The effect of notchplasty in anterior cruciate ligament reconstruction: a biomechanical study in the porcine knee

Abstract

Notchplasty had greater effect on anterior stability than rotational stability. This change in knee kinematics could be detrimental to a healing bone graft, ligamentization and could lead to failure of the reconstruction in early post-operative period.

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

“…No ITR differences (range 35°–41°) were expressed in either the intact, reconstructed or deficient ACL when 4 N*m of isolated ITT were simulated. [62] However, a 3 N*m increase in abduction torque during pivot-shift loading was responsible for increasing ensemble mean ATT and ensemble mean in situ ACL force in low flexion angles (Figure 4). [28, 36, 38, 42, 44–49, 55, 57, 58, 60, 63–66] These isolated abduction/adduction torques produced greater loads on intact ACLs (peak 41 N) than internal/external torques (peak 34 N).…”

“…[14] A lack of mechanical resistance to ITR was echoed in passive flexion simulations as ACLD did not increase ITR during weight-bearing and isolated ITT produced no ITR differences between ACL and ACLD specimens. [62, 73] If the ACL were a functional restraint to ITT, then the intact ligament should have restricted the observed ITR relative to the ACLD condition.…”

“…Altered magnitudes in external loading could have confounded or biased the ensemble averages through increased variability. 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.…”

What is the best candidate allograft for ACL reconstruction? An in vitro mechanical and histologic study in a canine model

“…These data suggested that abrasion may exist between ACL and intercondylar roof or PCL during impingement while the knee is moving that may lead to fractured bundles, guillotined remnants at the tibial insertion, parallel fragmentation of an uninterrupted graft, fibrous nodule, or an extrusion of graft material at the outlet of the notch, all of which were observed by Watanabe et al upon arthroscopic follow-up (Watanabe and Howell, 1995). Although a notchplasty is often performed to avoid graft impingement, greater blood loss and possible alteration to knee kinematics caused by this procedure are concerns (Keklikci et al, 2013; Pape et al, 2001). Therefore, the frictional of the ACL graft material is an important parameter that may affect the clinical outcomes after ACL reconstruction.…”

The inferior medial genicular artery and its vascularization of the pes anserinus superficialis

“…Recent discussions on to the surgical management of torn ACL focus on the postoperative treatment and on potential influences other than personal skill that surgeons might exert on postoperative ligamentization9101112131415 and tendon-to-bone healing 1617. Besides, there exist several new approaches including therapeutic gene modulation18 and the usage of platelet-derived growth-factor 15…”