Effects of the tibial tunnel position on knee joint stability and meniscal contact pressure after double-bundle anterior cruciate ligament reconstruction

Sakamoto, Yukiko; Tsukada, Harehiko; Sasaki, Shizuka; Kimura, Yuka; Yamamoto, Yuji; Tsuda, Eiichi; Ishibashi, Yasuyuki

doi:10.1016/j.jos.2019.12.006

Cited by 8 publications

(10 citation statements)

References 27 publications

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“…demonstrated that contact pressure (i.e., compressive stress) in the posteromedial regions of the meniscus that are under anterior load to the tibia is increased by ACLT. 15 In addition, previous studies reported that abnormal compressive stress induces proliferative changes in the meniscal after ACLT in guinea pig knees in vivo and bovine meniscus explants in vitro . 2 Meniscal proliferation after ACLT was also detected in our study; the meniscus area was enlarged via increases in both height and length at 4 weeks post-surgery.…”

Section: Discussionmentioning

confidence: 98%

“…Joint laxity induced by ACL injury increases mechanical stress on the meniscus. 12-15 For example, using freshly amputated human knees, Sakamoto et al . demonstrated that contact pressure (i.e., compressive stress) in the posteromedial regions of the meniscus that are under anterior load to the tibia is increased by ACLT.…”

Section: Discussionmentioning

confidence: 99%

“…The second aim of this study was to closely examine the protective effects of ACLR, which is the most common surgical treatment for ACL injury, 1 on secondary meniscal tears using histomorphological and histopathological methods. ACLR reduces joint laxity, which induces abnormal mechanical stresses on the meniscus, 13,15-17 and consequently decreases the risk of secondary meniscal tears. 4,18 ACL injury-induced joint laxity in humans is almost completely reversed by ACLR, 16 whereas the small body size of rats poses some technical difficulties to surgical precision.…”

Section: Discussionmentioning

confidence: 99%

“…2,11 Prevention of secondary meniscal tears is thus considered a critical issue in the management of patients with ACL injuries. Abnormal mechanical stresses due to joint laxity are considered to play an important role in the development of meniscal tears, 12-15 but the mechanisms for the formation of meniscal tears following ACL injury are not fully understood. Moreover, the interactions between meniscal tears, proliferation, and ossification are not well known.…”

Section: Introductionmentioning

confidence: 99%

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The Natural History of Medial Meniscal Tears in the ACL Deficient and ACL Reconstructed Rat Knee

et al. 2021

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Objective The process of anterior cruciate ligament (ACL) injury-induced meniscal tear formation is not fully understood. Clinical studies have shown that ACL reconstruction (ACLR) reduces the development of secondary meniscal tears, but it is difficult to gain insight into the protective effects of ACLR from clinical studies alone. Using rat ACL transection (ACLT) and ACLR models, we aimed to reveal (1) the formation process of meniscal tears secondary to ACLT and (2) the protective effects of ACLR on secondary meniscal tears. Design ACLT surgery alone or with ACLR was performed on the knees of rats. Histomorphological and histopathological changes were examined in the posteromedial region of the meniscus in intact rats and in rats that received ACLT or ACLR up to 12 weeks postsurgery. In addition, anterior-posterior joint laxity was measured using the universal testing machine to evaluate the effects of ACLT and ACLR on joint laxity. Results AAnterior-posterior laxity was significantly increased by ACLT compared to the intact knee. This ACLT-induced joint laxity was partially but significantly reduced by ACLR. Meniscal proliferation and hyaline cartilage–like tissue formation were detected in the medial meniscus at 4 weeks post-ACLT. At 12 weeks post-ACLT, hyaline cartilage–like tissue was replaced by ossicles and meniscal tears were observed. These ACLT-induced abnormalities were attenuated by ACLR. Conclusions Our results suggest that ACLT-induced joint laxity induces secondary medial meniscal tears through meniscal proliferation and ossicle formation via endochondral ossification. Joint re-stabilization by ACLR suppresses meniscal proliferation and ossicle formation and consequently prevents secondary meniscal tears.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Natural History of Medial Meniscal Tears in the ACL Deficient and ACL Reconstructed Rat Knee

et al. 2021

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“…Although ACL reconstruction is the standard treatment for ACL injury with satisfactory results in most cases, postoperative stability is not necessarily perceived as subjective improvement [ 1 ]. The most frequent technical error is an anterior placement of the femoral tunnel [ 2 ]; another reason for the unsatisfactory results is that the geometric complexity of the ACL cannot be completely reproduced during surgical reconstruction [ 3 ]. Therefore, numerous biomechanical and anatomical studies have been conducted on ACL reconstruction to improve its results.…”

Section: Introductionmentioning

confidence: 99%

Failure load of the femoral insertion site of the anterior cruciate ligament in a porcine model: comparison of different portions and knee flexion angles

et al. 2021

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Background This study compared the failure load of the femoral insertion site of the anterior cruciate ligament between different portions and knee flexion angles. Methods In total, 87 fresh-frozen, porcine knees were used in this study. Three knees were used for histological evaluation; the remaining 84 knees were randomly divided into 4 groups: anterior anteromedial bundle, posterior anteromedial bundle, anterior posterolateral bundle, and posterior posterolateral bundle groups (n=21 per group). The anterior cruciate ligament femoral insertion site was divided into these four areas and excised, leaving a 3-mm square attachment in the center of each bundle. Tibia-anterior cruciate ligament-femur complexes were placed in a material testing machine at 30°, 120°, and 150° of knee flexion (n=7), and the failure load for each portion was measured under anterior tibial loading (0.33 mm/s). Results Histological study showed that the anterior cruciate ligament femoral insertion site consisted of direct and indirect insertions. Comparison of the failure load between the knee flexion angles revealed that all the failure loads decreased with knee flexion; significant decreases were observed in the failure load between 30 and 150° knee flexion in the posterior anteromedial bundle and posterior posterolateral bundle groups. Comparison of the failure load according to different portions revealed a significant difference between the anteromedial and posterolateral bundle groups at 150° of knee flexion, but no significant difference among the groups at 30° of flexion. Conclusions Although the failure load of the posterior portion decreased significantly in the knee flexion position, it (mainly consisting of indirect insertion) plays a significant role against anterior tibial load in the knee extension position; this appears to be related to the characteristics of the insertion site. Reflecting the complex structure and function of the ACL, this study showed that the failure load of the femoral insertion site varies with differences in positions and knee flexion angles.

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Laterally shifted tibial tunnel can be the risk of residual knee laxity for double-bundle anterior cruciate ligament reconstruction

Chiba

Yamamoto

Kimura

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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Purpose To elucidate the relationship between graft tunnel position and knee laxity in the cases of double-bundle ACL reconstruction. Methods Total of 132 cases were included. Femoral and tibial tunnels were evaluated by quadrant method on 3D-CT. As additional reference of tibia, the distances from medial tibial spine to the tunnel center (D MS ) and from Parsons' knob to the tunnel center (D PK ) were evaluated; %D MS /ML and %D PK /AP were calculated (ML and AP: mediolateral and anteroposterior width of tibial plateau). Preoperative and postoperative (1 year from surgery) stabilities were evaluated by Lachman and pivot-shift procedures. If there was ≥ 2 mm side-to-side diference, the subject was deined as having anterior knee laxity (AKL); if the pivot-shift phenomenon was observed with IKDC grade ≥ 1, there was rotatory knee laxity (RKL). Multiple logistic regression analysis was conducted with the prevalence of AKL or RKL as the dependent variable and with tunnel positions as the independent variables. Results Overall, 21 subjects (15.9%) showed AKL, and 15 subjects (11.4%) showed RKL. Those with postoperative laxity showed higher %D MS /ML and higher femoral position than those without laxity. Regarding posterolateral bundle, logistic regression model estimated that %D MS /ML was associated with the prevalence of AKL (B = 0.608; p < 0.001) and RKL (B = 0.789; p < 0.001); %high-low femoral tunnel position (B = − 0.127; p = 0.023) was associated with that of RKL. Conclusion There was the risk of residual knee laxity in ACL-reconstructed knee when tibial tunnel shifted more laterally or higher femoral tunnel was created with regard to posterolateral bundle. Level of evidence III.

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Effects of the tibial tunnel position on knee joint stability and meniscal contact pressure after double-bundle anterior cruciate ligament reconstruction

Cited by 8 publications

References 27 publications

The Natural History of Medial Meniscal Tears in the ACL Deficient and ACL Reconstructed Rat Knee

The Natural History of Medial Meniscal Tears in the ACL Deficient and ACL Reconstructed Rat Knee

Failure load of the femoral insertion site of the anterior cruciate ligament in a porcine model: comparison of different portions and knee flexion angles

Laterally shifted tibial tunnel can be the risk of residual knee laxity for double-bundle anterior cruciate ligament reconstruction

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