An In Vivo Prediction of Anisometry and Strain in Anterior Cruciate Ligament Reconstruction – A Combined Magnetic Resonance and Dual Fluoroscopic Imaging Analysis

Kernkamp, Willem A.; Varady, Nathan H.; Li, Jingsheng; Tsai, Tsung‐Yuan; Asnis, Peter D.; Arkel, Ewoud R.A. van; Nelissen, Rob G H H; Gill, Thomas J.; Velde, Samuel K. Van de; Li, Guoan

doi:10.1016/j.arthro.2017.10.042

Cited by 10 publications

(8 citation statements)

References 32 publications

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“…A recent study highlighted the importance of restoring functional anatomy in ACL reconstruction to achieve normal knee function [ 4 ]. Isometric placement of the graft resulted in nonanatomical graft behaviour, which can overconstrain the knee at larger flexion angles [ 7 ]. Therefore, biomechanical considerations of grafts in ACL reconstruction are as important as isometric considerations are.…”

Section: Discussionmentioning

confidence: 99%

“…This approach is limited to ex vivo applications. Because forces and stresses are directly related to strains, investigators have measured ligament displacements and calculated strain patterns to gain an understanding of the in vivo biomechanics of ACL grafts recently [ 7 ]. The combined magnetic resonance (MR) and dual fluoroscopic imaging analysis is useful for in vivo applications.…”

Section: Introductionmentioning

confidence: 99%

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Dual fluoroscopic imaging and CT-based finite element modelling to estimate forces and stresses of grafts in anatomical single-bundle ACL reconstruction with different femoral tunnels

et al. 2021

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Purpose Little is known about the in vivo forces and stresses on grafts used in anterior cruciate ligament (ACL) reconstruction. The aims of this study were to evaluate and compare the forces and stresses on grafts used in anatomical single-bundle ACL reconstruction at different locations of the femoral footprint (anterior vs middle vs posterior; high vs middle vs low) during a lunge motion. Methods Establish subject-specific finite element models with different graft’s tunnel loci to represent the primary ACL reconstructions. A displacement controlled finite element method was used to simulate lunge motions (full extension to ~ 100° of flexion) with six-degree-of-freedom knee kinematics data obtained from the validated dual fluoroscopic imaging techniques. The reaction force of the femur and maximal principal stresses of the grafts were subsequently calculated during knee flexion. Results Increased and decreased graft forces were observed when the grafts were located higher and lower on the femoral footprint, respectively; anterior and posterior graft placement did not significantly affect the graft force. Lower and posterior graft placement resulted in less stress on the graft at higher degrees of flexion; there were no significant differences in stress when the grafts were placed from 0° to 30° of flexion on the femoral footprint. Conclusion The proposed method is able to simulate knee joint motion based on in vivo kinematics. The results demonstrate that posterior to the centre of the femoral footprint is the strategic location for graft placement, and this placement results in anatomical graft behaviour with a low stress state.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Dual fluoroscopic imaging and CT-based finite element modelling to estimate forces and stresses of grafts in anatomical single-bundle ACL reconstruction with different femoral tunnels

et al. 2021

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“…Laboureau [ 15 ] found the femoral isometric point is located anterior to the anatomic footprint region, at approximately 60% of the anteroposterior length of the condyle when measured on a line parallel to the Blumensaat's line. Recent computerized studies [ 17 , 18 ] have partially supported this viewpoint showing that an isometric region in the femoral sagittal condyle and the anterior non-anatomical point have better isometry compared to the anatomical point whilst individual differences exist. These studies focused more on the femoral tunnel position rather than the tibial position [ 8 , 11 ] and demonstrate that the femoral point option is more effective to the isometry of ACLR.…”

Section: Introductionmentioning

confidence: 99%

“…Several studies [ 7 , 8 , 12 , 13 ] have reported the anterior region of the tibial ACL footprint as the most isometric tibial tunnel position rather than the centric or posterior regions when matched with the anatomical femoral tunnel position. Other studies have focused on an “over the top” femoral tunnel position, however, a more posterior tibial tunnel position is recommended from the isometry [ 17 , 18 ] standpoint using the traditional transtibial technique.…”

Section: Introductionmentioning

confidence: 99%

Establishment of near and non isometric anterior cruciate ligament reconstruction with artificial ligament in a rabbit model

Jin

Cai

Sheng

et al. 2021

Journal of Orthopaedic Translation

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Background Tunnel position deicide the isometry of graft attachment in synthetic anterior cruciate ligament (ACL) reconstruction. Near-isometric tunnel position may have advantage in graft integration and knee function in ACL reconstruction (ACLR) with polyethylene terephthalate (PET) ligament. Few studies focused on tunnel position isometry when conduct ACLR with an animal model. This study aimed to establish a preclinical rabbit model of near and non isometric ACLR with PET ligament and investigate the advantage of near-isometric ACLR compared to non-isometric ACLR. Methods Nine hind limbs of rabbit were used in tunnel position study. Two femoral(anatomic, nonanatomic) tunnels and three tibial(anterior, middle, posterior) tunnels were used to measure tunnel position isometry during knee full range of motion. The tunnel position combination with minimal isometry was considered as near-isometric tunnel position. Then, 48 rabbits divided into two groups were conducted near or non isometric ACLR with PET ligament with graft fixation angle of 30° and constant tension of 5N. PET ligament isometry, range of motion(ROM) restriction, knee laxity were recorded after operation and followed up with macroscopic observation, microcomputed tomography (micro-CT) analysis, histology assessment and biomechanical test at 4 and 8 weeks postoperatively. Results The tunnel combination with minimal isometry was femoral anatomic position and tibial posterior position(5.19 ± 1.78%) and considered as near-isometric tunnel position. ROM restriction were observed in non-isometric group (22.50 ± 14.14°) while none in near-isometric group. However, no ROM restriction observed at 8 weeks in both group. Knee laxity compared to contralateral knee were better in near-isometric group than non-isometric group (stable/slack/total 10/2/12 VS 3/9/12, p = 0.012) at 8 weeks postoperatively. Supeiror PET ligament integration were also observed in near-isometric group through macroscopic observation, micro-CT analysis, histology assessment at both 4 and 8 weeks. The failure load in the Near-Isometric group at 8 weeks were higher than timezero reconstruction with statistical difference (156.8N ± 25.98N vs.102.6 ± 22.96N, p = 0.02). Conclusion A rabbit model of ACLR based on tunnel position isometry was successfully established in this study. The near-isometric tunnel position in rabbit model was femoral anatomic position and tibial posterior position. A near-isometric ACLR with PET ligament did not cause ROM restriction and had a better graft integration and follow-up stability than non-isometric ACLR with ROM restriction. The Translational Potential of this Article The study demonstrate the establishmentof near-isometric tunnel position and non-isometric tunnel position with significant difference of ROM restriction and graft-bone integration. The described tunnel positions with differential isometry in a rabbi...

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“…1 As previous research has demonstrated, these goals are best achieved using anatomic ACL reconstruction. 2 In the article titled "An In Vivo Prediction of Anisometry and Strain in Anterior Cruciate Ligament ReconstructiondA Combined Magnetic Resonance and Dual Fluoroscopic Image Analysis," 3 Kernkamp, Varady, Li, Tsai, Asnis, van Arkel, Nelissen, Gill, Van de Velde, and Li used dual fluoroscopy and magnetic resonance imaging to precisely track tibiofemoral motion during step-up and sit-to-stand motions in 18 healthy individuals. These tibiofemoral kinematics were used as input to a computer simulation to predict the strain in the ACL at 144 theoretical attachment sites on the femur and 3 theoretical attachment sites on the tibia.…”

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confidence: 99%

Editorial Commentary: Using Computer Simulations to Predict Functional Outcome After Surgery

Anderst

2018

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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An In Vivo Prediction of Anisometry and Strain in Anterior Cruciate Ligament Reconstruction – A Combined Magnetic Resonance and Dual Fluoroscopic Imaging Analysis

Cited by 10 publications

References 32 publications

Dual fluoroscopic imaging and CT-based finite element modelling to estimate forces and stresses of grafts in anatomical single-bundle ACL reconstruction with different femoral tunnels

Dual fluoroscopic imaging and CT-based finite element modelling to estimate forces and stresses of grafts in anatomical single-bundle ACL reconstruction with different femoral tunnels

Establishment of near and non isometric anterior cruciate ligament reconstruction with artificial ligament in a rabbit model

Editorial Commentary: Using Computer Simulations to Predict Functional Outcome After Surgery

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