Lateral Extra-articular Tenodesis Reduces Anterior Cruciate Ligament Graft Force and Anterior Tibial Translation in Response to Applied Pivoting and Anterior Drawer Loads

Marom, Niv; Ouanezar, Hervé; Jahandar, Hamidreza; Zayyad, Zaid; Fraychineaud, Thomas; Hurwit, Daniel; Imhauser, Carl W.; Wickiewicz, Thomas L.; Pearle, Andrew D.; Nawabi, Danyal H.

doi:10.1177/0363546520959322

Cited by 74 publications

(104 citation statements)

References 69 publications

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“… 6 , 27 Moreover, EAR techniques as well as ALL reconstructions are able to reduce the force applied to the ACL up to 80%, possibly protecting the repaired ACL during its spontaneous healing. 28 …”

Section: Discussionmentioning

confidence: 99%

Acute Primary Repair of the Anterior Cruciate Ligament With Anterolateral Ligament Augmentation

Monaco

Mazza

Daggett

et al. 2021

Arthroscopy Techniques

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Acute injuries of the anterior cruciate ligament are often associated with concurrent injuries to the structures of the anterolateral complex, specifically the anterolateral ligament. Some injury patterns of the anterior cruciate ligament involve tearing of the majority of the ligament from the femoral origin, leaving a large, viable ligament remnant. In these patients, a repair of the anterior cruciate ligament back to the femoral origin can be undertaken. Subsequently, percutaneous repair of the anterolateral ligament can be performed through anatomical, percutaneous suture tape augmentation. The combined technique of anterior cruciate ligament repair with anterolateral ligament reinforcement is presented.

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Section: Discussionmentioning

confidence: 99%

Acute Primary Repair of the Anterior Cruciate Ligament With Anterolateral Ligament Augmentation

Monaco

Mazza

Daggett

et al. 2021

Arthroscopy Techniques

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“…Loads were applied along an anatomic knee coordinate system defined using computed tomography (CT)-based registration and digitization (Gage; FARO, Inc). 8,21,41 Then, each knee was preconditioned with 10 cycles each of anterior loads and combined valgus and internal rotation torques. 41 Subsequently, 2 combinations of multiplanar loads simulating key components of a pivot-shift (PS) clinical examination were applied at 15° and 30° of flexion.…”

Section: Methodsmentioning

confidence: 99%

“…8,21,41 Then, each knee was preconditioned with 10 cycles each of anterior loads and combined valgus and internal rotation torques. 41 Subsequently, 2 combinations of multiplanar loads simulating key components of a pivot-shift (PS) clinical examination were applied at 15° and 30° of flexion. The knee was free to move in all other directions except flexion.…”

Section: Methodsmentioning

confidence: 99%

“…The sectioned lateral tissues included the anterolateral ligament and Kaplan fibers to replicate concomitant anterolateral knee injury with an ACL tear, as previously described. 41 ACLR with sectioned anterolateral tissues was not tested in isolation to reduce the number of cycles the ACL graft was loaded, thereby to decrease chances of graft or fixation failure in this cadaveric model.…”

Section: Methodsmentioning

confidence: 99%

“…4,7,24 These previous studies also did not investigate lateral compartment contact mechanics in response to multiplanar rotatory loads of the pivot shift. Simulated pivoting maneuvers increase force on the lateral compartment and load the LET 25,41 ; therefore, they may exacerbate changes to lateral compartment contact mechanics after lateral augmentation surgery.…”

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confidence: 99%

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Lateral Extra-articular Tenodesis Alters Lateral Compartment Contact Mechanics under Simulated Pivoting Maneuvers: An In Vitro Study

et al. 2021

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Background: There is concern that utilization of lateral extra-articular tenodesis (LET) in conjunction with anterior cruciate ligament (ACL) reconstruction (ACLR) may disturb lateral compartment contact mechanics and contribute to joint degeneration. Hypothesis: ACLR augmented with LET will alter lateral compartment contact mechanics in response to simulated pivoting maneuvers. Study Design: Controlled laboratory study. Methods: Loads simulating a pivot shift were applied to 7 cadaveric knees (4 male; mean age, 39 ± 12 years; range, 28-54 years) using a robotic manipulator. Each knee was tested with the ACL intact, sectioned, reconstructed (via patellar tendon autograft), and, finally, after augmenting ACLR with LET (using a modified Lemaire technique) in the presence of a sectioned anterolateral ligament and Kaplan fibers. Lateral compartment contact mechanics were measured using a contact stress transducer. Outcome measures were anteroposterior location of the center of contact stress (CCS), contact force from anterior to posterior, and peak and mean contact stress. Results: On average, augmenting ACLR with LET shifted the lateral compartment CCS anteriorly compared with the intact knee and compared with ACLR in isolation by a maximum of 5.4 ± 2.3 mm ( P < .001) and 6.0 ± 2.6 mm ( P < .001), respectively. ACLR augmented with LET also increased contact force anteriorly on the lateral tibial plateau compared with the intact knee and compared with isolated ACLR by a maximum of 12 ± 6 N ( P = .001) and 17 ± 10 N ( P = .002), respectively. Compared with ACLR in isolation, ACLR augmented with LET increased peak and mean lateral compartment contact stress by 0.7 ± 0.5 MPa ( P = .005) and by 0.17 ± 0.12 ( P = .006), respectively, at 15° of flexion. Conclusion: Under simulated pivoting loads, adding LET to ACLR anteriorized the CCS on the lateral tibial plateau, thereby increasing contact force anteriorly. Compared with ACLR in isolation, ACLR augmented with LET increased peak and mean lateral compartment contact stress at 15° of flexion. Clinical Relevance: The clinical and biological effect of increased anterior loading of the lateral compartment after LET merits further investigation. The ability of LET to anteriorize contact stress on the lateral compartment may be useful in knees with passive anterior subluxation of the lateral tibia.

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Compressive force and valgus torque are the predominant applied loads during the pivot shift exam: An in vitro study

Marom,

Amirtharaj,

Jahandar

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeDespite the clinical utility of the pivot shift exam, the requisite applied forces and torques to elicit a pivot shift remain unclear. The purposes of this study are (1) to identify the greatest forces and torques applied to the knee during the pivot shift exam and (2) to evaluate if the applied loads differ among experienced surgeons.MethodsThree cadaveric hemipelvis‐to‐toe specimens (ages 53, 36 and 31 years; two males and one female) with no history of knee or hip injury were utilized. The experimental setup consisted of securing the hemipelvis to a mounting frame via an external fixator to simulate patient positioning during the clinical exam. The hemipelvis, femur, and tibia were spatially tracked by motion capture and the applied loads were measured using a 6‐axis force‐torque sensor. After sectioning the anterior cruciate ligament (ACL), three board‐certified sports medicine surgeons then performed the pivot shift exam on each specimen utilizing their preferred technique. Forces (compression‐distraction, anterior‐posterior, and medial‐lateral) and torques (varus‐valgus, internal‐external rotation, and flexion‐extension) applied to the knee joint immediately preceding the reduction of the proximal lateral tibia during each pivot shift exam were calculated.ResultsCompression was the largest applied force averaging 95 N ± 15 N for all surgeons and knees, which was at least 4.5 times greater, on average, than the applied anterior and applied medial tibial forces (p < 0.0001). Valgus was the largest of the three applied torques, averaging 8.5 ± 2.1 Nm. Internal rotation torque was 3.7 times less, on average, than the applied valgus torque (p < 0.0001). Each surgeon applied compressive force. However, anterior force was more variable among surgeons, with one of the three surgeons applying minimal anterior force (p ≤ 0.024). The magnitude of applied torques was similar among examiners (n.s).ConclusionCompressive force and valgus torque were the predominant applied loads during the pivot shift exam. A lower magnitude of internal rotation torque was also applied. The anterior force was not consistently applied among examiners. These data can better inform clinical, cadaveric, and computational studies utilizing the pivot shift exam to assess knee biomechanics and can be used to educate trainees in conducting this complex manoeuvre.Level of EvidenceAn in vitro biomechanic study.

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Lateral Extra-articular Tenodesis Reduces Anterior Cruciate Ligament Graft Force and Anterior Tibial Translation in Response to Applied Pivoting and Anterior Drawer Loads

Cited by 74 publications

References 69 publications

Acute Primary Repair of the Anterior Cruciate Ligament With Anterolateral Ligament Augmentation

Acute Primary Repair of the Anterior Cruciate Ligament With Anterolateral Ligament Augmentation

Lateral Extra-articular Tenodesis Alters Lateral Compartment Contact Mechanics under Simulated Pivoting Maneuvers: An In Vitro Study

Compressive force and valgus torque are the predominant applied loads during the pivot shift exam: An in vitro study

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