Loss of Internal Tibial Rotation After Anterior Cruciate Ligament Reconstruction

Abstract

The flexion angle of the knee and the position of the tibia need to be considered during tensioning of the anterior cruciate ligament (ACL) graft to avoid overconstraining the knee. The purpose of this report was to describe 2 cases of loss of tibial internal rotation after single-bundle anatomic ACL reconstruction with graft tensioning in flexion. Retrospective review of each patient's operative chart revealed that the graft was tensioned in flexion and placed in an anatomic position in the femoral tunnel at the time of the index operation. Primary outcome was ACL revision surgery. Secondary outcome data included Lysholm scores and Lachman and pivot shift tests. Two patients underwent revision ACL reconstruction with a more vertical tunnel placed through a transtibial technique. The graft was tensioned in full knee extension and neutral rotation of the tibia. This resulted in restoration of normal tibial internal rotation to 10°. Lysholm scores improved from 35 to 90 in patient 1 and from 12 to 61 in patient 2. Patient 1 returned to college soccer at 6 months postoperatively. Her knee was stable to Lachman and pivot shift tests. Patient 2 has been followed for 12 months and has returned to all normal activities without pain or dysfunction. Anatomic femoral placement of the ACL with improper positioning of the knee during tensioning of the graft may capture the knee and lead to loss of the normal internal rotation. The surgeon should be aware of this complication during primary ACL reconstruction. [Orthopedics. 2018; 41(1):e22-e26.].

Medial and Lateral Hamstrings Response and Force Production at Varying Degrees of Knee Flexion and Tibial Rotation in Healthy Individuals

“…Other authors have shown there to be a fewer degree of tibial internal rotation anatomically present in the human body compared external rotation, therefore coupling knee flexion with incremental degrees of internal tibial rotation may not produce a significant effect on medial hamstring activation. 32,33 Conversely, with lateral hamstring activation (as well as overall force output), the overall magnitude of peak muscle activation continued to decrease as the knee angle became more flexed throughout the testing range, with the greatest activation and force being generated at the most extended knee angle tested (30°). This held true for all three orientations of the tibia, and to the author's knowledge is the first time this has been shown in a controlled experimental setting.…”