Loading of the two bundles of the posterior cruciate ligament: An analysis of bundle function in A-P drawer

Race, Amos; Amis, Andrew A.

doi:10.1016/0021-9290(95)00161-1

Cited by 107 publications

(88 citation statements)

References 19 publications

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“…It also consists of two bundles: anterolateral and posteromedial. While the posteromedial PCL is tight the anterolateral PCL is slack in extension and vice versa in the flexed knee [47]. It also resists internal rotation of the knee in deep flexion.…”

Section: Functional Biomechanicsmentioning

confidence: 99%

Clinically relevant biomechanics of the knee capsule and ligaments

Halewood

Amis

2015

Knee Surg Sports Traumatol Arthrosc

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Abstract:The paper describes the concepts of primary and secondary restraints to knee joint stability, and explains systematically how the tibia is stabilised against translational forces and rotational torques in different directions and axes, and how those vary across the arc of flexion-extension. It also shows how the menisci act to stabilise the knee, in addition to load-carrying across the joint. It compares the properties of the natural stabilising structures with the strength and stiffness of autogenous tissue grafts, and relates those strengths to the strength of graft fixation devices. A good understanding of the biomechanical behaviour of these various structures in the knee will help the surgeon in the assessment and treatment of single and multi-ligament injuries.Response to Reviewers: 1. At the end of the Abstract, please add a sentence or two about the … clinical relevance … Authors' response: this has been done 2. The different sections and subsections of the manuscript should not be numbered, e.g. it should be … Introduction and not … 1 Introduction, and this needs to be corrected throughout.Authors' response: this has been done 3. Tables (like table 1 Clinically relevant biomechanics of the knee capsule and ligaments AbstractThe paper describes the concepts of primary and secondary restraints to knee joint stability, and explains systematically how the tibia is stabilised against translational forces and rotational torques in different directions and axes, and how those vary across the arc of flexion-extension. It also shows how the menisci act to stabilise the knee, in addition to loadcarrying across the joint. It compares the properties of the natural stabilising structures with the strength and stiffness of autogenous tissue grafts, and relates those strengths to the strength of graft fixation devices. A good understanding of the biomechanical behaviour of these various structures in the knee will help the surgeon in the assessment and treatment of single and multi-ligament injuries.

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Section: Functional Biomechanicsmentioning

confidence: 99%

Clinically relevant biomechanics of the knee capsule and ligaments

Halewood

Amis

2015

Knee Surg Sports Traumatol Arthrosc

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“…In-vivo testing on subjects has advantages such as being able to perform normal activity, but 309 By imposing known displacements/rotations to the tibia at fixed flexion angles and 320 measuring the reduction of displacing force required by cutting ligaments around the knee, 321 the percentage contribution of various ligaments to resisting that movement can be 322 calculated (Race and Amis, 1996). 323…”

Section: In Vitro Cadaver Testing 308mentioning

confidence: 99%

Clinical biomechanics of instability related to total knee arthroplasty

Athwal

Hunt

Davies

et al. 2014

Clinical Biomechanics

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Background: Tibiofemoral instability is a common reason for total knee arthroplasty failure, and may be attributed to soft tissue deficiency and incorrect ligament balancing. There are many different designs of implant with varying levels of constraint to overcome this instability; however there is little advice for surgeons to assess which is suitable for a specific patient, and soft tissue balance testing during arthroplasty is very subjective. Method: The current theories on primary and secondary soft tissue restraints to anterior/ posterior, varus/ valgus, and internal/ external rotational motion of the knee are discussed. The paper reviews biomechanics literature to evaluate instability in the intact and implanted knee. Findings: The paper highlights important intra-and extra-capsular structures in the knee and describes the techniques used by clinicians to assess instability perioperatively. In vitro cadaveric studies were found to be a very useful tool in comparing different implants and contributions of different soft tissues. Interpretation: In vitro cadaveric studies can be utilised in helping less experienced surgeons with soft tissue releases and determining the correct implant. For this to happen, more biomechanical studies must be done to show the impact of release sequences on implanted cadavers, as well as determining if increasingly constrained implants restore the stability of the knee to pre-deficient conditions.

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“…A selective cutting study by Race and Amis [39] found that the aPC was the primary restraint to 6 mm tibial posterior translation from 30 to 120 degrees knee flexion (Fig. 3).…”

Section: Figmentioning

confidence: 99%

The effects of lateral meniscal allograft transplantation techniques on tibio-femoral contact pressures

McDermott

Lie

Edwards

et al. 2008

Knee Surg Sports Traumatol Arthr

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102

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This paper reviews and updates our knowledge of the anatomy and biomechanics of the posterior cruciate ligament, and of the posterolateral, posteromedial and meniscofemoral ligaments of the knee. The posterior cruciate ligament is shown to have two functional fibre bundles that are tight at different angles of knee flexion. It is the primary restraint to tibial posterior draw at all angles of knee flexion apart from near full extension. In contrast, the posterolateral and posteromedial structures are shown to tighten as the knee extends, and to be well-aligned to resist tibial posterior draw. These structures also act as primary restraints against other tibial displacements. Tibial internal rotation is restrained by the medial and posteromedial structures, while tibial external rotation is restrained by the lateral and posterolateral structures. They are also the primary restraints against tibial abduction-adduction rotations. The meniscofemoral ligaments are shown, for the first time, to contribute significantly to resisting tibial posterior draw, and to have a strength of approximately 300 N. Taken together, this evidence shows how the posterolateral and posteromedial structures are responsible for posterior knee stability near extension, and this, along with the action of the meniscofemoral ligaments, may explain why an isolated rupture of the posterior cruciate ligament does not often lead to knee instability

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Loading of the two bundles of the posterior cruciate ligament: An analysis of bundle function in A-P drawer

Cited by 107 publications

References 19 publications

Clinically relevant biomechanics of the knee capsule and ligaments

Clinically relevant biomechanics of the knee capsule and ligaments

Clinical biomechanics of instability related to total knee arthroplasty

The effects of lateral meniscal allograft transplantation techniques on tibio-femoral contact pressures

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