Effect of Percentage of Femoral Anterior Cruciate Ligament Insertion Site Reconstructed With Hamstring Tendon on Knee Kinematics and Graft Force

2021 ◽  
Vol 49 (5) ◽  
pp. 1279-1285
Author(s):  
Yusuke Sasaki ◽  
Masataka Fujii ◽  
Daisuke Araki ◽  
Brandon D. Marshall ◽  
Monica A. Linde ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Insertion Site ◽  
Double Bundle ◽  
Anterior Tibial Translation ◽  
Single Bundle ◽  
Knee Biomechanics ◽  
Femoral Insertion ◽  
Anterior Tibial ◽  
Tibial Translation ◽  
Graft Reconstruction

Background: Previous studies have stated that closely matching the size of the anterior cruciate ligament (ACL) insertion site footprint is important for biomechanical function and clinical stability after ACL reconstruction. However, the ACL varies widely regarding the area of femoral insertion, tibial insertion, and midsubstance of ACL, and reconstructing the insertion site area with a uniform diameter graft can result in a cross-sectional area that is greater than that of the midsubstance of the native ACL. Therefore, understanding the effect of relative graft size in ACL reconstruction on knee biomechanics is important for surgical planning. Purpose: To assess how the percentage of femoral insertion site affects knee biomechanics in single- and double-bundle ACL reconstruction. Study Design: Controlled laboratory study. Methods: A total of 14 human cadaveric knees were scanned with magnetic resonance imaging and tested using a robotic system under an anterior tibial load and a combined rotational load. In total, 7 knee states were evaluated: intact ACL; deficient ACL; single-bundle ACL reconstruction with approximate graft sizes 25% (small), 50% (medium), and 75% (large) of the femoral insertion site; and double-bundle reconstruction of approximately 50% (medium) and 75% (large) of the femoral insertion site, based on the ratio of the cross-sectional area of the graft to the area of the femoral ACL insertion site determined by magnetic resonance imaging. Results: Anterior tibial translation was not significantly larger than the intact state in single-bundle and double-bundle medium graft reconstructions ( P > .05) and was significantly greater in the single-bundle small graft reconstruction ( P < .05). Anterior knee translation in single-bundle medium graft and large graft reconstructions was not statistically different ( P > .05). In contrast, the anterior tibial translation for double-bundle large graft reconstruction was significantly smaller than for double-bundle medium graft reconstruction at low flexion angles ( P < .05). The single-bundle small graft force was significantly different from the intact ACL in situ force ( P < .05). The graft force with double-bundle large reconstruction was significantly greater than that with the double-bundle medium reconstruction ( P < .05) but was not significantly different from that of the intact ACL ( P > .05). Conclusion: Knee biomechanics with a single-bundle small graft tended to be significantly different from those of the intact knee. In the kinematic and kinetic data for the single- and double-bundle medium graft reconstruction, only the anterior translation at full extension for the single-bundle reconstruction was significantly different (lower) from that of intact knee. This was a time zero study. Clinical Relevance: This study can provide surgeons with guidance in selecting the graft size for ACL reconstruction.

A Comparison of Central Anatomic Single-Bundle Reconstruction and Anatomic Double-Bundle Reconstruction in Anteroposterior and Rotational Knee Stability: Intraoperative Biomechanical Evaluation

2020 ◽  
Author(s):  
Yasunari Ikuta ◽  
Atsuo Nakamae ◽  
Ryo Shimizu ◽  
Masakazu Ishikawa ◽  
Tomoyuki Nakasa ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Knee Flexion ◽  
Double Bundle ◽  
Anterior Tibial Translation ◽  
Single Bundle ◽  
Tibial Rotation ◽  
Knee Stability ◽  
Flexion Extension ◽  
Anterior Tibial ◽  
Tibial Translation

AbstractPostoperative anterior and rotational stability are still controversial when compared with single-bundle (SB) and double-bundle (DB) anterior cruciate ligament (ACL) reconstruction. This study aimed to compare the central anatomical SB and anatomical DB ACL reconstruction in intraoperative knee kinematics during continuous knee flexion-extension. A total of 34 patients who underwent ACL reconstruction using the hamstring tendon were evaluated intraoperatively before and immediately after ACL reconstruction using OrthoPilot ACL Navigation System Version 3.0. The patients were prospectively randomized into the central anatomical SB (17 knees) and the anatomical DB reconstruction (17 knees) groups. The tibial translation and rotation were continuously measured during knee flexion-extension under conventional knee motion, anterior tibial load (100N), and internal-external torque (3 N·m). The anterior tibial translation and total range of tibial rotation were calculated from the measurement values from 20 to 50 degrees at each 5-degree point. The anterior tibial translation (p = 0.59; two-factor repeated measures analysis of variance; η 2G = 0.0077) and total range of tibial rotation (p = 0.95; η 2G = 0.0001) at each knee flexion angle showed no significant difference between the central anatomical SB and anatomical DB reconstruction groups. It is suggested that the central anatomical SB reconstruction is comparable with the anatomical DB reconstruction in biomechanical anteroposterior and rotational knee stability at time 0.

scholarly journals Clinical study of anatomical ACL reconstruction using a rounded rectangular dilator

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Junsuke Nakase ◽  
Yasushi Takata ◽  
Kengo Shimozaki ◽  
Kazuki Asai ◽  
Rikuto Yoshimizu ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Femoral Tunnel ◽  
Clinical Results ◽  
Hamstring Tendon ◽  
Bone Tunnel ◽  
Anterior Tibial Translation ◽  
Single Bundle ◽  
Tunnel Enlargement ◽  
Bone Tunnel Enlargement ◽  
Tibial Translation

Abstract Background The aim of this study was that to compare clinical results between the rounded rectangular femoral tunnel ACL reconstruction (RFTR) and the conventional round femoral tunnel ACL reconstruction using a hamstring tendon. The hypothesis was that ACL reconstruction performed using the rounded rectangular dilator technique was better than that performed using the conventional round femoral tunnel technique in terms of clinical results and bone tunnel enlargement. Methods We conducted retrospective study. After exclusions, 40 patients were included in the conventional anatomical single-bundle ACL reconstruction (ASBR) group and 40 patients were included in the RFTR group. The evaluation items were knee stability, Lysholm knee score, IKDC subjective score at 2 years after surgery and bone tunnel enlargement. Results The RFTR group had a larger femoral tunnel area (average area, 53.1 ± 4.0 mm2 vs. 46.1 ± 7.0 mm2; P < 0.01), better anteroposterior stability, and higher Lysholm scores than the ASBR group (average side-to-side difference for anterior tibial translation, 0.6 ± 0.8 mm vs. 1.6 ± 1.4 mm; P < 0.01; average Lysholm score, 98.5 ± 2.1 vs. 97.5 ± 3.5; P < 0.01). Further, bone tunnel enlargement ratio was significantly lower in the RFTR group (73 ± 38% vs. 107 ± 41%; P < 0.01). Conclusions We designed and developed an original rounded rectangular dilator to perform a novel ACL surgery. This technique can create a larger bone tunnel and improve clinical results than the conventional round anatomical single-bundle ACL reconstruction.

scholarly journals Clinical and radiological results after Internal Brace suture versus the all-inside reconstruction technique in anterior cruciate ligament tears 12 to 18 months after index surgery

2020 ◽  
Author(s):  
Georg Mattiassich ◽  
Reinhold Ortmaier ◽  
Harald Kindermann ◽  
Jürgen Barthofer ◽  
Imre Vasvary ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Anterior Tibial Translation ◽  
German Version ◽  
Anterior Tibial ◽  
Kt 1000 ◽  
Internal Brace ◽  
Anterior Cruciate ◽  
Tibial Translation

Abstract Background Anterior cruciate ligament (ACL) injury can lead to reduced function, meniscal lesions, and early joint degeneration. Preservation of a torn ACL using the Internal Brace technique might re-establish normal knee kinematics, avoid donor-site morbidity due to tendon harvesting, and potentially maintain proprioception of the knee. Methods Fifty subjects were recruited for this study between December 2015 and October 2016. Two groups of individuals who sustained a unilateral ACL rupture were included: those who underwent surgery with preservation of the injured ACL (Internal Brace technique; IB) and those who underwent ACL reconstruction using a hamstring tendon graft (all-inside technique; AI). Subjective self-administered scores were used: the German version of the IKDC Subjective Knee Form (International Knee Documentation Committee), the German version of the WOMAC (Western Ontario and McMaster Universities Arthritis Index), SF-36 (short form), the German version of the KOOS (Knee Osteoarthritis Outcome Score), and the German version of themodified Lysholm Score by Lysholm and Gillquist. Anterior tibial translation was assessed using the KT-1000 Arthrometer (KT-1000 Knee Ligament Arthrometer, MEDmetric Corp., San Diego, CA, USA). Magnetic resonance evaluation was performed in all cases. Results Twenty-three subjects (46 %) were men, and the mean age was 34.7 years. The objective IKDC scores were “normal” in 15 and 14 patients, “nearly normal” in 11 and 7 patients, and “abnormal” in 1 and 2 patients, in the IB and AI groups, respectively. KT-1000 assessment showed a sideto-side difference of more than 3 mm on maximum manual testing in 11 (44 %) and 6 subjects (28.6 %) in the IB and AI groups, respectively. In the postoperative MRI, 20 (74 %) and 22 subjects (96 %) in the IB and AI groups had an intact ACL. Anterior tibial translation was significantly higher in the IB group compared with the AI group in the manual maximum test. Conclusions Preservation of the native ACL with the Internal Brace primary repair technique can achieve comparable results to ACL reconstruction using Hamstring autografts over a short term. Clinically relevant limitations such as a higher incidence of pathologic laxity, with patients more prone to pivot-shift phenomenon were observed during the study period.

Clinical and radiological results after Internal Brace ® suture versus the all-inside reconstruction technique in anterior cruciate ligament tears 12 to 18 months after index surgery.

2020 ◽  
Author(s):  
Georg Mattiassich ◽  
Reinhold Ortmaier ◽  
Harald Kindermann ◽  
Jürgen Barthofer ◽  
Imre Vasvary ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Anterior Tibial Translation ◽  
German Version ◽  
Anterior Tibial ◽  
Kt 1000 ◽  
Internal Brace ◽  
Anterior Cruciate ◽  
Tibial Translation

Abstract Background Anterior cruciate ligament (ACL) injury can lead to reduced function, meniscal lesions, and early joint degeneration. Preservation of a torn ACL using the Internal Brace® technique might re-establish normal knee kinematics, avoid donor-site morbidity due to tendon harvesting, and potentially maintain proprioception of the knee. Methods Fifty subjects were recruited for this study between December 2015 and October 2016. Two groups of individuals who sustained unilateral ACL rupture were included: those who underwent surgery with preservation of the injured ACL (Internal Brace® technique; IB) and those who underwent ACL reconstruction using a hamstring tendon graft (all-inside technique; AI). Subjective self-administered scores were used: the German Version of the IKDC Subjective Knee Form (International Knee Documentation Committee), the German Version of the WOMAC (Western Ontario and McMaster Universities Arthritis Index), SF-36 (short form), the German Version of the KOOS (Knee Osteoarthritis Outcome Score), and the German Version of the modified Lysholm-score by Lysholm and Gillquist. Anterior tibial translation was assessed using the KT-1000 arthrometer® (KT-1000 Knee Ligament Arthrometer, MEDmetric Corp., San Diego, CA, USA). Magnetic resonance evaluation was performed in all cases. Results Twenty-three subjects (46%) were men, and the mean age was 34.7 years. The objective IKDC scores were “normal” in 15 and 14 patients, “nearly normal” in 11 and 7 patients, and “abnormal” in 1 and 2 patients, in the IB and AI groups, respectively. KT-1000 assessment showed a side-to-side difference of more than 3 mm on maximum manual testing in 11 (44%) and 6 subjects (28.6%) in the IB and AI groups, respectively. In the postoperative MRI, 20 (74%) and 22 subjects (96%) in the IB and AI groups showed an intact ACL. Anterior tibial translation was significantly higher in the IB group compared to the AI group in the manual maximum test. Conclusions Preservation of the native ACL with the Internal Brace ® primary repair technique can achieve comparable results to ACL reconstruction using Hamstring autografts over a short term. Clinically relevant limitations such as a higher incidence of pathologic laxity, with patients more prone to pivot shift phenomenon were observed during the study period.

Characteristics of anterior tibial translation with active and isokinetic knee extension exercise before and after ACL reconstruction

2002 ◽  
Vol 7 (3) ◽  
pp. 341-347 ◽  
Author(s):  
Hiroshi Higuchi ◽  
Masanori Terauchi ◽  
Masashi Kimura ◽  
Kenji Shirakura ◽  
Masayoshi Katayama ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Knee Extension ◽  
Anterior Tibial Translation ◽  
Anterior Tibial ◽  
Before And After ◽  
Tibial Translation ◽  
Knee Extension Exercise

scholarly journals Knee laxity and functional knee outcome after contralateral ACLR are comparable to those after primary ACLR

2021 ◽  
Author(s):  
Riccardo Cristiani ◽  
Sofia Viheriävaara ◽  
Per-Mats Janarv ◽  
Gunnar Edman ◽  
Magnus Forssblad ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Knee Laxity ◽  
Anterior Tibial Translation ◽  
Inclusion Criteria ◽  
Level Of Evidence ◽  
Anterior Tibial ◽  
The Mean ◽  
Tibial Translation

Abstract Purpose To evaluate and compare knee laxity and functional knee outcome between primary and contralateral anterior cruciate ligament (ACL) reconstruction. Methods Patients who underwent primary and subsequent contralateral ACL reconstruction (ACLR) at Capio Artro Clinic, Stockholm, Sweden, from 2001 to 2017, were identified in our local database. The inclusion criteria were: the same patients who underwent primary and contralateral hamstring tendon or bone-patellar tendon-bone autograft ACLR and no associated ligament injuries. The KT-1000 arthrometer, with an anterior tibial load of 134 N, was used to evaluate knee laxity preoperatively and 6 months postoperatively. The Knee injury and Osteoarthritis Outcome Score (KOOS) was collected preoperatively and at the 1-year follow-up. Results A total of 326 patients with isolated primary and contralateral ACLR met the inclusion criteria (47.9% males; mean age at primary ACLR 23.9 ± 9.4 years and contralateral ACLR 27.9 ± 10.1 years). The arthrometric laxity measurements were available for primary and contralateral ACLR for 226 patients. The mean preoperative and postoperative anterior tibial translation (ATT), as well as the mean ATT reduction from preoperatively to postoperatively, did not differ significantly between primary and contralateral ACLR. The KOOS was available for primary and contralateral ACLR for 256 patients. No significant differences were found preoperatively and at the 1-year follow-up between primary and contralateral ACLR for any of the five KOOS subscales. Conclusion The findings in this study showed that anterior knee laxity and functional knee outcome after contralateral ACLR are comparable to those after primary ACLR. It is important for clinicians to counsel patients about their expectations after contralateral ACLR. This study shows that the results after contralateral ACLR in terms of knee laxity and functional knee outcome are predictable and likely to be comparable to those after primary ACLR. Level of evidence Level III.

scholarly journals The Comparison of Clinical Result between Primary Repair of the Anterior Cruciate Ligament with Additional Internal Bracing and Anatomic Single Bundle Reconstruction—A Retrospective Study

2021 ◽  
Vol 10 (17) ◽  
pp. 3948
Author(s):  
Dawid Szwedowski ◽  
Łukasz Paczesny ◽  
Jan Zabrzyński ◽  
Maciej Gagat ◽  
Marcin Domżalski ◽  
...  
Keyword(s):  
Primary Repair ◽  
Cruciate Ligament ◽  
Anterior Tibial Translation ◽  
Single Bundle ◽  
Acl Repair ◽  
Anterior Tibial ◽  
Internal Bracing ◽  
Anterior Cruciate ◽  
Tibial Translation ◽  
Repair Group

Background: The current standard of treatment of anterior cruciate ligament (ACL) is reconstruction (ACLR). This technique has some disadvantages: poor proprioception, donor site morbidity and the inability to restore joint kinematics. ACL repair could be an alternative treatment. The purpose of the study was to compare the stability and the function after ACL primary repair versus single-bundle ACLR. Methods: In a retrospective study, 12 patients underwent primary ACL repair with internal bracing, 15 patients underwent standard ACLR. Follow-up examinations were evaluated at up to 2 years postoperatively. One patient in the ACL repair group was lost to follow-up due to re-rupture. The absolute value of anterior tibial translation (ATT) and the side-to-side difference in the same patient (ΔATT) were evaluated using the GNRB arthrometer. The Lysholm knee scoring was obtained. Re-ruptures and other complications were recorded. Results: Anterior tibial translation (ATT) was significantly decreased in the ACL repair group compared with the ACLR group (5.31 mm vs. 7.18 mm, respectively; p = 0.0137). Arthrometric measurements demonstrated a mean side-to-side difference (ΔATT) 1.87 (range 0.2 to 4.9) mm significantly decreased compared to ACLR 3.36 (range 1.2–5.6 mm; p = 0.0107). The mean Lysholm score was 85.3 points in the ACL repair group and 89.9 in ACLR group. No significant differences between ACL repair and ACLR were found for the Lysholm score. There was no association between AP laxity and clinical outcomes. There were two complications in the internal bracing group: one patient had re-rupture and was treated by ACLR, another had limited extension and had arthroscopic debridement. Conclusions: Anterior tibial translation was significantly decreased after ACL repair. Additionally, the functional results after ACL repair with internal bracing were comparable with those after ACLR. It should be noted that the two complications occurred. The current study supports further development of ACL repair techniques.

scholarly journals Two Cases of Contact Anterior Cruciate Ligament Rupture Combined with a Posterolateral Tibial Plateau Fracture

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Liangjun Jiang ◽  
Haobo Wu ◽  
Shigui Yan
Keyword(s):  
Acl Reconstruction ◽  
Tibial Plateau ◽  
Tibial Plateau Fracture ◽  
Acl Rupture ◽  
Anterior Tibial Translation ◽  
Single Bundle ◽  
Reconstruction Technique ◽  
Tibial Rotation ◽  
Plateau Fracture ◽  
Tibial Translation

Background.The combined occurrence of ACL rupture with a posterolateral tibial plateau fracture has not yet been reported. Two cases of such injuries have been treated in our department for the past three years.Findings.The two patients both suffered injuries from traffic accidents. The radiological examinations showed a ruptured ACL with fracture of the posterolateral tibial plateau. Reconstruction of the ACL was performed via a standard anatomical single bundle ACL reconstruction technique with autologous tendon by arthroscopy. A posterolateral tibia plateau approach was used to reduce and fix the fractured area with the aid of lag screws. After a one-year follow-up, the two patients recovered well and physical examinations showed full knee range of motion with no evidence of ACL instability.Conclusions.The cause of this type injury of ACL rupture with a posterolateral tibial plateau fracture was thought to be by a violent internal tibial rotation/anterior tibial translation without any valgus or varus knee force mechanism during the accident. Satisfactory clinical results were achieved with a standard anatomical single bundle ACL reconstruction by arthroscopy and ORIF for the posterolateral plateau fracture. Both patients reported excellent knee function and fracture healing.

Robotically Simulated Clinical Pivot Shift: A Better Tool for Analyzing ACL Reconstructions?

2013 ◽  
Author(s):  
R. W. Colbrunn ◽  
J. E. Dumpe ◽  
T. F. Bonner ◽  
J. D. Kolmodin ◽  
W. K. Barsoum ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Pivot Shift ◽  
Cruciate Ligament ◽  
Anterior Tibial Translation ◽  
Anterior Tibial ◽  
Robotic Testing ◽  
Anterior Cruciate ◽  
Tibial Translation

A pivot shift is a useful exam for evaluating anterior cruciate ligament (ACL) reconstruction surgery. A positive result is a perceived “clunk” and is quantified by the kinematics that occur during the tibial reduction phase. In vitro evaluation of ACL reconstruction techniques includes robotic testing of cadaveric knees where the applied loads represent estimated in situ loads. Early understanding of the mechanism of the pivot shift has resulted in a simplified representation where static “rotary loads” (10Nm valgus torque, 5Nm internal tibial torque) are applied at a few discrete flexion angles, and changes in anterior tibial translation (ATT) are compared [1]. Building upon this work, and with advances in technology, we are now able to create a robotic test that is more like the clinical exam. Our hypothesis was that kinematics produced during the robotically simulated pivot shift would be similar to the clinical pivot shift but would be significantly different from the rotary loads method. The ability for a test to produce larger kinematic differences between native and deficient states may suggest a more robust methodology by which to evaluate the efficacy of ACL reconstructions.

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