Effect of femoral tunnel positions on graft stress in outside‐in ACL reconstruction surgery during continuous knee motion: A simulation study

Kang, Kyung-Min; Bae, Tae Soo

doi:10.1002/rcs.1817

Cited by 10 publications

(15 citation statements)

References 20 publications

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“…Large stresses on the graft and stresses close to the femoral or tibial tunnels were thought to be closely related to graft injuries and the widening of tunnels after surgery [ 15 , 32 ]. Given the importance of avoiding high levels of stress, the results of this study seem to be significant.…”

Section: Discussionmentioning

confidence: 99%

Dual fluoroscopic imaging and CT-based finite element modelling to estimate forces and stresses of grafts in anatomical single-bundle ACL reconstruction with different femoral tunnels

et al. 2021

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Purpose Little is known about the in vivo forces and stresses on grafts used in anterior cruciate ligament (ACL) reconstruction. The aims of this study were to evaluate and compare the forces and stresses on grafts used in anatomical single-bundle ACL reconstruction at different locations of the femoral footprint (anterior vs middle vs posterior; high vs middle vs low) during a lunge motion. Methods Establish subject-specific finite element models with different graft’s tunnel loci to represent the primary ACL reconstructions. A displacement controlled finite element method was used to simulate lunge motions (full extension to ~ 100° of flexion) with six-degree-of-freedom knee kinematics data obtained from the validated dual fluoroscopic imaging techniques. The reaction force of the femur and maximal principal stresses of the grafts were subsequently calculated during knee flexion. Results Increased and decreased graft forces were observed when the grafts were located higher and lower on the femoral footprint, respectively; anterior and posterior graft placement did not significantly affect the graft force. Lower and posterior graft placement resulted in less stress on the graft at higher degrees of flexion; there were no significant differences in stress when the grafts were placed from 0° to 30° of flexion on the femoral footprint. Conclusion The proposed method is able to simulate knee joint motion based on in vivo kinematics. The results demonstrate that posterior to the centre of the femoral footprint is the strategic location for graft placement, and this placement results in anatomical graft behaviour with a low stress state.

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Section: Discussionmentioning

confidence: 99%

Dual fluoroscopic imaging and CT-based finite element modelling to estimate forces and stresses of grafts in anatomical single-bundle ACL reconstruction with different femoral tunnels

et al. 2021

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“…For this, a model capable of MFBD analysis was implemented using a commercial analysis program (RecurDyn V9R1, FunctionBay, Korea) [6].…”

Section: Three-dimensional Multiflexible Body Dynamic Modelmentioning

confidence: 99%

Biomechanical Effects of Aspect Ratio of the Knee during Outside-In Anterior Cruciate Ligament Reconstruction Surgery

Bae

Cho

Kwak

2021

BioMed Research International

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We analyzed tunnel length, graft bending angle, and stress of the graft according to tunnel entry position and aspect ratio (ASR: ratio of anteroposterior depth to mediolateral width) of the articular surface for the distal femur during single-bundle outside-in anterior cruciate ligament reconstruction (ACLR) surgery. We performed multiflexible body dynamic analyses with four ASR (98, 105, 111, and 117%) knee models. The various ASRs were associated with approximately 1 mm changes in tunnel length. The graft bending angle increased when the entry point was far from the lateral epicondyle and was larger when the ASR was smaller. The graft was at maximum stress, 117% ASR, when the tunnel entry point was near the lateral epicondyle. The maximum stress value at a 5 mm distance from the lateral epicondyle was 3.5 times higher than the 15 mm entry position, and the cases set to 111% and 105% ASR showed 1.9 times higher stress values when at a 5 mm distance compared with a 15 mm distance. In the case set at 98% ASR, the low-stress value showed a without-distance difference from the lateral epicondyle. Our results suggest that there is no relationship between the ASR and femoral tunnel length. A smaller ASR causes a higher graft bending angle, and a larger ASR causes greater stress in the graft.

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“…The work of Kim et al (2011) was used as a validation case study by Bae et al (2016). Finally, three papers did not refer to any validation assessment (Chizari et al, 2008;Abdullah et al, 2012;Kang and Bae, 2017) presenting preliminary results or mentioned the use of commercial FE analysis softwares.…”

Section: Verification and Validation Assessmentmentioning

confidence: 99%

“…Concerning the FE modeling, most of the studies attempted to simulate the single-bundle technique Suggs et al, 2003;Peña et al, 2005Peña et al, , 2006Chizari et al, , 2011Wan et al, 2011Wan et al, , 2017Westermann et al, 2013Westermann et al, , 2017Wang et al, 2015;Bae et al, 2016;Vairis et al, 2016;Kang and Bae, 2017;Bae and Cho, 2019;Tampere et al, 2019;Completo et al, 2019). In particular, in Suggs et al (2003), Wang et al (2015) a single nonlinear spring was used to capture the behavior of the ACL and the grafts.…”

Section: Single-or Double-bundle Acl Reconstructionmentioning

confidence: 99%

A Review on Finite Element Modeling and Simulation of the Anterior Cruciate Ligament Reconstruction

Benos

Stanev

Spyrou

et al. 2020

Front. Bioeng. Biotechnol.

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The anterior cruciate ligament (ACL) constitutes one of the most important stabilizing tissues of the knee joint whose rapture is very prevalent. ACL reconstruction (ACLR) from a graft is a surgery which yields the best outcome. Taking into account the complicated nature of this operation and the high cost of experiments, finite element (FE) simulations can become a valuable tool for evaluating the surgery in a pre-clinical setting. The present study summarizes, for the first time, the current advancement in ACLR in both clinical and computational level. It also emphasizes on the material modeling and properties of the most popular grafts as well as modeling of different surgery techniques. It can be concluded that more effort is needed to be put toward more realistic simulation of the surgery, including also the use of two bundles for graft representation, graft pretension and artificial grafts. Furthermore, muscles and synovial fluid need to be included, while patellofemoral joint is an important bone that is rarely used. More realistic models are also required for soft tissues, as most articles used isotropic linear elastic models and springs. In summary, accurate and realistic FE analysis in conjunction with multidisciplinary collaboration could contribute to ACLR improvement provided that several important aspects are carefully considered.

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Effect of femoral tunnel positions on graft stress in outside‐in ACL reconstruction surgery during continuous knee motion: A simulation study

Abstract: Considering the availability of surgery, it was identified that the optimum femoral tunnel location is at 10 mm radius locations at a proximal posterior of 45°.

Cited by 10 publications

References 20 publications

Dual fluoroscopic imaging and CT-based finite element modelling to estimate forces and stresses of grafts in anatomical single-bundle ACL reconstruction with different femoral tunnels

Dual fluoroscopic imaging and CT-based finite element modelling to estimate forces and stresses of grafts in anatomical single-bundle ACL reconstruction with different femoral tunnels

Biomechanical Effects of Aspect Ratio of the Knee during Outside-In Anterior Cruciate Ligament Reconstruction Surgery

A Review on Finite Element Modeling and Simulation of the Anterior Cruciate Ligament Reconstruction

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