Muscle contributions to medial tibiofemoral compartment contact loading following ACL reconstruction using semitendinosus and gracilis tendon grafts

Abstract

BackgroundThe muscle-tendon properties of the semitendinosus (ST) and gracilis (GR) are substantially altered following tendon harvest for the purpose of anterior cruciate ligament reconstruction (ACLR). This study adopted a musculoskeletal modelling approach to determine how the changes to the ST and GR muscle-tendon properties alter their contribution to medial compartment contact loading within the tibiofemoral joint in post ACLR patients, and the extent to which other muscles compensate under the same external loading conditions during walking, running and sidestep cutting.Materials and methodsMotion capture and electromyography (EMG) data from 16 lower extremity muscles were acquired during walking, running and cutting in 25 participants that had undergone an ACLR using a quadruple (ST+GR) hamstring auto-graft. An EMG-driven musculoskeletal model was used to estimate the medial compartment contact loads during the stance phase of each gait task. An adjusted model was then created by altering muscle-tendon properties for the ST and GR to reflect their reported changes following ACLR. Parameters for the other muscles in the model were calibrated to match the experimental joint moments.ResultsThe medial compartment contact loads for the standard and adjusted models were similar. The combined contributions of ST and GR to medial compartment contact load in the adjusted model were reduced by 26%, 17% and 17% during walking, running and cutting, respectively. These deficits were balanced by increases in the contribution made by the semimembranosus muscle of 33% and 22% during running and cutting, respectively.ConclusionAlterations to the ST and GR muscle-tendon properties in ACLR patients resulted in reduced contribution to medial compartment contact loads during gait tasks, for which the semimembranosus muscle can compensate.

Identification of locations susceptible to osteoarthritis in patients with anterior cruciate ligament reconstruction: Combining knee joint computational modelling with follow-up T1ρ and T2 imaging

“…In that study, it was shown that simpler knee models can produce similar cartilage responses with more complex models. The FE model with motion implemented using kinetics and kinematics (forces and rotations), and without patella and quadriceps forces, produced reaction forces and contact pressures within physiological limits (Gilbert et al, 2014;Konrath et al, 2017;Kutzner et al, 2010;Pizzolato et al, 2017). Details of the material properties for each soft tissue are shown in Table 1.…”

“…Postoperatively, knee OA can be present even in short-term follow-ups of ACLR (Culvenor et al, 2015;Eckstein et al, 2015;Williams et al, 2017). One of the mechanisms leading to OA for ACLR patients could be altered joint biomechanics and excessive stresses and strains experienced by articular cartilage (Gardinier et al, 2013;Konrath et al, 2017;Wellsandt et al, 2016).…”

Do There Exist Innovative Perspectives in Tissue Engineering-Based Ligament Reconstruction?

“…At many locations autografts represent the gold standard of ligament reconstruction, associated with limited availability and donor site morbidity. 40 Therefore, biological tissue engineered constructs would be appreciated as a novel approach. So far no tissue engineering-based ligament reconstruction strategy is available for clinical application.…”

Adaptation after vastus lateralis denervation in rats suggests neural regulation of joint stresses and strains

“…This previous work, however, has generally ignored another critical aspect of muscle actions: how muscles act on internal joint structures such as ligaments or articular cartilage between bones 11 . Although muscle actions on internal joint structures have been considered in clinical biomechanics or sports medicine in the context of injuries [12][13][14][15] , their more general role in the context of the neural control of movement and how they are balanced with task goals remains poorly understood. We examine these issues in this study, evaluating the hypothesis that the nervous system chooses muscle activations to achieve task performance while minimizing internal joint stresses and strains.…”