Central femoral tunnel placement can reduce stress and strain around bone tunnels and graft more than anteromedial femoral tunnel in anterior cruciate ligament reconstruction

Abstract

The present study investigated the effects of anteromedial (AM) and central femoral footprint placement on stress and strain distribution around the femoral and tibial tunnel and graft following anterior cruciate ligament reconstruction (ACLR). A three‐dimensional (3D) reconstructed knee model was validated and used for simulating ACLR by finite element analysis. A combined loading during normal human walking was applied to the knee models using different anatomic femoral tunnel placement at 20° knee flexion. The results of von Mises stress and principal strain at the entrances of the femoral and tibial tunnel and ACL graft was determined. The peak von Mises stress and the maximum principal strain in the AM footprint group were 8.78 MPa and 8850.89 μ‐strain at the entrance of femoral tunnel, and 5.29 MPa and 5553.27 μ‐strain at the entrance of tibial tunnel. The results in the AM footprint group were higher than that in the central footprint group. The peak von Mises stress around the ACL graft following AM footprint ACLR was 28.63 MPa, higher than that following the central footprint ACLR. The AM footprint ACLR generated more significant peak von Mises stress and maximum principal strain around the entrances of femoral and tibial tunnel and the graft than the central footprint. The present results are of clinical relevance as they can provide a better understanding of tunnel enlargement and graft failure.

Increased ACL direct insertion coverage provided more positive biomechanical effects on graft and bone tunnel during knee flexion: a simulation study

“…Repeated bone strains cause microscopic fatigue damage in bone with an operational threshold strain range greater than 3000 microstrain [ 6 ]. Researchers also used the strain around the bone tunnel to account for bone tunnel enlargement after ACL reconstruction in FE simulation [ 2 ]. The current results showed that the volume of cancellous bone strain within 1000–3000 microstrain increased as the tunnel flattened.…”

“…Author details 1 Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China. 2 The First Clinical College of Southern Medical University, Guangzhou, China. 3 Department of Orthopedic Surgery and Orthopedic Biomechanical Laboratory, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.…”

Hourglass-shaped grafts are superior to conventional grafts for restoring knee stability and graft force at knee flexion angle of 30° following anterior cruciate ligament reconstruction: A finite element analysis

“…Commonly used ACL grafts include autologous tendons such as the hamstring tendon and the patellar tendon, allogeneic tendons and artificial grafts ( Wang et al, 2020a ). Different positions, shapes and quantities of bone tunnels have also been used to achieve anatomic and non-anatomic reconstructions of the bone insertions ( Yao et al, 2012 ; Wang et al, 2020b ; Cheng et al, 2021 ; Cheng et al, 2022 ). Clinical outcomes have been reported to be good to excellent at 2 years post-surgery ( Komzak et al, 2021 ).…”

The Damage Deterioration Mechanism of Tunnel Structure under the Effect of Thermo-Mechanical Coupling and Its Maintenance

“…Tunnel projects are facing more engineering challenges as the tunnels are becoming longer, bigger, deeper, and clustered these days [1][2][3][4][5][6][7][8][9]. Under the condition of high ground temperature, the stress on tunnel support structure and surrounding rock is even more complex under the multiple and simultaneous actions of temperature, stress, internal water pressure, and ground stress, etc.…”