterior Tibial Translation ◽  
Posterior Tibial ◽  
Tibial Translation ◽  
Intact Knee ◽  
Popliteus Muscle

To investigate the effect of simulated contraction of the popliteus muscle on the in situ forces in the posterior cruciate ligament and on changes in knee kinematics, we studied 10 human cadaveric knees (donor age, 58 to 89 years) using a robotic manipulator/universal force moment sensor system. Under a 110-N posterior tibial load (simulated posterior drawer test), the kinematics of the intact knee and the in situ forces in the ligament were determined. The test was repeated with the addition of a 44-N load to the popliteus muscle. The posterior cruciate ligament was then sectioned and the knee was subjected to the same tests. The additional popliteus muscle load significantly reduced the in situ forces in the ligament by 9% to 36% at 90° and 30° of flexion, respectively. No significant effects on posterior tibial translation of the intact knee were found. However, in the ligament-deficient knee, posterior tibial translation was reduced by up to 36% of the translation caused by ligament transection. A coupled internal tibial rotation of 2° to 4° at 60° to 90° of knee flexion was observed in both the intact and ligament-deficient knees when the popliteus muscle load was added. Our results indicate that the popliteus muscle shares the function of the posterior cruciate ligament in resisting posterior tibial loads and can contribute to knee stability when the ligament is absent.

Characterization of a Biomechanical Animal Model for Intact Knee Kinematics and ACL Function Using 6-DOF Robotic Technology

2011 ◽  
Author(s):  
Daniel V. Boguszewski ◽  
Safa T. Herfat ◽  
Christopher T. Wagner ◽  
David L. Butler ◽  
Jason T. Shearn
Keyword(s):  
Animal Model ◽  
Degrees Of Freedom ◽  
Cruciate Ligament ◽  
Knee Kinematics ◽  
Biomechanical Model ◽  
Ligament Injury ◽  
Joint Stability ◽  
Robotic Technology ◽  
Anterior Cruciate ◽  
Intact Knee

Anterior cruciate ligament injury (ACL) affects an estimated 250,000 people annually [1]. Unfortunately, even with ACL reconstruction, the likely prognosis is long-term osteoarthritis (OA) [2]. Many strides have been made in attempting to understand and improve this outcome. The use of robotic technology has provided an avenue for researchers to examine the ACL’s role in knee joint stability in all six anatomical degrees of freedom (DOF) [3]. The overall goal of our lab robotics research is to use this technology to understand ACL function during activities of daily living (ADLs) in hopes of developing a biomechanical animal model which can be used as a preclinical tool to design new repair methods and materials. We have examined three species (ovine, porcine, and human), measuring all forces and moments produced from displacement control motion paths developed for cyclic testing in a robotic system (KUKA; KR210). This information will provide a basis for comparing intact knee biomechanics and ACL function across species. With these robotic inputs, we have performed a series of studies to aid in the development of a biomechanical model of the human knee.

The Biomechanical Analysis of a Double Bundle Posterior Cruciate Ligament Reconstruction Using Robotic Technology

1999 ◽  
Author(s):  
Marsie A. Janaushek ◽  
Savio L.-Y. Woo ◽  
Akihiro Kanamori ◽  
Tracy M. Vogrin ◽  
Masayoshi Yagi ◽  
...  
Keyword(s):  
Cruciate Ligament ◽  
Knee Kinematics ◽  
Double Bundle ◽  
Biomechanical Analysis ◽  
External Loading ◽  
Single Bundle ◽  
Pcl Reconstruction ◽  
Replacement Surgery ◽  
Intact Knee

Abstract The PCL consists of two primary bundles, the anterolateral (AL) and posteromedial (PM). The AL bundle is larger, stiffer, and has a higher ultimate load (Harner, 1995), and has been the focus of PCL replacement surgery (Clancy, 1983). However, clinical outcomes of PCL reconstruction have been unsatisfactory (Lipscomb, 1993); which has led to the question of the advancement of a double bundle procedure in hopes to more accurately reproduce the PCL (Clancy, 1998). It was therefore the objective of this study to evaluate the biomechanics of a double bundle PCL reconstruction (PCL-2), and compare these results with those obtained for the intact knee as well as a single bundle PCL reconstruction (PCL-1). To study this, a robotic/universal force-moment sensor (UFS) testing system which measures the multiple degree of freedom (DOF) knee kinematics determines the in situ force in the ligaments (or replacement grafts) in response to external loading conditions was utilized. The hypothesis was that PCL-2 would improve knee kinematics and in situ forces to those of the intact knee throughout the range of knee flexion as compared to PCL-1.

Sign in / Sign up

Export Citation Format

Share Document