Direct in vitro measurement of forces in the cruciate ligaments. Part II

Markolf, Keith L.; Wascher, Daniel C.; Finerman, Gerald A. M.

doi:10.2106/00004623-199303000-00010

Cited by 166 publications

(71 citation statements)

References 11 publications

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“…The percentage of increase in the ACL graft forces ranges from 98% at 0°of flexion to 229% at 90°of flexion. However, in contrast to our results, LaPrade et al [11] and Markolf et al [10] found that the ACL and ACL graft were unloaded (decrease in ACL and ACL graft forces) under external tibial torque, when the LCL and PC or LCL and posterolateral capsular structures were sectioned. While there is no obvious explanation for the discrepancy observed between these studies and our results, critical factors such as the differences in the loading conditions, sequence of sectioning the PLS and coupled motions under external tibial torque may have contributed.…”

Section: Discussioncontrasting

confidence: 99%

“…While isolated injuries to the PLS are less common (28%) [5], about 29-89% of the patients injure their PLS in conjunction with the anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL) or both [4,[6][7][8][9]. Failure to diagnose the injury to the PLS has been found to increase the forces experienced by the ACL and ACL grafts and lead to their subsequent failure [10,11]. Hence, recently more rigorous examination for posterolateral injuries and their treatment has been emphasised.…”

Section: Introductionmentioning

confidence: 99%

“…Load sharing patterns of intact ACL and PCL in knees with uninjured and combined injury of lateral collateral ligament (LCL) and PLS were investigated in a cadaver model under various external loading conditions [10]. This study demonstrated that sectioning of LCL and PLS increased the forces in the ACL under both varus and internal tibial torques.…”

Section: Introductionmentioning

confidence: 99%

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The effect of isolated popliteus tendon complex injury on graft force in anterior cruciate ligament reconstructed knees

Gadikota

Seon

et al. 2010

International Orthopaedics (SICOT)

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Failure to diagnose injury to the posterolateral structures has been found to increase the forces experienced by the anterior cruciate ligament (ACL) and ACL grafts which may cause their subsequent failure. An isolated injury to the popliteus complex (PC) consisting of the popliteus tendon and popliteofibular ligament is not uncommon. Therefore, the purpose of this study was to discover if an isolated injury to the PC can significantly affect the forces experienced by the ACL graft under external loading conditions. We hypothesised that, under external tibial torque, the ACL graft will experience a significant increase in force, in knees with PC injury compared to the intact PC condition. Under varus tibial torque (10 N m), we observed minimal changes in the varus tibial rotation due to isolated sectioning of the PC in an ACL reconstructed knee (P> 0.05). Consequently, no significant increase in the ACL graft force was observed under varus tibial torque. In contrast, sectioning the PC resulted in a significant increase in the external tibial rotation compared to the intact PC knee condition under the external rotational tibial torque (5 N m) at all flexion angles (P<0.05). These changes in kinematics under external tibial torque were manifested as elevated ACL graft forces at all selected flexion angles (P<0.05). Prompt diagnosis of isolated PC injury and its treatment are warranted to prevent potential failure of ACL reconstruction.

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Section: Discussioncontrasting

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The effect of isolated popliteus tendon complex injury on graft force in anterior cruciate ligament reconstructed knees

Gadikota

Seon

et al. 2010

International Orthopaedics (SICOT)

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“…Selected bundles of knee ligaments were instrumented and the loads in two flexion angles of the joint measured. To obtain whole ligament forces, Markolf et al (1991Markolf et al ( , 1993 and Wascher et al (1993) connected a load-cell to the tibial insertion sites of the anterior and posterior cruciate ligaments of the knee. These studies have provided considerable in formation concerning the in situ forces developed within the cruciate ligaments.…”

Section: Introductionmentioning

confidence: 99%

An inverse dynamics modeling approach to determine the restraining function of human knee ligament bundles

Mommersteeg

Huiskes

Blankevoort

et al. 1997

Journal of Biomechanics

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Abstract-During knee motion, the fiber bundles of ligaments are nonuniformly loaded in a recruitment pattern which is different for successive knee-joint positions. As a result, the restraining functions of these ligaments are variable. To analyze the relative restraint contributions of the fiber bundles in different knee-joint positions, a new method was developed. Its application was illustrated for the cruciate ligaments of one knee-joint specimen.The methods developed to estimate bundle forces comprise five steps. First, the three-dimensional motions of a knee specimen are measured for anterior-posterior forces, using Rdntgcn Stereophotogrammetric Analysis. Second, bone-ligament-bone tensile tests are performed to evaluate the mechanical properties of these structures in several relative orientations of the bones. Third, multiple fiber bundles are identified in each ligament, based on the main fiber orientations. Fourth, the nonlinear force-length relationship of each functional bundle, as defined by a stiffness and a recruitment parameter, is determined by combining the multidirectional tensile tests with a multiline-element ligament model. Finally, the information obtained is combined in a whole-joint computer model of the knee, to determine the internal forces in the initial kinematic experiment, using an inverse dynamics approach.The technique appeared to be extremely time consuming and technologically involved. However, it was demonstrated to be useful and effective. The preliminary results reveal that the fiber bundle restraints are extremely sensitive to the knee flexion angle and the restraining forces are highly variable within the ligaments. For both cruciate ligaments, a gradual transition was demonstrated in load transfer from the posterior bundles to the more anteriorly positioned ones during knee flexion. Furthermore, it appeared that relatively high forces were carried by only a few fiber bundles at each flexion angle. Based on these preliminary results, it is concluded that the determination of forces in multiple ligament bundles is important for the understanding of failure mechanisms of ligaments. In particular, alternate loading of different fiber bundles suggests that successful operative reconstruc tion of the cruciate ligaments may not be achieved simply by a one-bundle preparation.

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“…Tensile load and elongation were usually measured in only one direction. In functional analyses, forces were determined in whole ligaments (Markolf et al, 1993) In previous studies, we proposed an alternative concept of the ligaments to evaluate their functions. They were considered, conceptually, as collections of several tensile elements with vari able orientations, lengths and mechanical properties, rather than as one-dimensional structures (Mommersteeg et «/., 1996).…”

Section: Introductionmentioning

confidence: 99%

A global verification study of a quasi-static knee model with multi-bundle ligaments

Mommersteeg

1996

Journal of Biomechanics

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Abstract-The ligaments of the knee consist of fiber bundles with variable orientations, lengths and mechanical properties. In concept, however, these structures were too often seen as homogeneous structures, which are either stretched or slack during knee motions. In previous studies, we proposed a new structural concept of the ligaments of the knee. In this concept, the ligaments were considered as multi-bundle structures, with nonuniform mechanical properties and zero force lengths. The purpose of the present study was to verify this new concept.For this purpose, laxity characteristics of a human knee joint were compared as measured in an experiment and predicted in a model simulation study. In the experiment, the varus-valgus and anterior-posterior laxities of a knee-joint specimen containing the ligaments and the articular surfaces only, were determined. From this knee-joint, geometric and mechanical parameters were derived to supply the parameters for a three-dimensional quasi-static knee-joint model. These parameters included (i) the three-dimensional insertion points of bundles, defined in the four major knee ligaments, (ii) the mechanical properties of these ligament, as functions of their relative insertion orientations and ( From the model-experiment comparisons it was concluded that the proposed structural representations of the ligaments and their mechanical property distributions seem to be valid for studying the anterior-posterior and varus-valgus laxity characteristics of the human knee-joint,

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Direct in vitro measurement of forces in the cruciate ligaments. Part II

Cited by 166 publications

References 11 publications

The effect of isolated popliteus tendon complex injury on graft force in anterior cruciate ligament reconstructed knees

The effect of isolated popliteus tendon complex injury on graft force in anterior cruciate ligament reconstructed knees

An inverse dynamics modeling approach to determine the restraining function of human knee ligament bundles

A global verification study of a quasi-static knee model with multi-bundle ligaments

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