Peak stresses shift from femoral tunnel aperture to tibial tunnel aperture in lateral tibial tunnel ACL reconstructions: a 3D graft-bending angle measurement and finite-element analysis

Bracht, Hans Van Der; Tampere, Thomas; Beekman, Pieter; Schepens, Alexander; Devriendt, Wouter; Cromheecke, Michiel; Verdonk, Peter; Victor, Jan

doi:10.1007/s00167-017-4739-8

Cited by 8 publications

(7 citation statements)

References 53 publications

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“…Anterior tibia forces of 103 N or 134 N were also included during the subluxation phase [37, 49, 50]. In other FE studies the PS was a combination of a knee flexion of 20 ◦ and a tibia torsion about a vertical axis [40, 48]. Although, our PS profile acts on the reverse direction compared to the mentioned FE studies, the adopted values for the torques are similar.…”

Section: Discussionmentioning

confidence: 99%

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Can lateral tenodesis improve the rotational stability of the ACL reconstruction? A finite element analysis

Risvas,

Stanev,

Moustakas

2023

Preprint

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One of the most common knee injuries is the Anterior Cruciate Ligament (ACL) rupture with severe implications on knee stability. The usual treatment is the ACL Reconstruction (ACLR) surgery where the surgeon replaces the torn ligament with a graft in an effort to restore knee kinematics. In case of excessive rotatory instability, Lateral Extra - Articular Tenodesis (LET) can be performed in combination with ACLR. Additionally, LET appears to reduce ACLR graft forces reducing graft failure chances. However, there are concerns about overconstraining physiological rotation. To gain insight in this controversial topic, we developed an automatic, open-source tool to create a series of Finite Element (FE) models attempting to investigate the interactions of ACLR and LET through simulation. We started by creating a validated model of the healthy knee joint that served as reference for subsequent FE simulations. Then, we created FE models of standalone ACLR and combined ACLR - LET. Each model was assessed by applying a loading profile that resembles the Pivot - Shift clinical exam. We measured the External Tibia Rotation (ETR), the Anterior Tibia Translation (ATT) of the lateral tibial compartment, and the ACLR graft stress developed around the femoral tunnel insertion site. We observed the following: a) LET reduces ETR and ATT compared to isolated ACLR, b) combined ACLR - LET is more sensitive to LET graft pretension with lower values showcasing performance closer to the healthy joint, c) LET reduces ACLR graft forces for the same pretension values, d) LET exhibits significant overconstraint for higher pretension values. In general, these findings are in agreement with relevant clinical studies and accentuate the potential of the developed framework as a tool that can assist orthopaedists during surgery planning. We provide open access for the FE models of this study to enhance research transparency, reproducibility and extensibility.

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Section: Discussionmentioning

confidence: 99%

“…Regarding boundary conditions, most of the FE ACLR studies simulated clinical exams, such as the Lachman Test (or Anterior Drawer test) [27, 28, 31–33, 37–40, 47] and the PS test [37, 40, 48–50]. Simulations of dynamic physical activities, such as gait can be also found [29, 47].…”

Section: Introductionmentioning

confidence: 99%

Can lateral tenodesis improve the rotational stability of the ACL reconstruction? A finite element analysis

Risvas,

Stanev,

Moustakas

2023

Preprint

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“…Exploring the stress characteristics of the ACL and further determining the key factors affecting the ACL stress will reveal the risk factors for ACL injury. The validation and optimization of ACL reconstruction, such as the tunnel position or orientation, are also needed [ 42 ]. Since this model contains the cartilage and meniscus, the effects of ACL injury or reconstruction on the cartilage and meniscus could be simulated by the model in future studies [ 43 , 44 ].…”

Section: Discussionmentioning

confidence: 99%

Finite Element Analysis and Experimental Validation of the Anterior Cruciate Ligament and Implications for the Injury Mechanism

et al. 2022

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This study aimed to establish a finite element model that vividly reflected the anterior cruciate ligament (ACL) geometry and investigated the ACL stress distribution under different loading conditions. The ACL’s three-dimensional finite element model was based on a human cadaveric knee. Simulations of three loading conditions (134 N anterior tibial load, 5 Nm external tibial torque, 5 Nm internal tibial torque) on the knee model were performed. Experiments were performed on a knee specimen using a robotic universal force/moment sensor testing system to validate the model. The simulation results of the established model were in good agreement with the experimental results. Under the anterior tibial load, the highest maximal principal stresses (14.884 MPa) were localized at the femoral insertion of the ACL. Under the external and internal tibial torque, the highest maximal principal stresses (0.815 MPa and 0.933 MPa, respectively) were mainly concentrated in the mid-substance of the ACL and near the tibial insertion site, respectively. Combining the location of maximum stress and the location of common clinical ACL rupture, the most dangerous load during ACL injury may be the anterior tibial load. ACL injuries were more frequently loaded by external tibial than internal tibial torque.

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“…The effect of tibial tunnel orientation on the graft-bending angle and stress distribution in the ACL graft was investigated by Bracht, et al [97]. These authors refer that the risk of graft rupture was similar for medial tibial tunnels and lateral tibial tunnels, but the location of graft rupture changes from the femoral tunnel aperture towards the tibial tunnel aperture respectively [97].…”

Section: Graft and Tunnel Geometry And Orientationmentioning

confidence: 99%

A review on finite element analysis of the anterior cruciate ligament reconstruction

Simões¹,

Ramos²,

Oliveira³

et al. 2021

Open J Orthop Rheumatol

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A signifi cant number of papers relatively to the investigation made on Anterior Cruciate Ligament (ACL) Reconstruction (ACLR) has been published in orthopaedic related journals. Finite Element (FE) Analysis (FEA) has been used to predict the performance of biomechanical-biomedical systems as well as the effect of clinical factors on the ACLR success. This research tool presents some advantages relatively to experimental studies in assessing stresses and strains in soft tissues of the knee joint. By interpreting correctly FE results, it is possible to extrapolate them to clinical situations. This article reviews papers published from 2016 until nowadays on FEA for ACLR studies searched in Google Scholar, Medline and PubMed databases. Only studies that addressed surgery techniques, type and size of grafts, tunnel geometry and orientation, and fi xation devices are reviewed and presented.

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Peak stresses shift from femoral tunnel aperture to tibial tunnel aperture in lateral tibial tunnel ACL reconstructions: a 3D graft-bending angle measurement and finite-element analysis

Abstract: I.

Cited by 8 publications

References 53 publications

Can lateral tenodesis improve the rotational stability of the ACL reconstruction? A finite element analysis

Can lateral tenodesis improve the rotational stability of the ACL reconstruction? A finite element analysis

Finite Element Analysis and Experimental Validation of the Anterior Cruciate Ligament and Implications for the Injury Mechanism

A review on finite element analysis of the anterior cruciate ligament reconstruction

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