Comparison of In Situ Forces and Knee Kinematics in Anteromedial and High Anteromedial Bundle Augmentation for Partially Ruptured Anterior Cruciate Ligament

Xu, Yan; Liu, Jianyu; Kramer, Scott; Martins, Cesar A. Q.; Kato, Yuki; Linde-Rosen, Monica; Smolinski, Patrick; Fu, Freddie H.

doi:10.1177/0363546510383479

Cited by 63 publications

(63 citation statements)

References 34 publications

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“…However, biomechanical tendencies in investigations with different loading magnitudes were often similar as ACLD increased ATT relative to ACL-intact knees throughout flexion under each Lachman’s and pivot-shift loads;[32, 62, 64, 66, 69, 96–101] ACLR restored ATT relative to ACLD under Lachman’s loads, but not necessarily to the level of ACL-intact knees;[62, 96, 99, 101] ACLR restored ITR relative to ACL-intact knees under rotational loads;[31, 41, 62] and ACLR graft forces were not consistent with ACL-intact ligament forces. [63–65, 99, 101] Therefore, normalized mechanical response of ACL, ACLD, and ACLR specimens generally remains constant across varied magnitudes of external loading, though absolute values may differ. Another limitation that was faced by this study was the definition of coordinate systems at the knee.…”

Section: Discussionmentioning

confidence: 99%

Anterior cruciate ligament biomechanics during robotic and mechanical simulations of physiologic and clinical motion tasks: A systematic review and meta-analysis

Bates

Myer

Shearn

et al. 2015

Clinical Biomechanics

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Investigators use in vitro joint simulations to invasively study the biomechanical behaviors of the anterior cruciate ligament. The aims of these simulations are to replicate physiologic conditions, but multiple mechanisms can be used to drive in vitro motions, which may influence biomechanical outcomes. The objective of this review was to examine, summarize, and compare biomechanical evidence related to anterior cruciate ligament function from in vitro simulations of knee motion. A systematic review was conducted (2004 to 2013) in Scopus, PubMed/Medline, and SPORTDiscus to identify peer-reviewed studies that reported kinematic and kinetic outcomes from in vitro simulations of physiologic or clinical tasks at the knee. Inclusion criteria for relevant studies were articles published in English that reported on whole-ligament anterior cruciate ligament mechanics during the in vitro simulation of physiologic or clinical motions on cadaveric knees that were unaltered outside of the anterior-cruciate-ligament-intact, -deficient, and -reconstructed conditions. A meta-analysis was performed to synthesize biomechanical differences between the anterior-cruciate-ligament-intact and reconstructed conditions. 77 studies met our inclusion/exclusion criteria and were reviewed. Combined joint rotations have the greatest impact on anterior cruciate ligament loads, but the magnitude by which individual kinematic degrees of freedom contribute to ligament loading during in vitro simulations is technique-dependent. Biomechanical data collected in prospective, longitudinal studies corresponds better with robotic-manipulator simulations than mechanical-impact simulations. Robotic simulation indicated that the ability to restore intact anterior cruciate ligament mechanics with anterior cruciate ligament reconstructions was dependent on loading condition and degree of freedom examined.

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Section: Discussionmentioning

confidence: 99%

Anterior cruciate ligament biomechanics during robotic and mechanical simulations of physiologic and clinical motion tasks: A systematic review and meta-analysis

Bates

Myer

Shearn

et al. 2015

Clinical Biomechanics

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“…[112] Current techniques in ACLR over the past several years have focused on reproducing more anatomical tunnel placement and graft geometry to restore knee kinematics. [98] Xu et al[113] demonstrated in a cadaveric study that an anatomic anteromedial tunnel placement can lead to biomechanical advantages when compared to a non-anatomic placement, and the anatomic placement better restores knee kinematics to the native intact ACL state. [113] However, the anatomic placement had significantly greater in situ forces than the non-anatomic placement making it more vulnerable to graft failure.…”

Section: Functional Recovery Of the Kneementioning

confidence: 99%

“…[98] Xu et al[113] demonstrated in a cadaveric study that an anatomic anteromedial tunnel placement can lead to biomechanical advantages when compared to a non-anatomic placement, and the anatomic placement better restores knee kinematics to the native intact ACL state. [113] However, the anatomic placement had significantly greater in situ forces than the non-anatomic placement making it more vulnerable to graft failure. [113] Therefore, delaying a return to activity longer than the expected timeline may significantly help the recovering knee withstand the forces of returning to sport.…”

Section: Functional Recovery Of the Kneementioning

confidence: 99%

“…[113] However, the anatomic placement had significantly greater in situ forces than the non-anatomic placement making it more vulnerable to graft failure. [113] Therefore, delaying a return to activity longer than the expected timeline may significantly help the recovering knee withstand the forces of returning to sport. It is likely that misplaced tunnels are responsible for early traumatic failures, but also may predispose a graft to aberrant biomechanics causing it to rupture at a later time.…”

Section: Functional Recovery Of the Kneementioning

confidence: 99%

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Should Return to Sport be Delayed Until 2 Years After Anterior Cruciate Ligament Reconstruction? Biological and Functional Considerations

2016

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Anterior cruciate ligament (ACL) tears are common knee injuries sustained by athletes during sports participation. A devastating complication of returning to sport following ACL reconstruction (ACLR) is a second ACL injury. Strong evidence now indicates that younger, more active athletes are at particularly high risk for a second ACL injury and this risk is greatest within the first two years following ACLR. Nearly one-third of the younger cohort that resumes sports participation will sustain a second ACL injury within the first two years after ACLR. The evidence indicates that the risk of second injury may abate over this time period. The incidence rate of second injuries in the first year after ACLR is significantly greater than the rate in the second year. The lower relative risk in the second year may be related to athletes achieving baseline joint health and function well after the current expected timeline (6 to 12 months) to be released to unrestricted activity. This highlights a considerable debate in the return to sport decision process as to whether an athlete should wait until two years after ACLR to return to unrestricted, sports activity. In this review, we present evidence in the literature that athletes achieve baseline joint health and function approximately two years after ACLR. We postulate that delay in returning to sports for nearly two years will significantly reduce the incidence of second ACL injuries.

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“…Subjects with femoral and tibia graft tunnels placed outside of the previously described native ACL footprints were included into the non-anatomic ACL group (Figure 1). [9,15,17] Based on previous studies [42,46], subjects with high AM tunnels were also included into the non-anatomic group (Figure 1). …”

Section: Methodsmentioning

confidence: 99%

In vivo posterior cruciate ligament elongation in running activity after anatomic and non-anatomic anterior cruciate ligament reconstruction

Tang

Thorhauer

Bowman

et al. 2016

Knee Surg Sports Traumatol Arthrosc

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Purpose The goals of this study were to (1) investigate the in vivo elongation behavior of the posterior cruciate ligament (PCL) during running in the uninjured knee; and (2) evaluate changes in PCL elongation during running after anatomic or non-anatomic anterior cruciate ligament (ACL) reconstruction. Methods Seventeen unilateral ACL-injured subjects were recruited after undergoing anatomic (n=9) or non-anatomic (n=8) ACL reconstruction. Bilateral high-resolution CT scans were obtained to produce 3D models. Anterolateral (AL) and posteromedial (PM) bundles insertion sites of the PCL were identified on the 3D CT scan reconstructions. Dynamic knee function was assessed during running using a Dynamic Stereo X-ray (DSX) system. The lengths of the AL and PM bundles were estimated from late swing through mid-stance. The contralateral knees served as normal controls. Results Control knees demonstrated a slight decrease in AL bundle, and a significant decrease in PM bundle length following foot strike. Length and elongation patterns of the both bundles of the PCL in the anatomic ACL reconstruction group were similar to the controls. However, the change in dynamic PCL length was significantly greater in the non-anatomic group than in the anatomic reconstruction group after foot strike (P<0.05). Conclusion The AL bundle length decreased slightly and the PM bundle length significantly decreased after foot strike during running in uninjured knees. Anatomic ACL reconstruction maintained normal PCL elongation patterns more effectively than non-anatomic ACL reconstruction during high-demand, functional loading. These results support the use of anatomic ACL reconstruction to achieve normal knee function in high-demand activities. Level of evidence Case-control study, Level III

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Comparison of In Situ Forces and Knee Kinematics in Anteromedial and High Anteromedial Bundle Augmentation for Partially Ruptured Anterior Cruciate Ligament

Abstract: Anatomic AM augmentation can lead to biomechanical advantages at time zero when compared with the nonanatomic (high AM) augmentation. Anatomic AM augmentation better restores the knee kinematics to the intact ACL state.

Cited by 63 publications

References 34 publications

Anterior cruciate ligament biomechanics during robotic and mechanical simulations of physiologic and clinical motion tasks: A systematic review and meta-analysis

Anterior cruciate ligament biomechanics during robotic and mechanical simulations of physiologic and clinical motion tasks: A systematic review and meta-analysis

Should Return to Sport be Delayed Until 2 Years After Anterior Cruciate Ligament Reconstruction? Biological and Functional Considerations

In vivo posterior cruciate ligament elongation in running activity after anatomic and non-anatomic anterior cruciate ligament reconstruction

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