Biomechanical Comparison Between the Rectangular-Tunnel and the Round-Tunnel Anterior Cruciate Ligament Reconstruction Procedures With a Bone–Patellar Tendon–Bone Graft
“…As the crescent-shaped ACL femoral attachment area located at the superior-posterior margin of the lateral wall of the notch is less than 10 mm in width [ 14 , 15 ], this technique makes it possible to create a robust tunnel aperture inside an attachment area with greater cortical thickness [ 7 ]. Biomechanically, this reconstruction technique is superior to the conventional transtibial tunnel single-bundle procedure [ 16 ]. Fig.…”
Section: Aclr With Bone–patellar Tendon–bone Graftmentioning
confidence: 99%
“…Tibial fixation is achieved with a modified pullout suture technique using the DSP system at an optional/predetermined amount of initial tension. According to our cadaveric experiment, the mean laxity-match tension for the ART ACLR knees was 8.6 ± 4.8 N, and the recommended initial tension to the graft at the time of its final fixation could be reasonably assumed to be 10–20 N [ 16 ].…”
Section: Aclr With Bone–patellar Tendon–bone Graftmentioning
Anatomic ACL reconstruction is the reasonable approach to restore stability without loss of motion after ACL tear. To mimic the normal ACL like a ribbon, our preferred procedures is the anatomic rectangular tunnel (ART) technique with a bone-patellar tendon-bone (BTB) graft or the anatomic triple bundle (ATB) procedure with a hamstring (HS) tendon graft. It is important to create tunnel apertures inside the attachment areas to lessen the tunnel widening. To identify the crescent-shaped ACL femoral attachment area, the upper cartilage margin, the posterior cartilage margin and the resident’s ridge are used as landmarks. To delineate the C-shaped tibial insertion, medial intercondylar ridge, Parson’s knob and anterior horn of the lateral meniscus are helpful. In ART-BTB procedure which is suitable for male patients engaged in contact sports, the parallelepiped tunnels with rectangular apertures are made within the femoral and tibial attachment areas. In ATB-HS technique which is mainly applied to female athletes engaged in non-contact sports including skiing or basketball, 2 femoral and 3 tibial round tunnels are created inside the attachment areas. These techniques make it possible for the grafts to run as the native ACL without impingement to the notch or PCL.
After femoral fixation with an interference screw or cortical fixation devices including Endobutton, the graft is pretensioned in situ by repetitive manual pulls at 15–20° of flexion, monitoring the graft tension with tensioners on a tensioning boot installed on the calf. Tibial fixation with pullout sutures is achieved using Double Spike Plate and a screw at the pre-determined amount of tension of 10–20N. While better outcomes with less failure rate are being obtained compared to those in the past, higher graft tear rate remains a problem. Improved preventive training may be required to avoid secondary ACL injuries.
“…As the crescent-shaped ACL femoral attachment area located at the superior-posterior margin of the lateral wall of the notch is less than 10 mm in width [ 14 , 15 ], this technique makes it possible to create a robust tunnel aperture inside an attachment area with greater cortical thickness [ 7 ]. Biomechanically, this reconstruction technique is superior to the conventional transtibial tunnel single-bundle procedure [ 16 ]. Fig.…”
Section: Aclr With Bone–patellar Tendon–bone Graftmentioning
confidence: 99%
“…Tibial fixation is achieved with a modified pullout suture technique using the DSP system at an optional/predetermined amount of initial tension. According to our cadaveric experiment, the mean laxity-match tension for the ART ACLR knees was 8.6 ± 4.8 N, and the recommended initial tension to the graft at the time of its final fixation could be reasonably assumed to be 10–20 N [ 16 ].…”
Section: Aclr With Bone–patellar Tendon–bone Graftmentioning
Anatomic ACL reconstruction is the reasonable approach to restore stability without loss of motion after ACL tear. To mimic the normal ACL like a ribbon, our preferred procedures is the anatomic rectangular tunnel (ART) technique with a bone-patellar tendon-bone (BTB) graft or the anatomic triple bundle (ATB) procedure with a hamstring (HS) tendon graft. It is important to create tunnel apertures inside the attachment areas to lessen the tunnel widening. To identify the crescent-shaped ACL femoral attachment area, the upper cartilage margin, the posterior cartilage margin and the resident’s ridge are used as landmarks. To delineate the C-shaped tibial insertion, medial intercondylar ridge, Parson’s knob and anterior horn of the lateral meniscus are helpful. In ART-BTB procedure which is suitable for male patients engaged in contact sports, the parallelepiped tunnels with rectangular apertures are made within the femoral and tibial attachment areas. In ATB-HS technique which is mainly applied to female athletes engaged in non-contact sports including skiing or basketball, 2 femoral and 3 tibial round tunnels are created inside the attachment areas. These techniques make it possible for the grafts to run as the native ACL without impingement to the notch or PCL.
After femoral fixation with an interference screw or cortical fixation devices including Endobutton, the graft is pretensioned in situ by repetitive manual pulls at 15–20° of flexion, monitoring the graft tension with tensioners on a tensioning boot installed on the calf. Tibial fixation with pullout sutures is achieved using Double Spike Plate and a screw at the pre-determined amount of tension of 10–20N. While better outcomes with less failure rate are being obtained compared to those in the past, higher graft tear rate remains a problem. Improved preventive training may be required to avoid secondary ACL injuries.
“…These machines typically fix the femur and use a six-DOF robotic arm manipulator to move the tibia to desired locations or exert desired forces onto the joint. [29][30][31][32] The hamstrings and quadriceps muscles can be loaded or unloaded throughout testing, producing different desired joint conditions. A load cell fixed to the bone end allows for joint loads to be measured and control systems to be designed based on the loads measured.…”
In vitro testing of the human knee provides valuable insight that contributes to further understanding knee biomechanics. Cadaveric testing correlates well with clinical trials because the tissue has similar properties to that of live subjects. In addition, in vitro testing allows studies to be performed that would otherwise be unethical to evaluate in vivo. Due to their many advantages, cadaveric testing has been utilized to evaluate many of medical devices and surgical techniques that have been developed in recent decades. This article aims to review the current technologies and methodologies utilized in experimental in vitro testing of the human knee. The article provides a summary of the different rigs and machines that are currently used to examine the biomechanics of the knee. It also highlights the variable experimental techniques and measurement systems that are used to collect the kinematics and kinetics of the knee joint. As technologies advance so do the measurement systems and equipment in the experimental biomechanics field. The influence of improvements to these testing equipment and measurement devices on in vitro testing of the knee will also be discussed in this review.
“…In addition, the shape of the boneblock and tunnel has an effect on the restoration of ACL kinematics as the reconstruction using a rectangular block and tunnel more closely resembled the mechanical behavior of the native ACL compared to round grafts and tunnels. Conversely, reconstruction using the round shape appeared to better control anterior translation by means of more superior graft tensioning; however, the positioning of the tibia with respect to the femur was impaired [58]. Therefore, the process of harvesting from the patellar tendon constitutes a very important factor for the subsequent outcome and has recently been given more consideration.…”
Anterior cruciate ligament (ACL) reconstruction aims to restore the translational and rotational motion to the knee joint that is lost after injury. However, despite technical advancements, clinical outcomes are less than ideal, particularly in return to previous activity level. A major issue is the inability to standardize treatment protocols due to variations in materials and approaches used to accomplish ACL reconstruction. These include surgical techniques such as the transtibial and anteromedial portal methods that are currently under use and the wide availability of graft types that will be used to reconstruct the ACL. In addition, concomitant soft tissue injuries to the menisci and capsule are frequently present after ACL injury and, if left unaddressed, can lead to persistent instability even after the ACL has been reconstructed. Advances in the field of biomechanics that help to objectively measure motion of the knee joint may provide more precise data than current subjective clinical measurements. These technologies include extra-articular motion capture systems that measure the movement of the tibia in relation to the femur. With data gathered from these devices, a threshold for satisfactory knee stability may be established in order to correctly identify a successful reconstruction following ACL injury.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
