An experimental evaluation of isometric placement for extraarticular reconstructions of the anterior cruciate ligament

Abstract

We measured the changes in distance between the tibial and femoral attachment points of the extraarticular ACL substitute during knee motion. To measure the changes in distance continuously and directly, a computer-assisted experimental system was developed using an electrolyte-in-rubber transducer. We used 6 cadaveric knees to measure changes in distance of 15 combinations during a simple flexion and extension knee motion. The distance became longer with flexion in each pair of attachment locations. Although the smallest change in distance was obtained between the posterolateral site of the femoral distal metaphysis and a point posterior to the Gerdy tubercle (percent average of the maximum strain was about 12%), it was concluded that the extraarticular ACL reconstruction is not recommended from a standpoint of isometry of the substitute.

Length Change Patterns in the Lateral Extra-articular Structures of the Knee and Related Reconstructions

“…Only a few studies of the isometry of lateral extra-articular reconstructions have been published, with none of these considering a graft passing deep to the LCL. 10,22,23,41 Given that a lateral reconstruction is intended to stabilize the weightbearing knee and that the knee has greater rotational laxity when flexed, it may be desirable for a graft to be longer/tighter in extension and shorter/slacker in flexion.…”

Absolute Isolated Avulsion of the Anterolateral Complex of the Knee: A Segond Fracture

“…Its free end was prepared with Krakow sutures using Ethibond 2 (Ethicon, Somerville, NJ, USA). For the femoral fixation, an 8mm diameter tunnel was drilled at the most isometric femoral point described by Kurosawa et al 16 for ACL extra-articular reconstruction. The graft was routed deeply to the lateral collateral ligament (LCL) according to the Cooker-Arnold technique.…”

“…The graft was routed deeply to the lateral collateral ligament (LCL) according to the Cooker-Arnold technique. 16 An interference screw BIORCI HA 8mm x 35mm (Smith & Nephew, Inc, Andover, MA, USA) was used to fix the graft with the knee at 45º of flexion in neutral rotational. During the stability evaluation tests, it was noticed a graft rupture at the femoral tunnel aperture.…”

“…Several extra-articular ACL reconstruction techniques exist for an ACL injury model. 19 The authors utilized the femoral isometric point suggested by Kurosawa et al 16 and the final aspect of the reconstruction was similar to the ALL reconstruction technique proposed by Claes 15 at 2013.…”

Experimental Evaluation of 3-Dimensional Kinematic Behavior of the Cruciate Ligaments

“…Researchers who agree with the standards indicated by our results for these fiber bundles are Crowninshield et al 7 and Shelburne & Pandy, 27 although the latter reported a slight slackening of the fibers in the 30°-to-60° angular moment, and Fox et al 28 and Li et al 23 found a maximum tension of the bundle at 90°. On the other hand Kurosawa et al 29,30 described a slackening of the fibers in the most posterior positions, while Beynnon et al 22 reported a slackening of the fibers as a unit during knee flexion, and Amis et al 31 reported that the posterolateral and posteromedial structures tighten as the knee extends. Harner et al 32,33 indicated that this bundle plays an important role in joint stabilization after PCL reconstruction.…”