Excursion of bone-patella tendon-bone grafts during the flexion–extension movement in anterior cruciate ligament reconstruction: Comparison between isometric and anatomic reconstruction techniques

Take, Yasuhiro; Mae, Tatsuo; Nakata, Ken; Nakagawa, Shigeto; Tachibana, Yuta; Shino, Konsei

doi:10.1016/j.asmart.2015.03.002

Cited by 3 publications

(6 citation statements)

References 38 publications

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“…Second, because the diameter of the thread graft used in this study was thin (0.8 mm), we cannot refer to the length changes of the thick tendon graft in the ACL-reconstructed knee. However, a thin thread graft has been commonly used in many length measurement studies, 3 , 5 , 7 , 8 , 19 , 20 , 22 , 30 , 33 because a thick graft can hardly move within a bone tunnel due to the high friction force between the graft surface and the tunnel wall, so that it is difficult to precisely measure length changes of the graft. Therefore, we believe that the study design using the thin thread graft is acceptable for a biomechanical length measurement study.…”

Section: Discussionmentioning

confidence: 99%

“… 3 , 8 , 19 The length change of several grafts can be repeatedly measured in 1 knee because the measurement rarely destroys the bone tunnels or the graft fixation site. Therefore, measurement of graft length changes has been frequently used not only in basic science studies 3 , 7 , 8 , 19 , 20 , 22 but also in clinical studies 5 , 30 , 33 to evaluate the function of grafts reconstructed with various ACL reconstruction procedures.…”

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confidence: 99%

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Comparison of Graft Length Changes During Knee Motion Among 5 Different Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction Approaches: A Biomechanical Study

Tanabe

Yasuda

Kondo

et al. 2019

Orthopaedic Journal of Sports Medicine

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Background:In several anatomic single-bundle anterior cruciate ligament (ACL) reconstruction (ASB-ACLR) procedures, the femoral and tibial tunnel apertures are created at different locations within the native ACL attachment area.Hypothesis:Graft length changes during knee motion will be different among ASB-ACLR procedures with different femoral and tibial tunnel aperture locations.Study Design:Controlled laboratory study.Methods:A total of 12 cadaveric knees were used in this study. In each knee, 4 and 3 thin tunnels were created within the ACL attachment area on the femur and the tibia, respectively. Using 1 of 5 different combinations of femoral and tibial tunnel aperture location, 5 ASB-ACLRs were performed on each knee. In each reconstruction approach, a strong thread was used in place of the tendon graft, and the tibial graft end was tethered to a custom-made isometric positioner at 0° of knee flexion, with an approximately 12-N load applied to the thread. Then, each specimen underwent 5 cycles of knee flexion-extension motion in a range between 0° and 120°, and graft length changes were determined for each SB-ACLR approach.Results:The length changes of the graft were significantly different among the 5 ASB-ACLRs. The maximum length change values of the 3 grafts that were implanted between the femoral and tibial centers of the posterolateral bundle attachments or implanted into the femoral tunnel created at the center of the fanlike extension fiber attachment were significantly greater than those of the graft implanted between the centers of the anteromedial bundle attachments (P < .0001) and of the graft implanted between the centers of the whole ACL attachments (P < .0001).Conclusion:The length changes of the graft during knee motion were significantly different among the 5 ASB-ACLR approaches, even though all of the tunnel apertures were created within the femoral and tibial attachments of the native ACL.Clinical Relevance:The grafts in the first 3 graft locations may be so relaxed during knee flexion that they cannot resist anterior drawer loads exerted on the tibia.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Comparison of Graft Length Changes During Knee Motion Among 5 Different Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction Approaches: A Biomechanical Study

Tanabe

Yasuda

Kondo

et al. 2019

Orthopaedic Journal of Sports Medicine

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“…Take et al 21 compared the excursion of bone-patellar tendon-bone grafts during flexion-extension movement between isometric and anatomic reconstruction techniques in ACL reconstruction. The mean length change of the grafts in total was 1.0 ± 0.7 mm in the isometric technique and 3.4 ± 0.9 mm in the anatomic technique, quite similar to our results.…”

Section: Discussionmentioning

confidence: 99%

Effect of Nearly Isometric ACL Reconstruction on Graft-Tunnel Motion: A Quantitative Clinical Study

Wan

Chen

et al. 2019

Orthopaedic Journal of Sports Medicine

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Background: In anterior cruciate ligament (ACL) reconstruction, minimizing the graft-tunnel motion (GTM) will promote graft-to-bone healing and avoid graft loosening or tearing as well as potential bone tunnel enlargement. A nearly isometric state of the graft can be achieved by placing the tunnel properly to theoretically gain better graft-to-bone healing. However, little clinical evidence is available to quantify the relation between GTM and tunnel position. Purpose: To find the proper zones for the femoral and tibial tunnel apertures that minimize the GTM, referred to as the “nearly isometric zone,” through use of intraoperative GTM measurement and 3-dimensional computed tomography (3D-CT). Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 100 patients were enrolled in this study. Nearly isometric ACL reconstruction was performed, and an intra-articular GTM measuring device was designed to measure and record the amplitude of GTM while the knee was flexed from 0° to 120°. Postoperatively, the patients underwent multislice CT, and the images were used to create 3D-CT models. After tibial aperture examination, 5 patients were excluded due to the divergence of tibial aperture, and therefore 95 patients remained in the study. Patients were divided into 2 groups according to whether the lateral intercondylar ridge was absent or present. The Bernard-Hertel grid coordinates ( h, t) of the femoral tunnel were then quantified. Results: The maximal GTM (mGTM) was a mean ± SD of 1.06 ± 0.66 mm (range, 0.0-3.0 mm). The mGTM in patients with a lateral intercondylar ridge was significantly lower than that in patients without a lateral intercondylar ridge (0.81 ± 0.39 vs 1.59 ± 0.73 mm, respectively; P < .0001). The average h and t were 0.227 ± 0.079 and 0.429 ± 0.770, respectively. Notably, in 1 patient, the mGTM was 0 mm whereas the coordinates ( h, t) of the femoral tunnel were 0.250 and 0.255. The overall GTM slowly increased before 90° but increased significantly after the knee was bent 105° ( P = .010). Correlation analysis showed that the t coordiinate had significant correlation with mGTM ( R = 0.581; P < .001). A gradient pattern was created to show the nearly isometric blue zone (mGTM <0.5 mm), which was found to overlap with the IDEAL (isometric, direct insertion, eccentric, anatomic, low tension-flexion pattern) position. Conclusion: A method of measuring intraoperative GTM and quantifying femoral tunnel position on postoperative 3D-CT was successfully developed. The presence of a lateral condylar ridge can significantly reduce mGTM. A nearly isometric zone was described that was consistent with the IDEAL concept.

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“…The native ligament is anisometric with greatest tension and length in full extension. 1 , 2 , 3 , 4 Anatomic reconstructions mimic this anisometric behaviour 5 , 6 , 7 , 8 , 9 , 10 , 11 although the degree of anisometry varies depending on socket placement within the footprint, particularly on the femoral side. 5 , 9 , 10 , 12 Fixing an anatomic graft in a knee flexed position therefore, may over-constrain the joint as it extends into its anisometric range and result in high graft forces and a flexion deformity.…”

Section: Introductionmentioning

confidence: 94%

“…Anatomic centre-to-centre reconstruction (CTCR) has been shown to approximate the tension-flexion curve of the native ACL 1 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 and when tensioned with the knee in 20°-30° flexion, to better match the laxities of the intact knee than other anatomic constructs. 22 , 23 Much of the work on the biomechanics and isometricity of CTCRs has employed simulations or cadaveric models using 4-strand Gracilis-Semitendinosis (GST) grafts fixed with femoral closed loop devices (CLD) and tibial interference screw fixation.…”

Section: Introductionmentioning

confidence: 99%

Flexion deformity and laxity as a function of knee position at the time of tensioning of rigid anatomic hamstring ACL grafts

McEwen

McArthur

Brereton

et al. 2020

Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilit

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Background Anatomic ACL grafts routinely display the anisometric length-tension behaviour seen in the native ligament with maximum length in full knee extension. Recent improvements in hamstring graft preparation and fixation have improved graft rigidity to the point where total graft lengthening after implantation may be less than 1 mm. Despite this it remains common practice to fix these grafts in a knee flexed position. Methods Nineteen participants underwent all-inside ACL reconstruction with optimally preconditioned 4 strand semitendinosus grafts using bi-cortical adjustable suspensory loop fixation. Using a computer navigation system, baseline measures of anisometricity, extension range, and tibial rotation were made. The graft was tensioned and provisionally fixed with the knee flexed 5° beyond its anisometric point and extension range recorded. The graft was then definitively fixed with the knee fully extended and extension range and tibial rotation recorded again. Anterior laxity measurements were made pre-operatively and postoperatively using a manual arthrometer and compared to those from the contralateral limb. Results Fixing the graft with the knee flexed produced a mean FD of 10.9° (p < 0.0001) and fixing in extension restored full extension (p = 0.661). Fixing in extension restored anterior laxity at 30° (p = 0.224) and at 90° (p = 0.668). There were very strong correlations between post-operative and control extension range (r = 0.931, p < 0.0001) and anterior laxity and 30° (r = 0.830, p < 0.0001) measures. Constraint of tibial internal rotation increased by 2.9° during the pivot-shift (p < 0.001) and increased with pivot shift grade (r = 0.474, p = 0.040). Conclusion Fixing rigid anatomic hamstring grafts in a knee flexed position routinely produces a flexion deformity. Tensioning and fixing grafts with the knee fully extended restores full extension and anterior laxity at 30° and 90°. Rotational constraint is significantly improved and correlates with the pivot-shift grade. Clinical relevance Rigid anatomic grafts should be tensioned and fixed with the knee fully extended.

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Excursion of bone-patella tendon-bone grafts during the flexion–extension movement in anterior cruciate ligament reconstruction: Comparison between isometric and anatomic reconstruction techniques

Cited by 3 publications

References 38 publications

Comparison of Graft Length Changes During Knee Motion Among 5 Different Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction Approaches: A Biomechanical Study

Comparison of Graft Length Changes During Knee Motion Among 5 Different Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction Approaches: A Biomechanical Study

Effect of Nearly Isometric ACL Reconstruction on Graft-Tunnel Motion: A Quantitative Clinical Study

Flexion deformity and laxity as a function of knee position at the time of tensioning of rigid anatomic hamstring ACL grafts

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