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

Yang, Xiao; Ling, Ming; Liang, Zhenming; Ding, Jian; Shi, Zhan; Hu, Hai; Chen, Bin

doi:10.1007/s11548-021-02307-2

Cited by 11 publications

(13 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Furthermore, the maximum strain exceeding 4000 μ‐strain occurred around the P zone of the entrance of tibial tunnel. Lind et al 33 showed the femoral tunnel widening was more severe than tibial tunnel widening, which was consistent with the results of the present study, where the stress concentration was higher at the femoral side. Moreover, Fink et al 34 found that tibial tunnel enlargement in the sagittal plane was larger than that in the coronal plane.…”

Section: Discussionsupporting

confidence: 93%

“…Several studies 14,18,33,35 have showed the highest contact stress occurred at the femoral graft contact region when the ACL graft wrapped over the sharp entrances of the tunnels. Bae et al 18 reported that distributed regions of contact pressure occurred around the impingement site between the femoral tunnel entrance and the graft with AM portal and transtibial technique.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

Cheng

Wang

Dimitriou

et al. 2022

Numer Methods Biomed Eng

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

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

Cheng

Wang

Dimitriou

et al. 2022

Numer Methods Biomed Eng

View full text Add to dashboard Cite

show abstract

“…Hoshino et al in their cadaveric study, reported that different mechanical stress around the femoral tunnel was exhibited according to different directions [ 14 ]. Recent Finite element studies have demonstrated that the contact stress arising at the interface between the graft and the surrounding bony structures was influenced by different femoral tunnel positions, and changes in the reaction force and maximal stress of the graft was also affected by knee motion [ 15 , 18 ].…”

Section: Introductionmentioning

confidence: 99%

“…Different trajectories of the ACL graft could yield different tunnel parameters including length of the femoral tunnel and femoral graft bending angle [9][10][11][12][13]. Different tunnel parameters are consequently associated with different stress patterns around the femoral tunnel [14][15][16][17][18]. Hoshino et al in their cadaveric study, reported that different mechanical stress around the femoral tunnel was exhibited according to different directions [14].…”

Section: Introductionmentioning

confidence: 99%

Effects of modified trans-tibial versus trans-portal technique on stress patterns around the femoral tunnel in anatomical single-bundle ACL reconstruction with different knee flexion angles using finite element analysis

Moon

Song

et al. 2022

BMC Musculoskelet Disord

View full text Add to dashboard Cite

Background It is unclear whether different anterior cruciate ligament (ACL) graft trajectories in the distal femur would have different effects on stress generated within the distal femur around the femoral tunnel during knee motion. Thus, the purpose of this study was to determine differences in stress patterns around the femoral tunnel created by trans-portal (TP) vs. modified trans-tibial (TT) technique in anatomical ACL reconstruction at different knee flexion angles. Methods Twelve male subjects’ right knees were scanned with a high-resolution computed tomography (CT) scanner (slice thickness: 1 mm) at four different knee flexion angles (0°, 45°, 90°, and 135°). Three-dimensional (3D) models of these four different flexion angles were created and manipulated with several modelling programs. For the TP group, the virtual femoral tunnelling procedure was performed in a 135° flexion model from the low far anteromedial (AM) portal. For the modified TT group, the same knee models were drilled through the modified TT technique at 90° of flexion separately. Virtual grafts under tension of 40 N were put into corresponding bone tunnel and fixed at the outer aperture of femoral tunnels to simulate the suspensory fixation, followed by fixation of the grafts at the middle of tibial tunnels in the 0° knee flexion models. Finally, the models were exported to a finite element analysis package and analysed using ABAQUS/Explicit code (ABAQUS, USA) to monitor the stress occurring at the node where stress distribution occurred most significantly in the femoral bone around the bone tunnel. Results In general, both groups showed a high stress distribution in bony structures around inner and outer orifices of the femoral tunnel. Mean maximal stresses occurring at the lateral femoral condyle around the inner orifice of the femoral tunnel in the TP group were found to be significantly greater than those in the modified TT group at all flexion angles except 90° of flexion. Mean maximal stresses monitored around the outer orifice of the femoral tunnel in the TP group were also significantly greater than those in the modified TT group at all flexion angles. Conclusions Different tunnelling technologies could yield different stress patterns in the lateral femoral condyle around the femoral tunnel. During knee motion, higher stresses were noticed in the TP group than in the modified TT group, especially around inner and outer orifices of the tunnel. Position of the tunnel after reconstruction with the TP technique can have a greater effect on the stress increase in the femur compared to that with the modified TT technique.

show abstract

“…Does single bundle reconstruction have better anatomic AM selection? [8][9][10][11][12] Alternatively, is it better to choose the anatomic mid-bundle (the center of the femoral footprint)? [13][14][15] The current literature does not yet provide uniform conclusions [16].…”

mentioning

confidence: 99%

Comparison of second-look arthroscopic evaluations between two femoral tunnel locations in anatomical single-bundle ACL reconstruction

Zhang

Huo

Guo

et al. 2022

Preprint

View full text Add to dashboard Cite

Background Anterior cruciate ligament reconstruction (ACL-R) is the best treatment for anterior cruciate ligament (ACL) rupture, and the most widely used reconstruction technique is single beam reconstruction. One of the most important factors affecting the knee function after ACL-R is the location of the femoral tunnel. Therefore, how to accurately select the femoral tunnel during operation, and how to directly evaluate the integration, tension and synovial coverage of the graft after operation are all difficult problems. The purposes of this study were to determine the best femur tunnel for anterior cruciate ligament reconstruction based on a second-look arthroscopic study. Methods A total of 67 patients who were treated with single-beam ACL-R using allografts in our department between January 2014 and February 2020 ultimately met the inclusion criteria and were contacted for the study. A second-look arthroscopic evaluation was carried out one year after anatomical single-bundle ACL reconstruction. According to the postoperative 3D-CT, the patients were divided into the anatomic anteromedial (AM) group and the anatomic mid-bundle (center-center) group based on the femoral tunnel location. Results In terms of the Lysholm score, a significant difference existed between the groups at the last follow-up evaluation (p < 0.05). The tension of the graft involved was flabby in 2 patients (5.7%) in the center-AM group and 5 patients (15.6%) in the center-center group. Type I (tight cruciate ligament-like structured graft with complete synovial coating) and type II (tight, bundle-like structured graft with incomplete or lacking synovial coating) were found in 33 patients (94.29%) in the center-AM group and 27 patients (84.38%) in the center-center group. The statistical analysis showed a significant correlation between the femoral tunnel position and the arthroscopic evaluation of the grafts according to the Marburger Arthroscopy Score (MAS) (p = 0.02 < 0.05; Χ2 = 7.865). Conclusions Our data demonstrated a significant correlation between the femoral tunnel position, clinical condition, and arthroscopic graft constitution. We found that the anatomic AM bundle position of the graft was better than the anatomic mid-bundle placement after ACL reconstruction.

show abstract

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

Cited by 11 publications

References 31 publications

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

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

Effects of modified trans-tibial versus trans-portal technique on stress patterns around the femoral tunnel in anatomical single-bundle ACL reconstruction with different knee flexion angles using finite element analysis

Comparison of second-look arthroscopic evaluations between two femoral tunnel locations in anatomical single-bundle ACL reconstruction

Contact Info

Product

Resources

About