Knee Ligament Anatomy and Biomechanics

Hassebrock, Jeffrey D.; Gulbrandsen, Matthew T; Asprey, Walker; Makovicka, Justin L.; Chhabra, Anikar

doi:10.1097/jsa.0000000000000279

Cited by 66 publications

(53 citation statements)

References 66 publications

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“…Moreover, we modeled the posterior capsule, anterolateral and arcuate ligaments. These were included after the model validation simulations since the model was also used to experiment with dynamic movements where the role of these secondary ligaments cannot be ignored 66 – 68 . The values and constitutive models 39 , 69 – 72 for the above soft tissues are presented in the supplementary materials (Sect.…”

Section: Methodsmentioning

confidence: 99%

Evaluation of anterior cruciate ligament surgical reconstruction through finite element analysis

Risvas

Stanev

Benos

et al. 2022

Sci Rep

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Anterior cruciate ligament (ACL) tear is one of the most common knee injuries. The ACL reconstruction surgery aims to restore healthy knee function by replacing the injured ligament with a graft. Proper selection of the optimal surgery parameters is a complex task. To this end, we developed an automated modeling framework that accepts subject-specific geometries and produces finite element knee models incorporating different surgical techniques. Initially, we developed a reference model of the intact knee, validated with data provided by the Open Knee(s) project. This helped us evaluate the effectiveness of estimating ligament stiffness directly from MRI. Next, we performed a plethora of “what-if” simulations, comparing responses with the reference model. We found that (a) increasing graft pretension and radius reduces relative knee displacement, (b) the correlation of graft radius and tension should not be neglected, (c) graft fixation angle of 20$$^{\circ }$$ ∘ can reduce knee laxity, and (d) single-versus double-bundle techniques demonstrate comparable performance in restraining knee translation. In most cases, these findings confirm reported values from comparative clinical studies. The numerical models are made publicly available, allowing for experimental reuse and lowering the barriers for meta-studies. The modeling approach proposed here can complement orthopedic surgeons in their decision-making.

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Section: Methodsmentioning

confidence: 99%

Evaluation of anterior cruciate ligament surgical reconstruction through finite element analysis

Risvas

Stanev

Benos

et al. 2022

Sci Rep

View full text Add to dashboard Cite

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“…The precise attachment points on the lateral femoral condyle can be identified using the lateral intercondylar ridge (resident's ridge) and the lateral bifurcate ridge (cruciate ridge). 15 Within this area, the AM bundle occupies a position located on the proximal portion of the medial wall of the lateral femoral condyle, and the PL bundle occupies a more distal position near the anterior articular cartilage surface of the lateral femoral condyle. In general, the tibial attachment is located anterolaterally to the medial intercondylar tubercle ( Fig 2).…”

Section: Review Of Acl Anatomy and Biomechanicsmentioning

confidence: 99%

“…24 The ACL also serves as a secondary restraint to external and internal tibial rotation, in conjunction with the medial collateral ligament and surrounding posteromedial structures. 15,25,26 The bundles serve unique roles throughout the entirety of the knee range of motion (ROM)dthe AM bundle is tight in flexion and is primarily responsible for restraining anterior tibial translation, whereas the PL bundle is tight in extension and more responsible for rotational stability. 27,28 The bundles change alignment as the knee moves from extension to flexion.…”

Section: Review Of Acl Anatomy and Biomechanicsmentioning

confidence: 99%

“…Evidence in the literature has indicated that the tensile strength of the ACL is affected by age, stress, and overall strain. 15 In a cadaveric study, Woo et al 29 reported that the tensile strength of the ACL in patients ages 22 to 35 was approximately 2160 N, with tensile strength reducing by a factor of 2.5 as age increases. Several studies have shown that the AM bundle has a higher maximum stress and strain (change in length under a certain load) compared to the PL bundle.…”

Section: Review Of Acl Anatomy and Biomechanicsmentioning

confidence: 99%

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Contemporary Principles for Postoperative Rehabilitation and Return to Sport for Athletes Undergoing Anterior Cruciate Ligament Reconstruction

Badawy

Jan

Beck

et al. 2022

Arthroscopy, Sports Medicine, and Rehabilitation

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Despite advancements in our understanding of anterior cruciate ligament (ACL) injury prevention and nonsurgical management, ACL reconstruction continues to occur at an alarming rate. Among athletic patients, individuals participating in basketball, soccer, and football have the highest incidence of ACL injury, often requiring surgical intervention. To ensure the optimal treatment strategy for return to sport and prevention of secondary graft re-tear, it is important to tailor to the specific demands of the injured athlete and apply evidence-based best practices and rehabilitation principles. The purpose of this review is to provide readers with a brief background regarding ACL injuries, a focused review of clinical outcome studies after ACL reconstruction, and an updated framework with expert-guided recommendations for postoperative rehabilitation and return to sporting activity. Currently, there is no gold standard for rehabilitation after ACL reconstruction, highlighting the need for robust studies evaluating the best modalities for athlete rehabilitation, as well as determining the efficacy of new tools for improving therapy including blood flow restriction therapy and neuromuscular electrical stimulation. Based on clinical experience, a renewed focus on objective, criteriabased milestones may maximize the ability of return to preinjury levels of athletic function.A t all participation levels, the risk of anterior cruciate ligament (ACL) injury is exceedingly high among athletes involved in jumping, pivoting, and rapid change of direction. Previous literature has demonstrated that soccer, football, basketball, and lacrosse are among the sports with highest incidence of ACL tears, with females having higher rates of injury per exposure. 1,2 Additionally, the large majority of ACL injuries result in surgical intervention, resulting in lost participation in sport and high risk of inability to return to baseline performance. 2,3 Although a number of studies in the literature have attempted to evaluate appropriate screening tests and prevention programs for ACL injuries in athletes, the frequency of ACL injury remains high, particularly among athletes after primary ACL reconstruction (ACLR), with estimates as high as 29% among those returning to pivoting/cutting sport. [4][5][6] To add to the complexity of managing ACL injuries, there are a plethora of studies describing outcomes at short-, mid-, and long-term follow-up for a number of different reconstruction modalities, with little consensus on a gold-standard for surgical treatment of ACL injuries in athletes. 7 Additionally, guidance on appropriate postoperative rehabilitation in the athlete population remains inconsistent. As such, the purpose of this review is to summarize the literature on clinical and functional outcomes after ACLR, with a

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“…Moreover, we modeled the posterior capsule, anterolateral and arcuate ligaments. These were included after the model validation simulations since the model was also used to experiment with dynamic movements where the role of these secondary ligaments cannot be ignored [66][67][68] . The values and constitutive models 39,[69][70][71][72] for the above soft tissues are presented in the supplementary materials (subsubsection 2.3).…”

Section: Materials Propertiesmentioning

confidence: 99%

Evaluation of Anterior Cruciate Ligament Surgical Reconstruction Through Finite Element Analysis

Risvas

Stanev

Benos³

et al. 2021

Preprint

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Anterior Cruciate Ligament (ACL) tear is one of the most common knee injuries. The ACL reconstruction surgery aims to restore healthy knee function by replacing the injured ligament with a graft. Proper selection of the optimal surgery parameters is a complex task. To this end, we developed an automated modeling framework that accepts subject-specific geometries and produces finite element knee models incorporating different surgical techniques. Initially, we developed a reference model of the intact knee, validated with data provided by the OpenKnee project. This helped us evaluate the effectiveness of estimating ligament stiffness directly from MRI. Next, we performed a plethora of “what-if” simulations, comparing responses with the reference model. We found that a) increasing graft pretension and radius reduces relative knee displacement, b) the correlation of graft radius and tension should not be neglected, c) graft fixation angle of 20 degrees can reduce knee laxity, and d) single-versus double-bundle techniques demonstrate comparable performance in restraining knee translation. In most cases, these findings confirm reported values from comparative clinical studies. The numerical models are made publicly available, allowing for experimental reuse and lowering the barriers for meta-studies. The modeling approach proposed here can complement orthopedic surgeons in their decision-making.

show abstract

Knee Ligament Anatomy and Biomechanics

Cited by 66 publications

References 66 publications

Evaluation of anterior cruciate ligament surgical reconstruction through finite element analysis

Evaluation of anterior cruciate ligament surgical reconstruction through finite element analysis

Contemporary Principles for Postoperative Rehabilitation and Return to Sport for Athletes Undergoing Anterior Cruciate Ligament Reconstruction

Evaluation of Anterior Cruciate Ligament Surgical Reconstruction Through Finite Element Analysis

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