Biomechanics of rotational instability and anatomic anterior cruciate ligament reconstruction

Amis, Andrew A.; Bull, Anthony M.J.; Lie, Denny

doi:10.1053/j.oto.2004.10.009

Cited by 115 publications

(92 citation statements)

References 40 publications

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“…By comparing the forces within the collateral ligaments, with intact and intra-articular reconstructed ACL procedure, our results are similar to previous findings (Amis et al, 2005;Fu et al, 1993) where the MCL were the major restraints to internal tibial rotation. In our study, we found that a resection of the ACL alters the force distribution within collateral ligaments when compared with an intact knee.…”

Section: Discussionsupporting

confidence: 90%

Biomechanical evaluation of intra-articular and extra-articular procedures in anterior cruciate ligament reconstruction: A finite element analysis

Ramaniraka

Saunier

Siegrist

et al. 2007

Clinical Biomechanics

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Background. Intra-articular techniques (single and double bundles) are the most widely used procedures for the anterior cruciate ligament reconstruction. Lemaire introduced in 1967 the extra-articular techniques, and combined intra-articular and extra-articular reconstruction, to better restore the stability of the knee. However, the effectiveness of these procedures (intra-articular, extra-articular combined or not with intra-articular) seems to be controversial.Methods. In the present study, we developed numerical models of a knee joint to evaluate the effects of these different procedures on the kinematics and biomechanics of the knee during an internal rotation test. Six cases were simulated: intact anterior cruciate ligament, intra-articular reconstructed anterior cruciate ligament (single and double bundles), extra-articular reconstructed anterior cruciate ligament alone, and combination of extra-and intra-articular reconstructions. The loading condition was an internal tibial torque of 2 N m at 0°, 15°, 30°and 45°of knee flexion. Internal rotation of the tibia and forces within the grafts and the ligaments were calculated.Findings. This study showed that both single and double bundles intra-articular reconstructions restore similar internal rotation control and biomechanics of the soft structures as the intact anterior cruciate ligament situation. On the other hand, our results indicate that extra-articular reconstruction reduces appreciably the internal rotation and modifies the charges distribution in the soft structures when compared to the intact anterior cruciate ligament.Interpretation. The extra-articular procedure alters the kinematics of the knee, which might overconstraint the ligaments and the femorotibial joints, leading to the failure of the anterior cruciate ligament reconstruction.

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Section: Discussionsupporting

confidence: 90%

Biomechanical evaluation of intra-articular and extra-articular procedures in anterior cruciate ligament reconstruction: A finite element analysis

Ramaniraka

Saunier

Siegrist

et al. 2007

Clinical Biomechanics

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“…Although a correlation between increased internal tibial rotation and deficient ACL seems obvious, the internal tibial rotation increases by less than 4°, from up to 30° of internal rotation in the intact knee [15] , when the ACL is completely ruptured [14,22] , as other collateral ligaments are also important stabilizers against internal rotation [23] . Although the resulting effect on isolated internal rotation stability seems small, the rotational axis of the knee alters from the center to a medial position near the pars intermedia of the internal meniscus when the ACL is ruptured [24] . As a consequence, the movement in the lateral compartment increases (Figure 4).…”

Section: Rotational Instability and Pivot Shift Testingmentioning

confidence: 99%

“…The complex kinematics of the knee joint and the altered strain of other ligamentous or cartilage structures suggest the importance of distinguishing the joint pressure in terms of its intraarticular sector, loading or passive condition and respective flexion angle [15] . In the ACL-deficient knee, there is a shift of the rotatory axis to the medial compartment with slightly increased freedom of motion [22,24] . Li et al [40] determined the tibiofemoral contact points during a onelegged lunge at different flexion angles in an in vivo study ( Figure 5).…”

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confidence: 99%

Biomechanics of the anterior cruciate ligament: Physiology, rupture and reconstruction techniques

Domnick

Raschke

Herbort

2016

WJO

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ligament (ACL) on kinematics and clinical outcomes have been investigated in many biomechanical and clinical studies over the last several decades. The knee is a complex joint with shifting contact points, pressures and axes that are affected when a ligament is injured. The ACL, as one of the intra-articular ligaments, has a strong influence on the resulting kinematics. Often, other meniscal or ligamentous injuries accompany ACL ruptures and further deteriorate the resulting kinematics and clinical outcomes. Knowing the surgical options, anatomic relations and current evidence to restore ACL function and considering the influence of concomitant injuries on resulting kinematics to restore full function can together help to achieve an optimal outcome. Conflict-of-interest statement:There are no conflicts of interest to declare. Open-Access:This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/ licenses/by-nc/4.0/ [1] . The ACL is a central ligament of the knee. The main functional role of the ACL is to provide stability against anterior tibial translation (ATT) and internal rotation. An acute ACL rupture is a common orthopedic trauma, with an estimated incidence of 78 per 100000 persons and a mean age of 32 years in Sweden and an estimated incidence of up to 84 per 100000 persons in the United States [2,3] . A common and frequent injury mechanism is noncontact combined valgus-and internal-rotation trauma [2,4] . Therefore, ACL injuries are often associated with other ligamentous injuries, such as a (partial) rupture of the medial collateral ligament (MCL) or the menisci. In addition, compression of the lateral condyle with a bone bruise or chondral lesion is often associated with the injury due to the valgus trauma. Persistent instability of the knee may be associated with long-term degenerative lesions. Surgical treatment of the ACL in the context of other injured structures and reconstruction of the intact joint kinematics are suggested to be the keys to a good clinical outcome [5,6] . ANATOMYThe ACL has its origin at the medial area of the lateral femoral condyle and inserts into the center of the eminentia of the tibia plateau next to the anterior horn of the lateral meniscus. The structure of the ACL has been described as two functional bundles: The anteromedial (AM) and the posterolateral (PL) bundle [7] . These two bundles have been associated with different roles in anteroposterior and complex-rotational stabilization of the joint [8][9][10] . The femoral origin was described as oval shaped with a longitudinal diameter of 18 mm and a width of approximately 11 mm [11,12] . ...

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“…In previous biomechanical 20 and clinical 7 studies, it was reported that single-bundle ACL reconstruction frequently leaves a residual mini-pivot. Amis et al 3 reported that 6 of 9 knees showed evidence of persistent residual laxity, giving rise to the phrase mini-pivot, with objective measurements of transient subluxations during pivot-shift testing at the end of ACL surgery. In previous clinical studies to evaluate single-bundle reconstruction, however, sufficient attention was not paid to the residual mini-pivot; the focus was on anterior laxity.…”

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confidence: 99%

Biomechanical Comparisons of Knee Stability After Anterior Cruciate Ligament Reconstruction Between 2 Clinically Available Transtibial Procedures

et al. 2010

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Biomechanics of rotational instability and anatomic anterior cruciate ligament reconstruction

Cited by 115 publications

References 40 publications

Biomechanical evaluation of intra-articular and extra-articular procedures in anterior cruciate ligament reconstruction: A finite element analysis

Biomechanical evaluation of intra-articular and extra-articular procedures in anterior cruciate ligament reconstruction: A finite element analysis

Biomechanics of the anterior cruciate ligament: Physiology, rupture and reconstruction techniques

Biomechanical Comparisons of Knee Stability After Anterior Cruciate Ligament Reconstruction Between 2 Clinically Available Transtibial Procedures

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