The Effectiveness of Reconstruction of the Anterior Cruciate Ligament With Hamstrings and Patellar Tendon

Woo, Savio L‐Y.; Kanamori, Akira; Zeminski, Jennifer; Yagi, Masafumi; Papageorgiou, Christos D.; Fu, Freddie H.

doi:10.2106/00004623-200206000-00003

Cited by 440 publications

(349 citation statements)

References 24 publications

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“…The importance of the PL bundle with the knee near full extension, particularly in response to rotatory loads, further suggests the need for a more anatomical reconstruction designed to replicate both bundles [36]. Our planned studies to investigate more physiologic loading conditions will enhance our understanding of the role of each ACL bundle.…”

Section: Discussionmentioning

confidence: 99%

“…However, under more complex rotatory motions, such as internal tibial rotation and valgus rotation, these reconstruction procedures are less successful [8,17,23]. In a cadaveric study, ACL replacement grafts could not replicate the function of the intact ACL under such a combined rotatory loading condition [36]. A potential limitation of ACL reconstruction could be, therefore, that the reconstruction is designed predominantly to replicate the anatomy of only the AM bundle.…”

Section: Introductionmentioning

confidence: 99%

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Distribution of in situ forces in the anterior cruciate ligament in response to rotatory loads

Gabriel

Wong

Woo

et al. 2004

Journal Orthopaedic Research

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596

431

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The anterior cruciate ligament (ACL) can be anatomically divided into anteromedial (AM) and posterolateral (PL) bundles. Current ACL reconstruction techniques focus primarily on reproducing the AM bundle, but are insufficient in response to rotatory loads. The objective of this study was to determine the distribution of in situ force between the two bundles when the knee is subjected to anterior tibial and rotatory loads. Ten cadaveric knees (50 k 10 years) were tested using a roboticluniversal forcemoment sensor (UFS) testing system. Two external loading conditions were applied: a 134 N anterior tibial load at full knee extension and 15", 30°, 60", and 90" of flexion and a combined rotatory load of 10 N m valgus and 5 N m internal tibial torque at 15" and 30" of flexion. The resulting 6 degrees of freedom kinematics of the knee and the in situ forces in the ACL and its two bundles were determined. Under an anterior tibial load, the in situ force in the PL bundle was the highest at full extension (67 k 30 N) and decreased with increasing flexion. The in situ force in the AM bundle was lower than in the PL bundle at full extension, but increased with increasing flexion, reaching a maximum (90 f 17 N) at 60" of flexion and then decreasing at 90". Under a combined rotatory load, the in situ force of the PL bundle was higher at 15" (21 k 11 N) and lower at 30" of flexion (14 f 6 N). The in situ force in the AM bundle was similar at 15" and 30" of knee flexion (30k 15 vs. 3 5 2 16 N, respectively). Comparing these two external loading conditions demonstrated the importance of the PL bundle, especially when the knee is near full extension. These findings provide a better understanding of the function of the two bundles of the ACL and could serve as a basis for future considerations of surgical reconstruction in the replacement of the ACL.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Distribution of in situ forces in the anterior cruciate ligament in response to rotatory loads

Gabriel

Wong

Woo

et al. 2004

Journal Orthopaedic Research

Self Cite

596

431

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“…Through this, diminution of excessive rotational movements was achieved, thus theoretically avoiding or delaying the appearance of arthrosis after the ACL injury (13,16) .…”

Section: Discussionmentioning

confidence: 99%

Reconstrução anatômica do LCA com duplo feixe: primeiros 40 casos

Zekcer¹,

Silva²,

Filho

2011

Rev. bras. ortop.

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“…With use of the robotic testing system, we measured the kinematics in nine cadaver tibiofemoral joints, from full extension to 90°of flexion both before and after anterior cruciate ligament resection, and found that anterior cruciate ligament deficiency not only altered anterior translation and axial rotation of the tibia (findings that have been documented extensively in the in vitro and in vivo literature [31][32][33][34][35][36] ) but also increased the medial translation of the tibia 37 . Our in vivo dual fluoroscopic imaging analysis of the tibiofemoral kinematics in ten patients with acute anterior cruciate ligament deficiency revealed analogous findings: an increased anterior translation (approximately 3 mm, Fig.…”

Section: Disturbed Tibiofemoral Joint Kinematicsmentioning

confidence: 96%

Evaluation of Kinematics of Anterior Cruciate Ligament-Deficient Knees with Use of Advanced Imaging Techniques, Three-Dimensional Modeling Techniques, and Robotics

Velde

Gill

2009

Journal of Bone and Joint Surgery

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Measuring knee biomechanics in six degrees of freedom with acceptable accuracy has been proven to be technically challenging. At our bioengineering laboratory, we have employed both an in vitro robotic testing system and an in vivo combined dual fluoroscopic and magnetic resonance imaging technique to analyze the impact of anterior cruciate ligament rupture on the knee joint.When measuring the tibiofemoral kinematics of nine cadavers with the robotic testing system, we found that anterior cruciate ligament deficiency not only altered anterior translation and axial rotation of the tibia, but it also increased the medial translation of the tibia as well. The in vivo dual fluoroscopic imaging analysis of tibiofemoral kinematics in ten anterior cruciate ligament-deficient patients revealed analogous findings: an increased medial translation of the tibia of approximately 1 mm between 15°and 90°of flexion was found in anterior cruciate ligament-deficient knees, in addition to an increased anterior translation (approximately 3 mm) and internal rotation (approximately 2°) of the tibia at low flexion angles. In a subsequent study of tibiofemoral cartilage contact, we found that the cartilage contact points shifted posteriorly-as was expected on the basis of the increased anterior tibial translation-as well as laterally on the surface of the tibial plateau.The data demonstrate how rupture of the anterior cruciate ligament initiates a cascade of events that eventually results in abnormal tibiofemoral cartilage contact in both the anteroposterior and mediolateral directions. If the restoration of normal knee homeostasis is the ultimate goal of ligament reconstruction, the normal function of the anterior cruciate ligament should be restored as closely as possible in all degrees of freedom.

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The Effectiveness of Reconstruction of the Anterior Cruciate Ligament With Hamstrings and Patellar Tendon

Cited by 440 publications

References 24 publications

Distribution of in situ forces in the anterior cruciate ligament in response to rotatory loads

Distribution of in situ forces in the anterior cruciate ligament in response to rotatory loads

Reconstrução anatômica do LCA com duplo feixe: primeiros 40 casos

Evaluation of Kinematics of Anterior Cruciate Ligament-Deficient Knees with Use of Advanced Imaging Techniques, Three-Dimensional Modeling Techniques, and Robotics

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