scholarly journals Influence of the Anterolateral Ligament on Knee Laxity: A Biomechanical Cadaveric Study Measuring Knee Kinematics in 6 Degrees of Freedom Using Dynamic Radiostereometric Analysis

2018 ◽  
Vol 6 (8) ◽  
pp. 232596711878969 ◽  
Author(s):  
Emil Toft Nielsen ◽  
Kasper Stentz-Olesen ◽  
Sepp de Raedt ◽  
Peter Bo Jørgensen ◽  
Ole Gade Sørensen ◽  
...  
Keyword(s):  
Internal Rotation ◽  
Acl Reconstruction ◽  
Knee Flexion ◽  
Degrees Of Freedom ◽  
Knee Kinematics ◽  
Knee Laxity ◽  
Anterolateral Ligament ◽  
Single Bundle ◽  
Anterior Translation ◽  
6 Degrees Of Freedom

Background: An anterior cruciate ligament (ACL) rupture often occurs during rotational trauma to the knee and may be associated with damage to extracapsular knee rotation–stabilizing structures such as the anterolateral ligament (ALL). Purpose: To investigate ex vivo knee laxity in 6 degrees of freedom with and without ALL reconstruction as a supplement to ACL reconstruction. Study Design: Controlled laboratory study. Methods: Cadaveric knees (N = 8) were analyzed using dynamic radiostereometry during a controlled pivotlike dynamic movement simulated by motorized knee flexion (0° to 60°) with 4-N·m internal rotation torque. We tested the cadaveric specimens in 5 successive ligament situations: intact, ACL lesion, ACL + ALL lesion, ACL reconstruction, and ACL + ALL reconstruction. Anatomic single-bundle reconstruction methods were used for both the ACL and the ALL, with a bone-tendon quadriceps autograft and gracilis tendon autograft, respectively. Three-dimensional kinematics and articular surface interactions were used to determine knee laxity. Results: For the entire knee flexion motion, an ACL + ALL lesion increased the mean knee laxity ( P < .005) for internal rotation (2.54°), anterior translation (1.68 mm), and varus rotation (0.53°). Augmented ALL reconstruction reduced knee laxity for anterior translation ( P = .003) and varus rotation ( P = .047) compared with ACL + ALL–deficient knees. Knees with ACL + ALL lesions had more internal rotation ( P < .001) and anterior translation ( P < .045) at knee flexion angles below 40° and 30°, respectively, compared with healthy knees. Combined ACL + ALL reconstruction did not completely restore native kinematics/laxity at flexion angles below 10° for anterior translation and below 20° for internal rotation ( P < .035). ACL + ALL reconstruction was not found to overconstrain the knee joint. Conclusion: Augmented ALL reconstruction with ACL reconstruction in a cadaveric setting reduces internal rotation, varus rotation, and anterior translation knee laxity similar to knee kinematics with intact ligaments, except at knee flexion angles between 0° and 20°. Clinical Relevance: Patients with ACL injuries can potentially achieve better results with augmented ALL reconstruction along with ACL reconstruction than with stand-alone ACL reconstruction. Furthermore, dynamic radiostereometry provides the opportunity to examine clinical patients and compare the recontructed knee with the contralateral knee in 6 degrees of freedom.

scholarly journals Stability Outcomes following Computer-Assisted ACL Reconstruction

2015 ◽  
Vol 2015 ◽  
pp. 1-7
Author(s):  
Melissa A. Christino ◽  
Bryan G. Vopat ◽  
Alexander Mayer ◽  
Andrew P. Matson ◽  
Steven E. Reinert ◽  
...  
Keyword(s):  
Internal Rotation ◽  
Acl Reconstruction ◽  
External Rotation ◽  
Patient Characteristics ◽  
Computer Assisted ◽  
Single Bundle ◽  
Anterior Instability ◽  
Knee Stability ◽  
Anterior Translation ◽  
Stability Measurements

Purpose. The purpose of this study was to determine whether intraoperative prereconstruction stability measurements and/or patient characteristics were associated with final knee stability after computer-assisted ACL reconstruction.Methods. This was a retrospective review of all patients who underwent computer-assisted single-bundle ACL reconstruction by a single surgeon. Prereconstruction intraoperative stability measurements were correlated with patient characteristics and postreconstruction stability measurements. 143 patients were included (87 male and 56 female). Average age was 29.8 years (SD ± 11.8).Results. Females were found to have significantly more pre- and postreconstruction internal rotation than males (P< 0.001 andP= 0.001, resp.). Patients with additional intra-articular injuries demonstrated more prereconstruction anterior instability than patients with isolated ACL tears (P< 0.001). After reconstruction, these patients also had higher residual anterior translation (P= 0.01). Among all patients with ACL reconstructions, the percent of correction of anterior translation was found to be significantly higher than the percent of correction for internal or external rotation (P< 0.001).Conclusion. Anterior translation was corrected the most using a single-bundle ACL reconstruction. Females had higher pre- and postoperative internal rotation. Patients with additional injuries had greater original anterior translation and less operative correction of anterior translation compared to patients with isolated ACL tears.

scholarly journals No Difference in Ligamentous Strain or Knee Kinematics Between Rectangular or Cylindrical Femoral Tunnels During Anatomic ACL Reconstruction With a Bone–Patellar Tendon–Bone Graft

2021 ◽  
Vol 9 (6) ◽  
pp. 232596712110095
Author(s):  
Timothy A. Burkhart ◽  
Takashi Hoshino ◽  
Lachlan M. Batty ◽  
Alexandra Blokker ◽  
Philip P. Roessler ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Acl Reconstruction ◽  
Patellar Tendon ◽  
Knee Flexion ◽  
Femoral Tunnel ◽  
Knee Kinematics ◽  
Anatomic Acl Reconstruction ◽  
Anterior Translation ◽  
Ligament Strain ◽  
Bone Patellar Tendon

Background: As our understanding of anterior cruciate ligament (ACL) anatomy has evolved, surgical techniques to better replicate the native anatomy have been developed. It has been proposed that the introduction of a rectangular socket ACL reconstruction to replace a ribbon-shaped ACL has the potential to improve knee kinematics after ACL reconstruction. Purpose: To compare a rectangular femoral tunnel (RFT) with a cylindrical femoral tunnel (CFT) in terms of replicating native ACL strain and knee kinematics in a time-zero biomechanical anatomic ACL reconstruction model using a bone–patellar tendon–bone (BTB) graft. Study Design: Controlled laboratory study. Methods: In total, 16 fresh-frozen, human cadaveric knees were tested in a 5 degrees of freedom, computed tomography–compatible joint motion simulator. Knees were tested with the ACL intact before randomization to RFT or CFT ACL reconstruction using a BTB graft. An anterior translation load and an internal rotation moment were each applied at 0°, 30°, 60°, and 90° of knee flexion. A simulated pivot shift was performed at 0° and 30° of knee flexion. Ligament strain and knee kinematics were assessed using computed tomography facilitated by insertion of zirconium dioxide beads placed within the substance of the native ACL and BTB grafts. Results: For the ACL-intact state, there were no differences between groups in terms of ACL strain or knee kinematics. After ACL reconstruction, there were no differences in ACL graft strain when comparing the RFT and CFT groups. At 60° of knee flexion with anterior translation load, there was significantly reduced strain in the reconstructed state ([mean ±standard deviation] CFT native, 2.82 ± 3.54 vs CFT reconstructed, 0.95 ± 2.69; RFT native, 2.77 ± 1.71 vs RFT reconstructed, 1.40 ± 1.76) independent of the femoral tunnel type. In terms of knee kinematics, there were no differences when comparing the RFT and CFT groups. Both reconstructive techniques were mostly effective in restoring native knee kinematics and ligament strain patterns as compared with the native ACL. Conclusion: In the time-zero biomechanical environment, similar graft strains and knee kinematics were achieved using RFT and CFT BTB ACL reconstructions. Both techniques appeared to be equally effective in restoring kinematics associated with the native ACL state. Clinical Relevance: These data suggest that in terms of knee kinematics and graft strain, there is no benefit in performing the more technically challenging RFT as compared with a CFT BTB ACL reconstruction.

Biomechanical Comparison of Anterolateral Procedures Combined With Anterior Cruciate Ligament Reconstruction

2016 ◽  
Vol 45 (2) ◽  
pp. 347-354 ◽  
Author(s):  
Eivind Inderhaug ◽  
Joanna M. Stephen ◽  
Andy Williams ◽  
Andrew A. Amis
Keyword(s):  
Anterior Cruciate Ligament ◽  
Internal Rotation ◽  
Acl Reconstruction ◽  
Repeated Measures ◽  
Knee Flexion ◽  
Cruciate Ligament ◽  
Knee Kinematics ◽  
Optical Tracking ◽  
Iliotibial Band ◽  
Anterior Cruciate

Background: Anterolateral soft tissue structures of the knee have a role in controlling anterolateral rotational laxity, and they may be damaged at the time of anterior cruciate ligament (ACL) ruptures. Purpose: To compare the kinematic effects of anterolateral operative procedures in combination with intra-articular ACL reconstruction for combined ACL plus anterolateral–injured knees. Study Design: Controlled laboratory study. Methods: Twelve cadaveric knees were tested in a 6 degrees of freedom rig using an optical tracking system to record the kinematics through 0° to 90° of knee flexion with no load, anterior drawer, internal rotation, and combined loading. Testing was first performed in ACL-intact, ACL-deficient, and combined ACL plus anterolateral–injured (distal deep insertions of the iliotibial band and the anterolateral ligament [ALL] and capsule cut) states. Thereafter, ACL reconstruction was performed alone and in combination with the following: modified MacIntosh tenodesis, modified Lemaire tenodesis passed both superficial and deep to the lateral collateral ligament, and ALL reconstruction. Anterolateral grafts were fixed at 30° of knee flexion with both 20 and 40 N of tension. Statistical analysis used repeated-measures analyses of variance and paired t tests with Bonferroni adjustments. Results: ACL reconstruction alone failed to restore native knee kinematics in combined ACL plus anterolateral–injured knees ( P < .05 for all). All combined reconstructions with 20 N of tension, except for ALL reconstruction ( P = .002-.01), restored anterior translation. With 40 N of tension, the superficial Lemaire and MacIntosh procedures overconstrained the anterior laxity in deep flexion. Only the deep Lemaire and MacIntosh procedures—with 20 N of tension—restored rotational kinematics to the intact state ( P > .05 for all), while the ALL underconstrained and the superficial Lemaire overconstrained internal rotation. The same procedures with 40 N of tension led to similar findings. Conclusion: In a combined ACL plus anterolateral–injured knee, ACL reconstruction alone failed to restore intact knee kinematics. The addition of either the deep Lemaire or MacIntosh tenodesis tensioned with 20 N, however, restored native knee kinematics. Clinical Relevance: The current study indicates that unaddressed anterolateral injuries, in the presence of an ACL deficiency, result in abnormal knee kinematics that is not restored if only treated with intra-articular ACL reconstruction. Both the modified MacIntosh and modified deep Lemaire tenodeses (with 20 N of tension) restored native knee kinematics at time zero.

Accelerated Versus Nonaccelerated Rehabilitation After Anterior Cruciate Ligament Reconstruction

2011 ◽  
Vol 39 (12) ◽  
pp. 2536-2548 ◽  
Author(s):  
Bruce D. Beynnon ◽  
Robert J. Johnson ◽  
Shelly Naud ◽  
Braden C. Fleming ◽  
Joseph A. Abate ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Muscle Strength ◽  
Acl Reconstruction ◽  
Degrees Of Freedom ◽  
Cruciate Ligament ◽  
Knee Laxity ◽  
Thigh Muscle ◽  
Anterior Cruciate ◽  
6 Degrees Of Freedom

Background: The relationship between the biomechanical dose of rehabilitation exercises administered after anterior cruciate ligament (ACL) reconstruction and the healing response of the graft and knee is not well understood. Hypothesis: After ACL reconstruction, rehabilitation administered with either accelerated or nonaccelerated programs produces the same change in the knees’ 6 degrees of freedom, or envelope, laxity values. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Patients who underwent ACL reconstruction with a bone–patellar tendon–bone autograft were randomized to rehabilitation with either accelerated (19 week) or nonaccelerated (32 week) programs. At the time of surgery, and then 3, 6, 12, and 24 months later, the 6 degrees of freedom knee laxity values were measured using roentgen stereophotogrammetric analysis and clinical, functional, and patient-oriented outcome measures. Results: Eighty-five percent of those enrolled were followed through 2 years. Laxity of the reconstructed knee was restored to within the limits of the contralateral, normal side at the time of surgery (baseline) in all participants. Patients in both programs underwent a similar increase in the envelope of knee laxity over the 2-year follow-up interval (anterior-posterior translation 3.2 vs 4.5 mm, and coupled internal-external rotations 2.6° vs 1.9° for participants in the accelerated and nonaccelerated programs, respectively). Those who underwent accelerated rehabilitation experienced a significant improvement in thigh muscle strength at the 3-month follow-up ( P < .05) compared with those who participated in nonaccelerated rehabilitation, but no differences between the programs were seen after this time interval. At the 2-year follow-up, the groups were similar in terms of clinical assessment, patient satisfaction, function, proprioception, and isokinetic thigh muscle strength. Conclusion: Rehabilitation with the accelerated and nonaccelerated programs administered in this study produced the same increase in the envelope of knee laxity. A majority of the increase in the envelope of knee laxity occurred during healing when exercises were advanced and activity level increased. Patients in both programs had the same clinical assessment, functional performance, proprioception, and thigh muscle strength, which returned to normal levels after healing was complete. For participants in both treatment programs, the Knee Injury and Osteoarthritis Outcome Score (KOOS) assessment of quality of life did not return to preinjury levels.

Biomechanical Evaluation of Anterolateral Ligament Repair augmented with Internal Brace

2021 ◽  
Author(s):  
Ryan P. Roach ◽  
David P. Beason ◽  
Jonathan S. Slowik ◽  
A. Ryves Moore ◽  
Ajay C. Lall ◽  
...  
Keyword(s):  
Internal Rotation ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Surgical Techniques ◽  
Anterolateral Ligament ◽  
Torsional Stiffness ◽  
Rotational Stability ◽  
Gap Formation ◽  
Internal Brace ◽  
Acl Deficient

AbstractInjuries to the anterolateral ligament (ALL) of the knee are commonly associated with anterior cruciate ligament (ACL) ruptures. Biomechanical studies have demonstrated conflicting results with regard to the role of the ALL in limiting tibial internal rotation. Clinically, residual pivot shift following ACL reconstruction has been reported to occur up to 25% and has been correlated with poor outcomes. As such, surgical techniques have been developed to enhance rotational stability. Recent biomechanical studies have demonstrated restoration of internal rotational control following ALL reconstruction. The purpose of our study was to understand the biomechanical effects of ACL reconstruction with an ALL internal brace augmentation. We hypothesized that (1) sectioning of the ALL while preserving other lateral extra-articular structures would lead to significant internal rotation laxity and gap formation and (2) ALL repair with internal brace augmentation would lead to reduction in internal rotation instability and gap formation. In total, 10 fresh-frozen cadaveric knees were thawed and biomechanically tested in internal rotation for 10 cycles of normal physiologic torque in the intact, ACL-deficient, ACL/ALL-deficient, ACL-reconstructed, and ALL-repaired conditions. Each condition was tested at 30, 60, and 90 degrees of flexion. Following the final ALL-repaired condition, specimens were additionally subjected to a final internal rotation to failure at 1 degree at the last-tested degree of flexion. Kinematic measurements of angle and linear gap between the femur and tibia were calculated in addition to torsional stiffness and failure torque. As hypothesized, ALL repair with internal brace augmentation significantly reduced internal rotation angular motion and gap formation at flexion angles greater than 30 degrees. Additionally, ALL sectioning produced nonsignificant increases in internal rotation laxity and gap formation compared with ACL-deficient and ACL-reconstructed states, which did not support our other hypothesis.

The Contribution of Partial Meniscectomy to Preoperative Laxity and Laxity After Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction: In Vivo Kinematics With Navigation

2019 ◽  
Vol 47 (13) ◽  
pp. 3203-3211
Author(s):  
Alberto Grassi ◽  
Stefano Di Paolo ◽  
Gian Andrea Lucidi ◽  
Luca Macchiarola ◽  
Federico Raggi ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Knee Flexion ◽  
Cruciate Ligament ◽  
Single Bundle ◽  
Anatomic Acl Reconstruction ◽  
Medial Meniscectomy ◽  
Lateral Meniscectomy ◽  
Anterior Cruciate

Background: Limited in vivo kinematic information exists on the effect of clinical-based partial medial and lateral meniscectomy in the context of anterior cruciate ligament (ACL) reconstruction. Hypothesis: In patients with ACL deficiency, partial medial meniscus removal increases the anteroposterior (AP) laxity with compared with those with intact menisci, while partial lateral meniscus removal increases dynamic laxity. In addition, greater postoperative laxity would be identified in patients with partial medial meniscectomy. Study design: Cross-sectional study; Level of evidence, 3. Methods: A total of 164 patients with ACL tears were included in the present study and divided into 4 groups according to the meniscus treatment they underwent: patients with partial lateral meniscectomy (LM group), patients with partial medial meniscectomy (MM group), patients with partial medial and lateral meniscectomy (MLM group), and patients with intact menisci who did not undergo any meniscus treatment (IM group). A further division in 2 new homogeneous groups was made based on the surgical technique: 46 had an isolated single-bundle anatomic ACL reconstruction (ACL group), while 13 underwent a combined single-bundle anatomic ACL reconstruction and partial medial meniscectomy (MM-ACL group). Standard clinical laxities (AP translation at 30° of knee flexion, AP translation at 90° of knee flexion) and pivot-shift (PS) tests were quantified before and after surgery by means of a surgical navigation system dedicated to kinematic assessment. The PS test was quantified through 3 different parameters: the anterior displacement of the lateral tibial compartment (lateral AP); the posterior acceleration of the lateral AP during tibial reduction (posterior acceleration); and finally, the area included by the lateral AP translation with respect to the flexion/extension angle (area). Results: In the ACL-deficient status, the MM group showed a significantly greater tibial translation compared with the IM group ( P < .0001 for AP displacement at 30° [AP30] and 90° [AP90] of flexion) and the LM group ( P = .002 for AP30 and P < .0001 for AP90). In the PS test, the area of LM group was significantly larger (57%; P = .0175) than the one of the IM group. After ACL reconstruction, AP translation at 30° was restored, while the AP90 remained significantly greater at 1.3 mm ( P = .0262) in the MM-ACL group compared with those with intact menisci. Conclusion: Before ACL reconstruction, partial medial meniscectomy increased AP laxity at 30° and 90° and lateral meniscectomy increased dynamic PS laxity with respect to intact menisci. Anatomic single-bundle ACL reconstruction decreased laxities, but a residual anterior translation of 1.3 mm at 90° remained in patients with partial medial meniscectomy, with respect to those with intact menisci.

scholarly journals Human standing: does the control strategy preprogram a rigid knee?

2013 ◽  
Vol 114 (12) ◽  
pp. 1717-1729 ◽  
Author(s):  
Irene Di Giulio ◽  
Vasilios Baltzopoulos ◽  
Constantinos N. Maganaris ◽  
Ian D. Loram
Keyword(s):  
Internal Rotation ◽  
Skill Acquisition ◽  
Knee Flexion ◽  
Degrees Of Freedom ◽  
Control Strategies ◽  
Response Patterns ◽  
Ankle Stiffness ◽  
Perturbation Force ◽  
Energy Absorbing ◽  
Hip Internal Rotation

Human standing requires control of multisegmental configuration. Does the postural system normally allow flexible adjustment of configuration, or does it minimize degrees of freedom at the ankle, knee, and hip joints? Gentle, external, unpredictable, sagittal, mechanical perturbations (randomized force, 1–10 N; duration, 0.2–2 s; and leg) were applied to either knee of 24 healthy participants who stood symmetrically for 200 s. The translation of knee perturbation force to ankle, knee, and hip joint rotations in the perturbed and unperturbed legs was studied. We assessed whether consequent joint rotations indicated a stiff configuration-conserving or viscous energy-absorbing relationship to the knee perturbation. Two distinctive response patterns were observed. Twenty-two participants showed limited knee flexion and high ankle stiffness, whereas two participants showed substantial knee flexion, low ankle stiffness, measurable internal rotation of the unperturbed hip (0.4 ± 0.3 vs. 3.0 ± 1°, 5.7 ± 17 vs. 0.5 ± 0.3 N/°, 1.1 ± 0.4°, respectively; mean ± SD), and a viscous relationship between perturbation force and subsequent ankle flexion, knee flexion, and perturbed and unperturbed hip internal rotation. The size of knee-flexion response to knee perturbations was uncorrelated with the extent of unperturbed standing sway. Normal standing conceals a large interindividual range in leg control strategies, indicating adaptive potential to progress with development and skill acquisition and decline with age, disease, injury, and fear. Commonly, leg configuration was maintained stiffly. Less commonly, a bilateral, low-stiffness, energy-absorbing strategy utilizing the available degrees of freedom was shown. We propose that identification of individual coordination strategy has diagnostic and prognostic potential in relation to perceptual-posture-movement-fall interactions.

scholarly journals A biomechanical study after combined reconstruction of the anterior cruciate and anterolateral ligaments: Comparison between anatomic anterolateral ligament reconstruction and lateral tenodesis using the modified Lemaire technique

2020 ◽  
Vol 8 (2_suppl) ◽  
pp. 2325967120S0000
Author(s):  
Jean-Romain Delaloye ◽  
christoph Hartog ◽  
Samuel Blatter ◽  
Dominik Müller ◽  
Michel Schläppi ◽  
...  
Keyword(s):  
Internal Rotation ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Anterolateral Ligament ◽  
The Other ◽  
Anterior Translation ◽  
Anterior Cruciate ◽  
Deficient Knee ◽  
Lemaire Procedure ◽  
Intact Knee

Objectives: To determine the stabilizing role of the anterolateral ligament reconstruction (ALLR) and the modified Lemaire lateral extraarticular tenodesis (LET) performed in combination with anterior cruciate ligament reconstruction (ACLR) and to determine if one of these two procedures was superior to the other. Methods: Six non paired cadaveric knees were tested with a 6 degrees of freedom robotic system (KUKA Robotics). Internal rotation and anterior tibial translation were measured between 0 and 90° knee flexion after applying 5 N-m Torque and a 134-N anterior load, respectively. A full kinematics assessment was performed in each following conditions: intact knee, after section of the anterior cruciate ligament (ACL), after section of the ACL and anterolateral ligament (ALL) and Kaplan fibers, after isolated ACLR, after combined ACLR+LET and ACLR+ALLR. ALLR was performed using Gracilis tendon while central strip of the ilio-tibial band was used for the modified Lemaire procedure. These different states were compared using a Tukey paired comparison test. Results: In combined ACL and anterolateral deficient knee, anterior translation and internal rotation remained significantly increased after isolated ACLR compared to intact knee (+2.33 ± 1.44 mm and +1.98 ± 1.06°; p > 0.01). On the other hand, the addition of an ALLR or a modified Lemaire LET to the ACLR allowed to restore anterior translation and internal rotation to values similar to the intact knee. Finally, the two anterolateral procedures had not significantly different values in both tests. This difference was 0.67 ± 1.46 mm for anterior translation (p=0.79) and 0.11 ± 1.11° for internal rotation (p=0.99). Conclusion: In ACL and anterolateral deficient knee, combined ACLR and anterolateral reconstruction allowed restoration of native stability of the knee in anterior translation and internal rotation contrary to isolated ACLR. Additionally, both types of extra-articular reconstruction, ALLR or modified Lemaire procedure, were similar in terms of restoring knee kinematics and neither overconstrained the knee.

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