Biomechanical Evaluation of Knee Joint Laxities and Graft Forces After Anterior Cruciate Ligament Reconstruction by Anteromedial Portal, Outside-In, and Transtibial Techniques

Sim, Jae Ang; Gadikota, Hemanth R.; Li, Jingsheng; Li, Guoan; Gill, Thomas J.

doi:10.1177/0363546511420810

Cited by 59 publications

(50 citation statements)

References 20 publications

(38 reference statements)

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“…These results are consistent with Schairer et al [38] and Sim et al [40] who found no difference in AP translation compared with the intact knee with either the TT or AM technique. This is in contrast to Bedi et al [9,10] who found the AM technique to result in more accurate positioning of the ACL footprint compared with the TT technique, which corresponded with less tibial translation according to the Lachman and pivot shift test as tested on five matched cadaveric knee pairs.…”

Section: Discussionsupporting

confidence: 91%

“…In addition, Sim et al found that when torque was applied, the modified TT technique, which placed the tibial tunnel in the posterolateral quadrant of the intact footprint, failed to restore intact anterior tibial translation at both 0°and 30°c ompared with the AM technique, which only failed to do so at 30°. However, similar to our study, Sim et al [40] went on to conclude that both techniques were similar in their ability to restore rotational stability of the knee. The similar results in our patient cohorts could be attributed to the fact that the surgeons erred for a more anatomic position, especially for the femoral socket.…”

Section: Discussionsupporting

confidence: 88%

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Does Anteromedial Portal Drilling Improve Footprint Placement in Anterior Cruciate Ligament Reconstruction?

Arno

Bell

Alaia

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Considerable debate remains over which anterior cruciate ligament (ACL) reconstruction technique can best restore knee stability. Traditionally, femoral tunnel drilling has been done through a previously drilled tibial tunnel; however, potential nonanatomic tunnel placement can produce a vertical graft, which although it would restore sagittal stability, it would not control rotational stability. To address this, some suggest that the femoral tunnel be created independently of the tibial tunnel through the use of an anteromedial (AM) portal, but whether this results in a more anatomic footprint or in stability comparable to that of the intact contralateral knee still remains controversial. Questions/purposes (1) Does the AM technique achieve footprints closer to anatomic than the transtibial (TT) technique? (2) Does the AM technique result in stability equivalent to that of the intact contralateral knee? (3) Are there differences in patient-reported outcomes between the two techniques? Methods Twenty male patients who underwent a bonepatellar tendon-bone autograft were recruited for this study, 10 in the TT group and 10 in the AM group. Patients in each group were randomly selected from four surgeons at our institution with both groups demonstrating similar demographics. The type of procedure chosen for each patient was based on the preferred technique of the surgeon. Some surgeons exclusively used the TT technique, whereas other surgeons specifically used the AM technique. Surgeons had no input on which patients were chosen to participate in this study. Mean postoperative time was 13 ± 2.8 and 15 ± 3.2 months for the TT and AM groups, respectively. Patients were identified retrospectively as having either the TT or AM Technique from our institutional database. At followup, clinical outcome scores were gathered as well as the footprint placement and knee stability assessed. To assess the footprint placement and knee stability, three-dimensional surface models of the femur, tibia, and ACL were created from MRI scans. The femoral and tibial footprints of the ACL reconstruction as compared with the intact contralateral ACL were determined. In addition, the AP displacement and rotational displacement of the femur were determined. Lastly, as a secondary measurement of stability, KT-1000 measurements were obtained at the followup visit. An a priori sample size calculation indicated that with 2n = 20 patients, we could detect a difference of 1 mm with 80% power at p \ 0.05. A Welch two-sample t-test (p \ 0.05) was performed to determine differences in the footprint measurements, AP displacement, rotational displacement, and KT-1000 measurements between the TT and AM groups. We further used the confidence interval approach with 90% confidence intervals on the pairwise mean group differences using a Games-Howell post hoc test to assess equivalence between the TT and AM groups for the previously mentioned measures. Results The AM and TT techniques were the same in terms of footprint except in the distal...

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 88%

Does Anteromedial Portal Drilling Improve Footprint Placement in Anterior Cruciate Ligament Reconstruction?

Arno

Bell

Alaia

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…Much of this work has evaluated and improved the efficaciousness of surgical methods and graft material selections used in ACL reconstructions with respect to native ACL biomechanics [12,15,19,20,28,35,43,49,51,[56][57][58]. These simulations have also gathered data on the mechanical contributions of the intact ACL in response to Lachman's and pivot shift tests [15,19,20,28,35,43,49,51,[56][57][58], gait cycles [23,39], and landing impact forces [32,40,41,46,52,53]. The accrued data have advanced the knowledge of ACL function and provided a baseline of comparison by which to evaluate the effectiveness of ACL injury treatments.…”

Section: Introductionmentioning

confidence: 99%

Knee Abduction Affects Greater Magnitude of Change in ACL and MCL Strains Than Matched Internal Tibial Rotation In Vitro

Bates

Nesbitt

Shearn

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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Background Anterior cruciate ligament (ACL) injures incur over USD 2 billion in annual medical costs and prevention has become a topic of interest in biomechanics. However, literature conflicts persist over how knee rotations contribute to ACL strain and ligament injury. To maximize the efficacy of ACL injury prevention, the effects of underlying mechanics need to be better understood. Questions/purposes We applied robotically controlled, in vivo-derived kinematic stimuli to the knee to assess ligament biomechanics in a cadaver model. We asked: (1) Does the application of abduction rotation increase ACL and medial collateral ligament (MCL) strain relative to the normal condition? (2) Does the application of internal tibial rotation impact ACL strain relative to the neutral condition? (3) Does combined abduction and internal tibial rotation increase ligament strain more than either individual contribution?Methods A six-degree-of-freedom robotic manipulator was used to position 17 cadaveric specimens free from knee pathology outside of low-grade osteoarthritis (age, 47 ± 8 years; 13 males, four females) into orientations that mimic initial contact recorded from in vivo male and female drop vertical jump and sidestep cutting activities. Four-degree rotational perturbations were applied in both directions from the neutral alignment position (creating an 8°range) for each frontal, transverse, and combined planes while ACL and MCL strains were continuously recorded with DVRT strain gauges implanted directly on each ligament. Analysis of variance models with least significant difference post hoc analysis were used to assess differences in ligament strain and joint loading between sex, ligament condition, or motion task and rotation type. Results For the female drop vertical jump simulation in the intact knee, isolated abduction and combined abduction/internal rotational stimuli produced the greatest This work was supported by National Institutes of Health/NIAMS Grants #R01-AR049735 (TEH), #R01-AR055563 (TEH), #R01-AR056660 (JTS), and #R01-AR056259 (TEH -017-5367-9 Clinical Orthopaedics and Related Research ® A Publication of The Association of Bone and Joint Surgeons® change in strain from the neutral position as compared with all other stimuli within the ACL (1.5% ± 1.0%, p B 0.035; 1.8% ± 1.3%, p B 0.005) and MCL (1.8% ± 1.0%, p \ 0.001; 1.6% ± 1.3%, p \ 0.001) compared with all other applied stimuli. There were no differences in mean peak ACL strain between any rotational stimuli (largest mean difference = 2.0%; 95% confidence interval [CI], À0.9% to 5.0%; p = 0.070). These trends were consistent for all four simulated tasks. Peak ACL strain in the intact knee was larger than peak MCL strain for all applied rotational stimuli in the drop vertical jump simulations (smallest mean difference = 2.1%; 95% CI, À0.4% to 4.5%; p = 0.047). Conclusions Kinematically constrained cadaveric knee models using peak strain as an outcome variable require greater than 4°rotational perturbations to elicit changes in intraa...

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“…Anatomic anterior cruciate ligament (ACL) reconstruction is emphasized to improve joint laxity and to potentially avert initiation of cartilage degeneration. There is a paucity of information on the efficacy of ACL reconstructions by currently practiced tunnel creation techniques in restoring normal joint laxity (2).…”

Section: Discussionmentioning

confidence: 99%

“…Anatomic ACL reconstruction improves joint laxity and prevents degeneration of cartilage (2). In ACL reconstruction nowadays, the importance is and should rightly be given to anatomical graft placements to recreate normal physiologic graft tension and more knee kinematics (3).…”

Section: Introductionmentioning

confidence: 99%

CT Based Analysis of Arthroscopic Femoral Tunnel Placement in Single Bundle Primary ACL Reconstruction Using Medial Portal Technique

Ghaffar¹,

Agrawal²,

Maheshwari³

et al. 2017

IOSR JDMS

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Biomechanical Evaluation of Knee Joint Laxities and Graft Forces After Anterior Cruciate Ligament Reconstruction by Anteromedial Portal, Outside-In, and Transtibial Techniques

Cited by 59 publications

References 20 publications

Does Anteromedial Portal Drilling Improve Footprint Placement in Anterior Cruciate Ligament Reconstruction?

Does Anteromedial Portal Drilling Improve Footprint Placement in Anterior Cruciate Ligament Reconstruction?

Knee Abduction Affects Greater Magnitude of Change in ACL and MCL Strains Than Matched Internal Tibial Rotation In Vitro

CT Based Analysis of Arthroscopic Femoral Tunnel Placement in Single Bundle Primary ACL Reconstruction Using Medial Portal Technique

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