scholarly journals The correlation between posterior tibial slope and dynamic anterior tibial translation and dynamic range of tibial rotation

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
M.J.M Zee ◽  
M.N.J Keizer ◽  
L Dijkerman ◽  
J.J.A.M van Raaij ◽  
J.M. Hijmans ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Dynamic Range ◽  
Cruciate Ligament ◽  
Tibial Slope ◽  
Wedge Osteotomy ◽  
Anterior Tibial Translation ◽  
Tibial Rotation ◽  
Before And After ◽  
Anterior Cruciate ◽  
Tibial Translation

Abstract Purpose The amount of passive anterior tibial translation (ATT) is known to be correlated to the amount of posterior tibial slope (PTS) in both anterior cruciate ligament-deficient and reconstructed knees. Slope-altering osteotomies are advised when graft failure after anterior cruciate ligament (ACL) reconstruction occurs in the presence of high PTS. This recommendation is based on studies neglecting the influence of muscle activation. On the other hand, if dynamic range of tibial rotation (rTR) is related to the amount of PTS, a “simple” anterior closing-wedge osteotomy might not be sufficient to control for tibial rotation. The purpose of this study was to evaluate the correlation between the amount of PTS and dynamic ATT and tibial rotation during high demanding activities, both before and after ACL reconstruction. We hypothesized that both ATT and rTR are strongly correlated to the amount of PTS. Methods Ten subjects were studied both within three months after ACL injury and one year after ACL reconstruction. Dynamic ATT and dynamic rTR were measured using a motion-capture system during level walking, during a single-leg hop for distance and during a side jump. Both medial and lateral PTS were measured on MRI. A difference between medial and lateral PTS was calculated and referred to as Δ PTS. Spearman’s correlation coefficients were calculated for the correlation between medial PTS, lateral PTS and Δ PTS and ATT and between medial PTS, lateral PTS and Δ PTS and rTR. Results Little (if any) to weak correlations were found between medial, lateral and Δ PTS and dynamic ATT both before and after ACL reconstruction. On the other hand, a moderate-to-strong correlation was found between medial PTS, lateral PTS and Δ PTS and dynamic rTR one year after ACL reconstruction. Conclusion During high-demand tasks, dynamic ATT is not correlated to PTS. A compensation mechanism may be responsible for the difference between passive and dynamic ATT in terms of the correlation to PTS. A moderate-to-strong correlation between amount of PTS and rTR indicates that such a compensation mechanism may fall short in correcting for rTR. These findings warrant prudence in the use of a pure anterior closing wedge osteotomy in ACL reconstruction. Trial registration Netherlands Trial Register, Trial 7686. Registered 16 April 2016—Retrospectively registered. Level of evidence Level 2, prospective cohort study

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 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 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.

The Effects of Removal and Reconstruction of the Anterior Cruciate Ligament on Patellofemoral Kinematics

1998 ◽  
Vol 26 (2) ◽  
pp. 201-209 ◽  
Author(s):  
Yeou-Fang Hsieh ◽  
Louis F. Draganich ◽  
Sherwin H. Ho ◽  
Bruce Reider
Keyword(s):  
Anterior Cruciate Ligament ◽  
Knee Flexion ◽  
External Rotation ◽  
Cruciate Ligament ◽  
Anterior Tibial Translation ◽  
Tibial Rotation ◽  
Patellar Tilt ◽  
Anterior Cruciate ◽  
Tibial Translation ◽  
Intact Knee

Patellofemoral pain may be associated with anterior cruciate ligament deficiency or may occur after anterior cruciate ligament reconstruction. We investigated the effects of the removal and reconstruction of the anterior cruciate ligament on the kinematics of the tibiofemoral and patellofemoral joints during physiologic levels of quadriceps muscle loads in seven cadaveric knees. A bone-patellar tendon-bone graft was used for intraarticular reconstruction of the anterior cruciate ligament. The spatial positions of the tibiofemoral and patellofemoral joints were measured between 0° and 90° of knee flexion in 15° increments with a six degree-of-freedom digitizing system. Excision of the anterior cruciate ligament resulted in statistically significant increases in anterior tibial translation between 0° and 90° and valgus tibial rotation between 30° and 90°; intraarticular reconstruction returned these to levels not significantly different from those of the intact knee. Excision of the anterior cruciate ligament resulted in significant increases in lateral patellar tilt, ranging from 6.3° to 9.0° between full extension and 90° of knee flexion, and in lateral patellar shift, ranging from 2.9 mm at 15° of knee flexion to 5.9 mm at 90°; intraarticular reconstruction returned these to levels not significantly different from those of the intact knee. Neither removal nor reconstruction of the anterior cruciate ligament significantly affected tibial internal-external rotation, patellar flexion, patellar mediolateral rotation, patellar anteroposterior translation, or patellar proximodistal translation.

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.

Is Remnant Preservation Truly Beneficial to Anterior Cruciate Ligament Reconstruction Healing? Clinical and Magnetic Resonance Imaging Evaluations of Remnant-Preserved Reconstruction

2017 ◽  
Vol 45 (5) ◽  
pp. 1049-1058 ◽  
Author(s):  
Takuya Naraoka ◽  
Yuka Kimura ◽  
Eiichi Tsuda ◽  
Yuji Yamamoto ◽  
Yasuyuki Ishibashi
Keyword(s):  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Anterior Tibial Translation ◽  
Resonance Imaging ◽  
Graft Incorporation ◽  
Remnant Preservation ◽  
Anterior Tibial ◽  
Anterior Cruciate ◽  
Tibial Translation

Background: Remnant-preserved anterior cruciate ligament (ACL) reconstruction was introduced to improve clinical outcomes and biological healing. However, the effects of remnant preservation and the influence of the delay from injury until reconstruction on the outcomes of this technique are still uncertain. Purpose/Hypothesis: The purposes of this study were to evaluate whether remnant preservation improved the clinical outcomes and graft incorporation of ACL reconstruction and to examine the influence of the delay between ACL injury and reconstruction on the usefulness of remnant preservation. We hypothesized that remnant preservation improves clinical results and accelerates graft incorporation and that its effect is dependent on the delay between ACL injury and reconstruction. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 151 consecutive patients who underwent double-bundle ACL reconstruction using a semitendinosus graft were enrolled in this study: 74 knees underwent ACL reconstruction without a remnant (or the remnant was <25% of the intra-articular portion of the graft; NR group), while 77 knees underwent ACL reconstruction with remnant preservation (RP group). These were divided into 4 subgroups based on the time from injury to surgery: phase 1 was <3 weeks (n = 24), phase 2 was 3 to less than 8 weeks (n = 70), phase 3 was 8 to 20 weeks (n = 32), and phase 4 was >20 weeks (n = 25). Clinical measurements, including KT-1000 arthrometer side-to-side anterior tibial translation measurements, were assessed at 3, 6, 12, and 24 months after reconstruction. Magnetic resonance imaging evaluations of graft maturation and graft-tunnel integration of the anteromedial and posterolateral bundles were assessed at 3, 6, and 12 months after reconstruction. Results: There was no difference in side-to-side anterior tibial translation between the NR and RP groups. There was also no difference in graft maturation between the 2 groups. Furthermore, the time from ACL injury until reconstruction did not affect graft maturation, except in the case of very long delays before reconstruction (phase 4). Graft-tunnel integration was significantly increased in both groups in a time-dependent manner. However, there was no difference between the NR and RP groups. Conclusion: Remnant preservation did not improve knee stability at 2 years after ACL reconstruction. Furthermore, remnant preservation did not accelerate graft incorporation, especially during the acute and subacute injury phases.

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