ACL Graft Position Affects in Situ Graft Force Following ACL Reconstruction

Abstract

Rehabilitation and return to sports progression may need to be modified to protect an anatomically placed graft after ACL reconstruction.

A prospective study to evaluate the clinico-radiological outcomes of arthroscopic single bundle versus double bundle anterior cruciate ligament reconstruction

“…Incorrect placement of the grafts is a primary reason for early graft failure, lack of extension and flexion, and residual instability with the single-bundle technique. 7,8,20 Thus, these findings suggest that there is a need for a more anatomical ACL reconstruction using a design that closely replicates the 2 bundles of the ACL in terms of anatomical tunnel placement leading to anatomical ACL graft angles and inclination in both sagittal as well as coronal planes.…”

“…Incorrect placement of the grafts is a common primary reason for early graft failure, lack of extension and flexion, and residual instability after ACLR. 7,8 Recently, many anatomical studies have evaluated the femoral and tibial insertion sites of the ACL bundle to determine correct tunnel placement when performing ACL reconstruction with the single or double-bundle technique. [9][10][11] Postoperative MRI scanning is a useful imaging tool to detail the graft orientation and inclination angles apart from its footprint size and tunnel location.…”

In Vivo Analysis of Dynamic Graft Bending Angle in Anterior Cruciate Ligament–Reconstructed Knees During Downward Running and Level Walking: Comparison of Flexible and Rigid Drills for Transportal Technique

“…A recent analysis based on the Danish ACL registry reported an increased revision rate with anatomic ACL reconstruction, compared with the conventional trans-tibial technique 25 . It has been suggested that anatomic reconstruction may contribute to graft damage or poor graft healing by creating higher stress between the bone and the graft, due to impingement against intercondylar wall 26,27 , higher forces or tension applied in the reconstructed graft near extension 2,28,29 , greater length change of the graft 30 and steeper graft bending angles at the tunnel aperture 31-33 . Simple physics would suggest that a properly sized, anatomically placed graft should not “impinge” any more than the native ACL, and should undergo similar stress and length change 34-38 .…”

Lateral Extraarticular Tenodesis in Combined ACL and ALL Reconstruction. Case presentation

“…To increase efficiency in the reconstruction of ACL and ALL ligaments, software, biointerfaces and robotic systems will be used in the future [28][29][30][31][32][33][34][35].…”