Anatomy and biomechanics of the anterior cruciate ligament

Dienst, Michael; Burks, Robert T.; Greis, Patrick E.

doi:10.1016/s0030-5898(02)00010-x

Cited by 141 publications

(103 citation statements)

References 71 publications

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“…Anatomically, the ACL can be divided into two functional bundles: the anteromedial (AM) and posterolateral (PL) bundles [5]. The AM bundle appears to be an important stabiliser against anteroposterior loads, particularly when a knee is flexed by more than 15°; whereas, the PL bundle provides additional anteroposterior knee stability when the knee is in the near-extended position [20].…”

Section: Discussionmentioning

confidence: 99%

Kinematic study following double-bundle, anterior cruciate ligament reconstruction

Seon

Song

Bae

et al. 2006

International Orthopaedics (SICO

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The purpose of this study was to evaluate tibiofemoral kinematics after double-bundle anterior cruciate ligament (ACL) reconstructions and compare them with those of successful single-bundle reconstructions and contralateral normal knees using open MR images. We obtained MR images based on the flexion angle without weight-bearing, from 20 patients with successful unilateral single-bundle (10 patients) and double-bundle (10 patients) ACL reconstructions with tibialis anterior allografts and a minimum 1-year follow-up. The MR images of the contralateral uninjured knees were used as normal controls. Sagittal images of the mid-medial and mid-lateral sections of the tibiofemoral compartments were used to measure the translation of the femoral condyles relative to the tibia. The mean translations of the medial femoral condyles on the tibial plateaus during knee joint motion showed no significant differences among normal, single-bundle, and double-bundle ACL reconstructed knees (all p>0.05). The mean translations of the lateral femoral condyles showed a significant difference between normal and single-bundle reconstructed knees, or between single-bundle and doublebundle reconstructed knees (p<0.05). However, there was no significant difference between normal and doublebundle reconstructed knees (p=0.220). These findings suggest that double-bundle ACL reconstruction restores normal kinematic tibiofemoral motion better than singlebundle reconstruction.Résumé Le but de cette étude était d'évaluer, par les images de résonnance magnétique, la cinématique tibiofémorale après reconstruction du ligament croisé antérieur par double tunnel et de la comparer avec celle obtenue après réussite des reconstructions à un seul tunnel et celle du genou normal controlatéral. Nous avons étudié des images basées sur l'angle de flexion en décharge chez 20 patients après reconstruction par allogreffe tibiale antérieure suivis au moins un an : 10 avec succés de la reconstruction par un seul tunnel et 10 avec reconstruction par un double tunnel. Les images du genou controlatéral non traumatisé servaient de contrôle. Des images sagittales de la partie moyenne des compartiments fémoro-tibiaux permettaient la mesure de la translation des condyles fémoraux par rapport au tibia. La translation du condyle interne pendant la flexion du genou n'était pas différente entre le genou normal et la reconstruction par simple ou double tunnel (p>0,05). La translation du condyle externe était significativement différente entre le genou normal et la reconstruction par simple tunnel et entre les reconstructions par simple et double tunnel (p<0,05). Cependant il n'y avait pas de différence entre le genou normal et la reconstruction par double tunnel (p=0,220). Ces résultats suggèrent que la reconstruction du croisé antérieur par double tunnel restore mieux la cinématique du genou que la reconstruction par simple tunnel.

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Section: Discussionmentioning

confidence: 99%

Kinematic study following double-bundle, anterior cruciate ligament reconstruction

Seon

Song

Bae

et al. 2006

International Orthopaedics (SICO

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“…16 This can be correlated with the findings of Dienst et al: a lower notch-width index is linked to a smaller ACL. 17 Another biological factor that correlates with ACL injury risk seems to be the maturation of the skeleton, muscles, and neurological function. There is no difference between pre-adolescent gender characteristics, but following maturation, males undergo an increase in strength and coordination, allowing an increased neuromuscular control with differences in jumping and landing.…”

Section: Risk Factorsmentioning

confidence: 99%

Prevention of Primary ACL Injuries: A Novel, Innovative Approach

Fleacă

Roman

Bățagă

et al. 2017

Journal of Interdisciplinary Medicine

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Anterior cruciate ligament (ACL) injuries are increasing amongst professional and recreational athletes, and creating prevention programs to reduce the occurrence of ACL damages is becoming a necessity. To prevent an ACL tear, it is necessary to comprehend the mechanisms and the risk factors of injury. Biomechanical and clinical studies try to understand these complex mechanisms in order to identify factors that can be improved and to develop training programs to prevent at least non-contact ACL injuries. There are several promising programs, but there are still many questions to answer. This paper analyzes the risk factors for ACL injuries and some aspects of the modern programs developed to decrease the rate of ACL tears.

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“…Femoral insertion of the ACL is located on the posterior aspect of the inner lateral femoral condyle (Dienst, Burks, & Greis, 2002;Duthon et al, 2006;Zantop et al, 2006) and bordered by the lateral inter-condylar ridge and lateral bifurcate ridge (Kopf et al, 2011). Described as a circle segment or oval shape, the size of the ACL at insertion ranges between 12.9 -17.2 mm proximal to distal and 6.8 -9.9 mm anterior to posterior (Piefer, Pflugner, Hwang, & Lubowitz, 2012), accounting for 45 -75 % of the lateral femoral notch (Dienst et al, 2002).…”

Section: Figure 2-2: Tibial Insertion Of the Aclmentioning

confidence: 99%

“…Described as a circle segment or oval shape, the size of the ACL at insertion ranges between 12.9 -17.2 mm proximal to distal and 6.8 -9.9 mm anterior to posterior (Piefer, Pflugner, Hwang, & Lubowitz, 2012), accounting for 45 -75 % of the lateral femoral notch (Dienst et al, 2002). Within the femoral footprint, the AM bundle is positioned proximal and anterior relative to the PL bundle, which is posterior and inferior [ Figure 2-3] (Bicer et al, 2010).…”

Section: Figure 2-2: Tibial Insertion Of the Aclmentioning

confidence: 99%

“…The tibio-femoral (TF) joint exhibits three degrees of translation (anterior-posterior, medial-lateral, proximal-distal) and three degrees of rotation (flexion-extension, external-internal, abductionadduction), allowing 12 possible movements (Dienst et al, 2002). Collectively, all ligamentous structures of the knee provide stability for each motion (Fu, Harner, Johnson, Miller, & Woo, 1993).…”

Section: Biomechanics Of the Aclmentioning

confidence: 99%

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Graft tensioning in anterior cruciate ligament reconstruction

Kirwan¹

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BackgroundAnterior cruciate ligament reconstruction (ACLR) is an effective procedure for restoring stability and function. Being a technically demanding procedure, patient outcomes are highly dependent on numerous surgical factors, which are critical for success. The application of tension to the graft prior to tibial fixation is one such factor and is considered essential for the restoration of joint stability, normal knee biomechanics, graft revascularisation and patient function. In applying tension, a key factor is the amount of force applied to the graft. However, the method of applying the tension, position of the knee during tensioning, properties of the graft material, tunnel placement and graft fixation device can all influence the effect that graft tension has on outcomes. Despite the reported importance of graft tension there has been limited empirical evidence defining the best tensioning practice for restoring patient outcome post ACLR. AimsThe goal of this program of research was to explore the effect that different aspects of graft tensioning has on patient function post ACLR. To address the aims of the thesis, three studies were conducted. The first study was a systematic review aimed at examining if a particular amount of tension results in better functional outcomes post ACLR. The second study aimed to compare the effect of two methods of applying graft tension on patient function post ACLR. The study used a prospective randomised controlled trial to compare manual tensioning with the use of a tensioning device. The third study aimed to define current graft tensioning practices and explore the factors that influence surgical decision making. A national survey of Australian orthopaedic surgeons was conducted to achieve the aims of the study. ResultsThe systematic review (study one) revealed that a medium graft tension of 79N to 90N produced the least side-to-side difference (STSD) in anterior posterior (AP) tibial translation as measured by a KT-1000 when compared to tensions <79 or >90N. However, the heterogeneous use of functional outcomes inhibited the ability to draw conclusions on other patient specific functional outcomes.Furthermore, the review highlighted the lack of high quality studies, which also failed to discuss other aspects of graft tension such as the method of applying tension.iii Building on the findings of study one, the second study undertook a RCT to compare the functional outcomes of applying 80N of force with a tensioning device (TD) (n=10) to a manual tensioning method (MT) (n=13) using an estimated force described as a sustained maximum one handed pull.Patients were assessed at pre-surgery and two weeks, three months, six months and 12 months post Based on the findings of study one, tensioning between 79N and 90N appeared to improve the restoration of joint stability, when compared to higher and lower tensions. However, no effect on patient function within 24 months post surgery was apparent. Furthermore, study two observed that tension did not appear to have an...

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Anatomy and biomechanics of the anterior cruciate ligament

Cited by 141 publications

References 71 publications

Kinematic study following double-bundle, anterior cruciate ligament reconstruction

Kinematic study following double-bundle, anterior cruciate ligament reconstruction

Prevention of Primary ACL Injuries: A Novel, Innovative Approach

Graft tensioning in anterior cruciate ligament reconstruction

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