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.

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.

Biomechanical Evaluation of Different Techniques in Double Bundle Anterior Cruciate Ligament Reconstruction Using Finite Element Analysis

2012 ◽  
Vol 13 ◽  
pp. 55-68 ◽  
Author(s):  
Rong Ying Huang ◽  
Hong Guang Zheng ◽  
Qiang Xu
Keyword(s):  
Finite Element ◽  
Anterior Cruciate Ligament ◽  
Soft Tissues ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Double Bundle ◽  
Rotational Stability ◽  
Single Bundle ◽  
Element Analysis ◽  
Anterior Cruciate

Anterior cruciate ligament injuries commonly in traffic accident, sports activities and extreme sports. Anterior cruciate ligament reconstruction is a common practice to help the patients restore the knee stability. However, there is no previous comparison study of single bundle reconstruction, double-femoral double-tibial tunnel reconstruction, single-femoral double-tibial tunnel reconstruction, and double-femoral single-tibial tunnel reconstruction with respect to biomechanical characteristics such as rotational stability, force and stress inside the ligament and grafts, stresses inside the soft tissues. In this study, we developed a pair of three-dimensional finite element models of a lower extremity including femur, tibia, fibula, cartilage, meniscus, and four major ligaments at 0°，25°，60° and 80°of knee flexion. Based on the intact models, single bundle reconstruction, double-femoral double-tibial tunnel reconstruction, single-femoral double-tibial tunnel reconstruction, and double-femoral single-tibial tunnel reconstruction models were also developed. Then, the anterior tibial translations, the forces and stresses inside the ACL and ACL replacements, as well as the stresses inside the menisci, femoral and tibial cartilage were predicted under a combined rotatory load of 10Nm valgus moment and 5 Nm internal torque, respectively using finite element analysis. The rotational stability, ligament forces and stresses in the menisci, femoral and tibial cartilage following double bundle augmentation were superior to the other reconstruction techniques, while there is little advantage in ligament stress compared to that of the single bundle reconstruction. We conclude that double-femoral double-tibial tunnel reconstruction may have advantages with regard to biomechanical characteristics such as rotational stability, force inside the ligament and grafts, stresses inside the soft tissues.

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