Does the anterolateral ligament protect the anterior cruciate ligament in the most common injury mechanisms? A human knee model study

Blanke, Fabian; Boljen, Matthias; Lutter, Christoph; Oehler, Nicola; Tischer, Thomas; Vogt, Stephan

doi:10.1016/j.knee.2021.02.026

Cited by 6 publications

(10 citation statements)

References 40 publications

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“…The knee angle has been adjusted to 25° in order to acquire a more critical reference configuration for ACL ruptures. In this configuration, the reference lengths of the ligaments were stated in a recent publication [ 15 ]. All material properties and contact definitions in the model components were kept constant and have not been modified.…”

Section: Methodsmentioning

confidence: 99%

“…However, the ALL is not able to stabilize the external rotation of the tibia which often is part of the ACL injury mechanism, especially in combination with valgus stressing, a fact that is often overlooked [ 11 – 14 ]. Therefore, to stabilize the tibial external rotation anteromedial structures should be brought into focus [ 15 ]. The fact of high rates of concomitant MCL ruptures during ACL injuries confirms this assumption [ 16 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

“…It should extend obliquely from the medial femoral epicondyle to the anterior medial part of the proximal tibia. This is already backed up by increasing interest in the medial side in ACL injuries and the importance of the complex architecture of the whole MCL with influence of the different fibers like the more anterior superficial MCL (sMCL) and the posterior oblique ligament (POL) [ 15 – 17 , 23 – 25 ].…”

Section: Introductionmentioning

confidence: 99%

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An anteromedial stabilization procedure has the most protective effect on the anterior cruciate ligament in tibial external rotation. A human knee model study

Blanke,

Boljen,

Oehler

et al. 2024

Arch Orthop Trauma Surg

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Introduction Anterior cruciate ligament (ACL) reconstruction remains associated with the risk of re-rupture and persisting rotational instability. Additional extraarticular anterolateral stabilization procedures stabilize the tibial internal rotation and lead to lower ACL failure rate and improved knee stability. However, data for additional stabilization of tibial external rotation is lacking and the importance of an anteromedial stabilization procedure is less well evaluated. Aim of this study is to investigate the influence of an extraarticular anteromedial stabilization procedure for the stabilization of the tibial external rotation and protection of the ACL from these rotational forces. Methods Internal and external rotations of the tibia were applied to a finite element (FE) model with anatomical ACL, posterior cruciate ligament (PCL), lateral collateral ligament (LCL), medial collateral ligament (MCL) and intact medial and lateral meniscus. Five additional anatomic structures (Anteromedial stabilization/anteromedial ligament, AML, augmented superficial medial collateral ligament, sMCL, posterior oblique ligament, POL, anterolateral ligament, ALL, and popliteal tendon, PLT) were added to the FE model separately and then combined. The force histories within all structures were measured and determined for each case. Results The anteromedial stabilization or imaginary AML was the main secondary stabilizer of tibial external rotation (90% of overall ACL force reduction). The AML reduced the load on the ACL by 9% in tibial external rotation which could not be achieved by an augmented sMCL (-1%). The AML had no influence in tibial internal rotation (-1%). In the combined measurements with all additional structures (AML, ALL, PLT, POL) the load on the ACL was reduced by 10% in tibial external rotation. Conclusion This study showed that an additional anteromedial stabilization procedure secures the tibial external rotation and has the most protective effect on the ACL during these external rotational forces.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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An anteromedial stabilization procedure has the most protective effect on the anterior cruciate ligament in tibial external rotation. A human knee model study

Blanke,

Boljen,

Oehler

et al. 2024

Arch Orthop Trauma Surg

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“…Meniscus and cartilage as a combination of [52,77]. For the ligaments, different sources were investigated, such as [48,57,78,79]. The implants were modeled following the properties given by [10].…”

Section: Declarations Fundingmentioning

confidence: 99%

How effective is proximal fibular osteotomy in redistributing joint pressures? Insights from an HTO comparative in-silico study

Avalos,

Guajardo

et al. 2024

Preprint

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Background: Knee osteoarthritis (KOA) represents a widespread degenerative condition among adults that significantly affects quality of life. This study aims to elucidate the biomechanical implications of proximal fibular osteotomy (PFO), a proposed cost-effective and straightforward intervention for KOA, comparing its effects against traditional high tibial osteotomy (HTO) through in-silico analysis. Methods: Using medical imaging and finite element analysis (FEA), this research quantitatively evaluates the biomechanical outcomes of a simulated PFO procedure in patients with severe medial compartment genu-varum, who 1 have undergone surgical correction with HTO. The study focused on evaluating changes in knee joint contact pressures, stress distribution, and anatomical positioning of the center of pressure (CoP). Three models are generated for each of the five patients investigated in this study, a preoperative original condition model, an in-silico PFO based on the same original condition data, and a reversed-engineered HTO in-silico model. Results: The novel contribution of this investigation is the quantitative analysis of the impact of PFO on the biomechanics of the knee joint. The results provide mechanical evidence that PFO can effectively redistribute and homogenize joint stresses, while also repositioning the CoP towards the center of the knee, similar to what is observed after HTO. The findings propose PFO as a potentially viable and simpler alternative to conventional surgical methods for managing severe KOA, specifically in subjects with medial compartment genu-varum. Conclusion: This research also marks the first application of FEA that may support one of the underlying biomechanical theories of PFO, providing a foundation for future clinical and in-silico studies.

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“…Meniscus and cartilage as a combination of [ 54 , 80 ]. For the ligaments, different sources were investigated, such as [ 50 , 59 , 81 , 82 ]. The implants were modeled following the properties given by [ 11 ] (Table 3 ).…”

Section: Appendix 1: Additional Tablesmentioning

confidence: 99%

How effective is proximal fibular osteotomy in redistributing joint pressures? Insights from an HTO comparative in-silico study

Morales Avalos,

Morales-Avalos,

Martínez-Guajardo

et al. 2024

J Orthop Surg Res

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Background Knee osteoarthritis (KOA) represents a widespread degenerative condition among adults that significantly affects quality of life. This study aims to elucidate the biomechanical implications of proximal fibular osteotomy (PFO), a proposed cost-effective and straightforward intervention for KOA, comparing its effects against traditional high tibial osteotomy (HTO) through in-silico analysis. Methods Using medical imaging and finite element analysis (FEA), this research quantitatively evaluates the biomechanical outcomes of a simulated PFO procedure in patients with severe medial compartment genu-varum, who have undergone surgical correction with HTO. The study focused on evaluating changes in knee joint contact pressures, stress distribution, and anatomical positioning of the center of pressure (CoP). Three models are generated for each of the five patients investigated in this study, a preoperative original condition model, an in-silico PFO based on the same original condition data, and a reversed-engineered HTO in-silico model. Results The novel contribution of this investigation is the quantitative analysis of the impact of PFO on the biomechanics of the knee joint. The results provide mechanical evidence that PFO can effectively redistribute and homogenize joint stresses, while also repositioning the CoP towards the center of the knee, similar to what is observed post HTO. The findings propose PFO as a potentially viable and simpler alternative to conventional surgical methods for managing severe KOA, specifically in patients with medial compartment genu-varum. Conclusion This research also marks the first application of FEA that may support one of the underlying biomechanical theories of PFO, providing a foundation for future clinical and in-silico studies.

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Does the anterolateral ligament protect the anterior cruciate ligament in the most common injury mechanisms? A human knee model study

Cited by 6 publications

References 40 publications

An anteromedial stabilization procedure has the most protective effect on the anterior cruciate ligament in tibial external rotation. A human knee model study

An anteromedial stabilization procedure has the most protective effect on the anterior cruciate ligament in tibial external rotation. A human knee model study

How effective is proximal fibular osteotomy in redistributing joint pressures? Insights from an HTO comparative in-silico study

How effective is proximal fibular osteotomy in redistributing joint pressures? Insights from an HTO comparative in-silico study

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