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Rao H, Bakker R, McLachlin S, Chandrashekar N. Computational study of extrinsic factors affecting ACL strain during single-leg jump landing. BMC Musculoskelet Disord 2024; 25:318. [PMID: 38654258 PMCID: PMC11036765 DOI: 10.1186/s12891-024-07372-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 03/21/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Non-contact anterior cruciate ligament (ACL) injuries are a major concern in sport-related activities due to dynamic knee movements. There is a paucity of finite element (FE) studies that have accurately replicated the knee geometry, kinematics, and muscle forces during dynamic activities. The objective of this study was to develop and validate a knee FE model and use it to quantify the relationships between sagittal plane knee kinematics, kinetics and the resulting ACL strain. METHODS 3D images of a cadaver knee specimen were segmented (bones, cartilage, and meniscus) and meshed to develop the FE model. Knee ligament insertion sites were defined in the FE model via experimental digitization of the specimen's ligaments. The response of the model was validated against multiple physiological knee movements using published experimental data. Single-leg jump landing motions were then simulated on the validated model with muscle forces and kinematic inputs derived from motion capture and rigid body modelling of ten participants. RESULTS The maximum ACL strain measured with the model during jump landing was 3.5 ± 2.2%, comparable to published experimental results. Bivariate analysis showed no significant correlation between body weight, ground reaction force and sagittal plane parameters (such as joint flexion angles, joint moments, muscle forces, and joint velocity) and ACL strain. Multivariate regression analysis showed increasing trunk, hip and ankle flexion angles decreases ACL strain (R2 = 90.04%, p < 0.05). CONCLUSIONS Soft landing decreases ACL strain and the relationship could be presented through an empirical equation. The model and the empirical relation developed in this study could be used to better predict ACL injury risk and prevention strategies during dynamic activities.
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Affiliation(s)
- Harish Rao
- Mechanical and Mechatronics Engineering, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | - Ryan Bakker
- Mechanical and Mechatronics Engineering, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | - Stewart McLachlin
- Mechanical and Mechatronics Engineering, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | - Naveen Chandrashekar
- Mechanical and Mechatronics Engineering, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada.
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2
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Ajdaroski M, Baek SY, Ashton-Miller JA, Esquivel AO. Predicting Leg Forces and Knee Moments Using Inertial Measurement Units: An In Vitro Study. J Biomech Eng 2024; 146:021006. [PMID: 38019183 PMCID: PMC10750790 DOI: 10.1115/1.4064145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 11/14/2023] [Accepted: 11/27/2023] [Indexed: 11/30/2023]
Abstract
We compared the ability of seven machine learning algorithms to use wearable inertial measurement unit (IMU) data to identify the severe knee loading cycles known to induce microdamage associated with anterior cruciate ligament rupture. Sixteen cadaveric knee specimens, dissected free of skin and muscle, were mounted in a rig simulating standardized jump landings. One IMU was located above and the other below the knee, the applied three-dimensional action and reaction loads were measured via six-axis load cells, and the three-dimensional knee kinematics were also recorded by a laboratory motion capture system. Machine learning algorithms were used to predict the knee moments and the tibial and femur vertical forces; 13 knees were utilized for training each model, while three were used for testing its accuracy (i.e., normalized root-mean-square error) and reliability (Bland-Altman limits of agreement). The results showed the models predicted force and knee moment values with acceptable levels of error and, although several models exhibited some form of bias, acceptable reliability. Further research will be needed to determine whether these types of models can be modified to attenuate the inevitable in vivo soft tissue motion artifact associated with highly dynamic activities like jump landings.
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Affiliation(s)
- Mirel Ajdaroski
- Department of Mechanical Engineering, University of Michigan – Dearborn, 4901 Evergreen Road, Dearborn, MI 48128
| | - So Young Baek
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI 48109
| | | | - Amanda O. Esquivel
- Department of Mechanical Engineering, University of Michigan – Dearborn, 4901 Evergreen Road, Dearborn, MI 48128
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3
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Beaulieu ML, Ashton-Miller JA, Wojtys EM. Loading mechanisms of the anterior cruciate ligament. Sports Biomech 2023; 22:1-29. [PMID: 33957846 PMCID: PMC9097243 DOI: 10.1080/14763141.2021.1916578] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 04/08/2021] [Indexed: 01/26/2023]
Abstract
This review identifies the three-dimensional knee loads that have the highest risk of injuring the anterior cruciate ligament (ACL) in the athlete. It is the combination of the muscular resistance to a large knee flexion moment, an external reaction force generating knee compression, an internal tibial torque, and a knee abduction moment during a single-leg athletic manoeuvre such as landing from a jump, abruptly changing direction, or rapidly decelerating that results in the greatest ACL loads. While there is consensus that an anterior tibial shear force is the primary ACL loading mechanism, controversy exists regarding the secondary order of importance of transverse-plane and frontal-plane loading in ACL injury scenarios. Large knee compression forces combined with a posteriorly and inferiorly sloped tibial plateau, especially the lateral plateau-an important ACL injury risk factor-causes anterior tibial translation and internal tibial rotation, which increases ACL loading. Furthermore, while the ACL can fail under a single supramaximal loading cycle, recent evidence shows that it can also fail following repeated submaximal loading cycles due to microdamage accumulating in the ligament with each cycle. This challenges the existing dogma that non-contact ACL injuries are predominantly due to a single manoeuvre that catastrophically overloads the ACL.
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Affiliation(s)
- Mélanie L. Beaulieu
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - James A. Ashton-Miller
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, USA
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Edward M. Wojtys
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
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4
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Shinde T, Saito A, Okada K, Wakasa M, Kimoto M, Kamada T, Shibata K, Okura K, Sato H, Takahashi Y. Influence of lower extremity rotation on knee kinematics in single-leg landing. Phys Ther Sport 2022; 58:87-92. [DOI: 10.1016/j.ptsp.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 10/02/2022] [Accepted: 10/03/2022] [Indexed: 11/29/2022]
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Koo YJ, Seon JK, Lee G, Koo S. Influences of Partial Anterior Cruciate Ligament Injury On Anterior Cruciate Ligament Tensional Force and Kinematic Stability During Walking. J Biomech Eng 2022; 145:1143182. [PMID: 35838323 DOI: 10.1115/1.4054982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Indexed: 11/08/2022]
Abstract
Injuries in the anterior cruciate ligament (ACL), including partial tear and lengthening of the ACL, change the dynamic function of the knee. However, there is a lack of information on the effect of ACL partial tear on knee kinematics during walking. This study aimed to investigate the effects of different levels of ACL injuries on the knee stability and ACL tensional force to identify the critical injury level. Motion data of five normal subjects were acquired along with the ground reaction force. A knee model with 14 ligaments was developed using cadaveric specimen data. The initial length and stiffness of the ACL were changed to develop ACL-injured knee models. Musculoskeletal simulations of the knee models were performed using the measured gait data. The average tibial anterior translation increased significantly by 2.6 ± 0.7 mm when the ACL stiffness decreased to 25% of its original stiffness. The average tibial anterior translation increased significantly by 2.6 ± 0.3 mm at an increase in initial length of 10%. The knee with partial ACL tear had a non-linear decrease in ACL forces owing to the increase in the level of ACL injury, while the knee with ACL lengthening had linear decreased ACL forces. The partial tear of the ACL caused translational instability, while the complete tear caused both rotational and translational instabilities during the musculoskeletal walking simulation. This study presents the effects of partial ACL injuries on joint kinematics and ACL tensional force during the dynamic motion of walking.
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Affiliation(s)
- Young-Jun Koo
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Jong Keun Seon
- Department of Orthopedic Surgery, Chonnam National University Bitgoeul Hospital, Gwangju, Republic of Korea
| | - Giuk Lee
- School of Mechanical Engineering, Chung-Ang University, Seoul, Republic of Korea
| | - Seungbum Koo
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
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6
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Saadat S, Stephenson ML, Gillette JC. Entry angle during jump landing changes biomechanical risk factors for ACL injury. Sports Biomech 2022:1-13. [PMID: 35714032 DOI: 10.1080/14763141.2022.2088399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 06/07/2022] [Indexed: 10/18/2022]
Abstract
ACL injuries are common among athletes. The injury usually occurs during sport movements involving sudden direction changes when landing and cutting. Twenty-one healthy females performed a series of jump-land-jump movements. They jumped from a 28 cm box onto two in-ground force platforms, followed by a maximal vertical jump. The direction of the first jump was tested with seven entry angles, jumping to the right (90 R, 60 R and 30 R), straight forward (0), and jumping to the left (90 L, 60 L and 30 L). Kinematic and kinetic data were recorded for data analysis. During the first 100 ms of landing, participants had significantly smaller peak knee flexion angles, larger initial knee valgus angles and larger peak knee joint external valgus moments when jumping to the right (90 R, 60 R and 30 R) compared to straight forward (0), and jumping to the left (90 L, 60 L and 30 L). Thus, entry angles to the right may increase the risk of ACL injury in the right knee. We suggest that these types of jumps should be used with caution during ACL rehabilitation, but may be useful for testing ACL risk factors in healthy individuals.
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Affiliation(s)
- Shekoofe Saadat
- Department of Kinesiology, Iowa State University, Ames, IA, USA
| | - Mitchell L Stephenson
- Department of Health and Human Performance, University of Montana Western, Dillon, SC, USA
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Mishra S, Mylarappa A, Satapathy D, Samal S. Morphometric Analysis of Anatomy of Anterior Cruciate Ligament of Knee and its Attachments - a Cadaveric Study in Indian Population. Malays Orthop J 2021; 15:8-14. [PMID: 34966489 PMCID: PMC8667243 DOI: 10.5704/moj.2111.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 06/24/2021] [Indexed: 11/10/2022] Open
Abstract
Introduction: The Anterior Cruciate Ligament tends to stabilise the knee in various range of extension and flexion. Precise study of anatomy, attachments and position of bundles is important for successful ACL reconstruction. In our study, we attempt to assess general anatomy of ACL, determine and compare its morphometric data pertaining to length and width and its tibio-femoral foot prints in different gender and secondarily determine changes in the same during ACL dynamics witnessed during knee flexion changes. Materials and methods: A total of 19 knees from 10 cadavers were used in the research with mean age of 61±7 years. After dissecting the skin, muscles, patellar and articular capsule were removed and bundle attachments were studied. Thereafter the relative length, width and stiffness of ACL bundles at 0, 90, 140 (maximum) angles of knee flexion were measured along with maximum horizontal and vertical bundle footprints at tibio-femoral attachments were recorded. Results: Mean length and width of insertion of anteromedial (AM) bundle on the tibial surface was 8.8mm and 9.0mm in males and 8.1mm and 8.8mm in females. Furthermore, that of PL bundle was 9.1mm and 7.8mm in males and 8.9mm and 7.1mm in females. Conclusion: The anteromedial (AM) bundle and posterolateral (PL) bundle of ACL were found to be most relaxed at full extension and were most taut at maximum flexion of 140°. AM bundle underwent greater stretching and change of length in comparison to the PL bundle, indicating that it is comparatively a more dominant bundle.
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Affiliation(s)
- S Mishra
- Department of Orthopaedics, Siksha O Anusandhan University Institute of Medical Sciences and SUM Hospital, Bhubaneswar, India
| | - A Mylarappa
- Department of Orthopaedics, Siksha O Anusandhan University Institute of Medical Sciences and SUM Hospital, Bhubaneswar, India
| | - D Satapathy
- Department of Orthopaedics, Siksha O Anusandhan University Institute of Medical Sciences and SUM Hospital, Bhubaneswar, India
| | - S Samal
- Department of Orthopaedics, Siksha O Anusandhan University Institute of Medical Sciences and SUM Hospital, Bhubaneswar, India
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Magnanelli S, Screpis D, Di Benedetto P, Natali S, Causero A, Zorzi C. Open-Wedge High Tibial Osteotomy Associated With Lipogems® Intra-Articular Injection For The Treatment Of Varus Knee Osteoarthritis - Retrospective Study. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:e2020022. [PMID: 33559633 PMCID: PMC7944687 DOI: 10.23750/abm.v91i14-s.10992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 11/30/2020] [Indexed: 12/18/2022]
Abstract
Background and aim: Open-wedge high tibial osteotomy (HTO) is a good choice in the treatment of varus knee medial osteoarthritis, with the restore of the correct mechanical axis of the lower limb. Autologous adipose derived stem cells (aASCs) are used in cartilage regeneration and in the treatment of early osteoarthritis. Aim of this study is to retrospectively analyze clinical (and radiological) results in two populations of patients with initial varus medial knee osteoarthritis, treated with HTO, with or without associated intra-articular injection of aASCs. Methods: In this study we analyze 85 patients treated with HTO for varus knee osteoarthritis with or without Lipogems® intra-articular injection. It was used of a single model of HTO plate. No associated procedure was performed. Results: Significant improvement in the daily life activity assessment (KOOS score) was observed in the group treated also with aASCs compared with group treated with isolated HTO. Conclusions: We suggest, in these patients, the surgical indication of an open-wedge high tibial osteotomy (HTO) and simultaneous injection with aASCs associated procedure to improve cartilage regeneration, with clinical improvement. (www.actabiomedica.it)
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Affiliation(s)
- Stefano Magnanelli
- Ortopedia e traumatologia, IRCCS Ospedale Sacro Cuore - Don Calabria, - Negrar (VR).
| | - Daniele Screpis
- Ortopedia e traumatologia, IRCCS Ospedale Sacro Cuore - Don Calabria, - Negrar (VR).
| | | | - Simone Natali
- Ortopedia e traumatologia, IRCCS Ospedale Sacro Cuore - Don Calabria, - Negrar (VR).
| | - Araldo Causero
- Clinic of Orthopedics, Academic Hospital of Udine, Udine, Italy Medical Department, Universitiy of Udine, Italy.
| | - Claudio Zorzi
- Ortopedia e traumatologia, IRCCS Ospedale Sacro Cuore - Don Calabria, - Negrar (VR).
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Rangel A, Colaço L, Nguyen N, Grosset JF, Egles C, Migonney V. Adapting Mechanical Characterization of a Biodegradable Polymer to Physiological Approach of Anterior Cruciate Ligament Functions. Ing Rech Biomed 2020. [DOI: 10.1016/j.irbm.2020.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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10
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Biomechanical Function and Size of the Anteromedial and Posterolateral Bundles of the ACL Change Differently with Skeletal Growth in the Pig Model. Clin Orthop Relat Res 2020. [PMID: 31373947 DOI: 10.1097/corr.0000000000000884.] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND ACL injuries are becoming increasingly common in children and adolescents, but little is known regarding age-specific ACL function in these patients. To improve our understanding of changes in musculoskeletal tissues during growth and given the limited availability of pediatric human cadaveric specimens, tissue structure and function can be assessed in large animal models, such as the pig. QUESTIONS/PURPOSES Using cadaveric porcine specimens ranging throughout skeletal growth, we aimed to assess age-dependent changes in (1) joint kinematics under applied AP loads and varus-valgus moments, (2) biomechanical function of the ACL under the same loads, (3) the relative biomechanical function of the anteromedial and posterolateral bundles of the ACL; and (4) size and orientation of the anteromedial and posterolateral bundles. METHODS Stifle joints (analogous to the human knee) were collected from female Yorkshire crossbreed pigs at five ages ranging from early youth to late adolescence (1.5, 3, 4.5, 6, and 18 months; n = 6 pigs per age group, 30 total), and MRIs were performed. A robotic testing system was used to determine joint kinematics (AP tibial translation and varus-valgus rotation) and in situ forces in the ACL and its bundles in response to applied anterior tibial loads and varus-valgus moments. To see if morphological changes to the ACL compared with biomechanical changes, ACL and bundle cross-sectional area, length, and orientation were calculated from MR images. RESULTS Joint kinematics decreased with increasing age. Normalized AP tibial translation decreased by 44% from 1.5 months (0.34 ± 0.08) to 18 months (0.19 ± 0.02) at 60° of flexion (p < 0.001) and varus-valgus rotation decreased from 25° ± 2° at 1.5 months to 6° ± 2° at 18 months (p < 0.001). The ACL provided the majority of the resistance to anterior tibial loading at all age groups (75% to 111% of the applied anterior force; p = 0.630 between ages). Anteromedial and posterolateral bundle function in response to anterior loading and varus torque were similar in pigs of young ages. During adolescence (4.5 to 18 months), the in situ force carried by the anteromedial bundle increased relative to that carried by the posterolateral bundle, shifting from 59% ± 22% at 4.5 months to 92% ± 12% at 18 months (data for 60° of flexion, p < 0.001 between 4.5 and 18 months). The cross-sectional area of the anteromedial bundle increased by 30 mm throughout growth from 1.5 months (5 ± 2 mm) through 18 months (35 ± 8 mm; p < 0.001 between 1.5 and 18 months), while the cross-sectional area of the posterolateral bundle increased by 12 mm from 1.5 months (7 ± 2 mm) to 4.5 months (19 ± 5 mm; p = 0.004 between 1.5 and 4.5 months), with no further growth (17 ± 7 mm at 18 months; p = 0.999 between 4.5 and 18 months). However, changes in length and orientation were similar between the bundles. CONCLUSION We showed that the stifle joint (knee equivalent) in the pig has greater translational and rotational laxity in early youth (1.5 to 3 months) compared with adolescence (4.5 to 18 months), that the ACL functions as a primary stabilizer throughout growth, and that the relative biomechanical function and size of the anteromedial and posterolateral bundles change differently with growth. CLINICAL RELEVANCE Given the large effects observed here, the age- and bundle-specific function, size, and orientation of the ACL may need to be considered regarding surgical timing, graft selection, and graft placement. In addition, the findings of this study will be used to motivate pre-clinical studies on the impact of partial and complete ACL injuries during skeletal growth.
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11
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Saito A, Okada K, Sasaki M, Wakasa M. Influence of the trunk position on knee kinematics during the single-leg landing: implications for injury prevention. Sports Biomech 2020; 21:810-823. [DOI: 10.1080/14763141.2019.1691642] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Akira Saito
- Department of Physical Therapy, Akita University Graduate School of Health Sciences, Akita, Japan
| | - Kyoji Okada
- Department of Physical Therapy, Akita University Graduate School of Health Sciences, Akita, Japan
| | - Makoto Sasaki
- Department of Physical Therapy, Akita University Graduate School of Health Sciences, Akita, Japan
| | - Masahiko Wakasa
- Department of Physical Therapy, Akita University Graduate School of Health Sciences, Akita, Japan
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12
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Cone SG, Lambeth EP, Ru H, Fordham LA, Piedrahita JA, Spang JT, Fisher MB. Biomechanical Function and Size of the Anteromedial and Posterolateral Bundles of the ACL Change Differently with Skeletal Growth in the Pig Model. Clin Orthop Relat Res 2019; 477:2161-2174. [PMID: 31373947 PMCID: PMC7000103 DOI: 10.1097/corr.0000000000000884] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 06/13/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND ACL injuries are becoming increasingly common in children and adolescents, but little is known regarding age-specific ACL function in these patients. To improve our understanding of changes in musculoskeletal tissues during growth and given the limited availability of pediatric human cadaveric specimens, tissue structure and function can be assessed in large animal models, such as the pig. QUESTIONS/PURPOSES Using cadaveric porcine specimens ranging throughout skeletal growth, we aimed to assess age-dependent changes in (1) joint kinematics under applied AP loads and varus-valgus moments, (2) biomechanical function of the ACL under the same loads, (3) the relative biomechanical function of the anteromedial and posterolateral bundles of the ACL; and (4) size and orientation of the anteromedial and posterolateral bundles. METHODS Stifle joints (analogous to the human knee) were collected from female Yorkshire crossbreed pigs at five ages ranging from early youth to late adolescence (1.5, 3, 4.5, 6, and 18 months; n = 6 pigs per age group, 30 total), and MRIs were performed. A robotic testing system was used to determine joint kinematics (AP tibial translation and varus-valgus rotation) and in situ forces in the ACL and its bundles in response to applied anterior tibial loads and varus-valgus moments. To see if morphological changes to the ACL compared with biomechanical changes, ACL and bundle cross-sectional area, length, and orientation were calculated from MR images. RESULTS Joint kinematics decreased with increasing age. Normalized AP tibial translation decreased by 44% from 1.5 months (0.34 ± 0.08) to 18 months (0.19 ± 0.02) at 60° of flexion (p < 0.001) and varus-valgus rotation decreased from 25° ± 2° at 1.5 months to 6° ± 2° at 18 months (p < 0.001). The ACL provided the majority of the resistance to anterior tibial loading at all age groups (75% to 111% of the applied anterior force; p = 0.630 between ages). Anteromedial and posterolateral bundle function in response to anterior loading and varus torque were similar in pigs of young ages. During adolescence (4.5 to 18 months), the in situ force carried by the anteromedial bundle increased relative to that carried by the posterolateral bundle, shifting from 59% ± 22% at 4.5 months to 92% ± 12% at 18 months (data for 60° of flexion, p < 0.001 between 4.5 and 18 months). The cross-sectional area of the anteromedial bundle increased by 30 mm throughout growth from 1.5 months (5 ± 2 mm) through 18 months (35 ± 8 mm; p < 0.001 between 1.5 and 18 months), while the cross-sectional area of the posterolateral bundle increased by 12 mm from 1.5 months (7 ± 2 mm) to 4.5 months (19 ± 5 mm; p = 0.004 between 1.5 and 4.5 months), with no further growth (17 ± 7 mm at 18 months; p = 0.999 between 4.5 and 18 months). However, changes in length and orientation were similar between the bundles. CONCLUSION We showed that the stifle joint (knee equivalent) in the pig has greater translational and rotational laxity in early youth (1.5 to 3 months) compared with adolescence (4.5 to 18 months), that the ACL functions as a primary stabilizer throughout growth, and that the relative biomechanical function and size of the anteromedial and posterolateral bundles change differently with growth. CLINICAL RELEVANCE Given the large effects observed here, the age- and bundle-specific function, size, and orientation of the ACL may need to be considered regarding surgical timing, graft selection, and graft placement. In addition, the findings of this study will be used to motivate pre-clinical studies on the impact of partial and complete ACL injuries during skeletal growth.
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Affiliation(s)
- Stephanie G Cone
- S. G. Cone, E. P. Lambeth, M. B. Fisher, Department of Biomedical Engineering, North Carolina State University and the University of North Carolina - Chapel Hill, Raleigh, NC, USA S. G. Cone, J. A. Piedrahita, M. B. Fisher, Comparative Medicine Institute, North Carolina State University, Raleigh, NC, USA H. Ru, Department of Computational Biology and Bioinformatics, North Carolina State University, Raleigh, NC, USA L. A. Fordham, Department of Radiology, University of North Carolina - Chapel Hill, Chapel Hill, NC, USA J. A. Piedrahita, Department of Molecular Biomedical Sciences, North Carolina State University, Raleigh, NC, USA J. T. Spang, M. B. Fisher, Department of Orthopaedics, University of North Carolina - Chapel Hill, Chapel Hill, NC, USA
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13
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Cone SG, Howe D, Fisher MB. Size and Shape of the Human Anterior Cruciate Ligament and the Impact of Sex and Skeletal Growth: A Systematic Review. JBJS Rev 2019; 7:e8. [PMID: 31246862 DOI: 10.2106/jbjs.rvw.18.00145] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND High rates of anterior cruciate ligament (ACL) injury and surgical reconstruction in both skeletally immature and mature populations have led to many studies investigating the size and shape of the healthy ligament. The purposes of the present study were to compile existing quantitative measurements of the geometry of the ACL, its bundles, and its insertion sites and to describe effects of common covariates such as sex and age. METHODS A search of the Web of Science was conducted for studies published from January 1, 1900, to April 11, 2018, describing length, cross-sectional area, volume, orientation, and insertion sites of the ACL. Two reviewers independently screened and reviewed the articles to collect quantitative data for each parameter. RESULTS Quantitative data were collected from 92 articles in this systematic review. In studies of adults, reports of average ACL length, cross-sectional area, and volume ranged from 26 to 38 mm, 30 to 53 mm, and 854 to 1,858 mm, respectively. Reported values were commonly found to vary according to sex and skeletal maturity as well as measurement technique. CONCLUSIONS Although the geometry of the ACL has been described widely in the literature, quantitative measurements can depend on sex, age, and measurement modality, contributing to variability between studies. As such, care must be taken to account for these factors. The present study condenses measurements describing the geometry of the ACL, its individual bundles, and its insertion sites, accounting for common covariates when possible, to provide a resource to the clinical and scientific communities. CLINICAL RELEVANCE Quantitative measures of ACL geometry are informative for developing clinical treatments such as ACL reconstruction. Age and sex can impact these parameters.
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Affiliation(s)
- Stephanie G Cone
- Joint Department of Biomedical Engineering, North Carolina State University and the University of North Carolina-Chapel Hill, Raleigh, North Carolina.,Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina
| | - Danielle Howe
- Joint Department of Biomedical Engineering, North Carolina State University and the University of North Carolina-Chapel Hill, Raleigh, North Carolina.,Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina
| | - Matthew B Fisher
- Joint Department of Biomedical Engineering, North Carolina State University and the University of North Carolina-Chapel Hill, Raleigh, North Carolina.,Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina.,Department of Orthopaedics, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina
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14
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Chang H, Zheng Z, Shao D, Yu Y, Hou Z, Zhang Y. Incidence and Radiological Predictors of Concomitant Meniscal and Cruciate Ligament Injuries in Operative Tibial Plateau Fractures: A Prospective Diagnostic Study. Sci Rep 2018; 8:13317. [PMID: 30190502 PMCID: PMC6127198 DOI: 10.1038/s41598-018-31705-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 08/09/2018] [Indexed: 11/08/2022] Open
Abstract
The aim of this prospective study was to determine the incidence of meniscal and cruciate ligament injuries in operative tibial plateau fractures detected using knee arthroscopy, and to identify the radiological predictors observed on CT images. From January 2016 to February 2017, a total of 102 closed tibial plateau fractures were enrolled in this prospective protocol. Each patient underwent arthroscopic examination following the tibial plateau internal fixation. Univariate analysis and multivariable logistic regression were used to assess the association between imaging parameters and soft-tissue injuries. The menisci were traumatically injured in 52.9% of subjects (54 of 102) and the cruciate ligaments injured in 22.5% (23 of 102). Significantly higher injury rates for bucket-handle meniscal tears were observed in Schatzker type VI fractures (P = 0.04). Greater risk of lateral meniscus injury was observed in patients with >6.3 mm of lateral joint depression. Greater risk of ACL injury when the volumetric lateral joint depression was ≤209.5 mm2 and/or with >5.7 mm lateral joint widening. Associated meniscal and ligament injuries were commonly seen among operative tibial plateau fractures. Preoperative CT measurements might help predict a higher risk of meniscus and ACL injury, providing guidance to the surgeon to look for and to be prepared to treat such injuries.
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Affiliation(s)
- Hengrui Chang
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, P.R. China
- Key laboratory of biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, P.R. China
| | - Zhanle Zheng
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, P.R. China
- Key laboratory of biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, P.R. China
| | - Decheng Shao
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, P.R. China
- Key laboratory of biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, P.R. China
| | - Yiyang Yu
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, P.R. China
- Key laboratory of biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, P.R. China
| | - Zhiyong Hou
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, P.R. China
- Key laboratory of biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, P.R. China
| | - Yingze Zhang
- Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, P.R. China.
- Key laboratory of biomechanics of Hebei Province, Shijiazhuang, Hebei, 050051, P.R. China.
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15
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Matsumoto A, Yamaguchi M, Sasaki K, Kanto R. Prediction of graft length by body height in anatomic double-bundle anterior cruciate ligament reconstruction. ASIA-PACIFIC JOURNAL OF SPORT MEDICINE ARTHROSCOPY REHABILITATION AND TECHNOLOGY 2018; 12:17-21. [PMID: 29963373 PMCID: PMC6022356 DOI: 10.1016/j.asmart.2018.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2017] [Revised: 01/22/2018] [Accepted: 01/26/2018] [Indexed: 11/17/2022]
Affiliation(s)
- Akio Matsumoto
- Department of Orthopaedic Surgery, Meiwa Hospital, 4-31 Agenaruo-cho, 663-8186 Nishinomiya City, Hyogo, Japan
| | - Motoi Yamaguchi
- Department of Orthopaedic Surgery, Meiwa Hospital, 4-31 Agenaruo-cho, 663-8186 Nishinomiya City, Hyogo, Japan
| | - Ken Sasaki
- Department of Orthopaedic Surgery, Anshin Hospital, 1-4-12 Minatojima-minamimachi Chuo-ku, 650-0047 Kobe City, Hyogo, Japan
| | - Ryo Kanto
- Department of Orthopaedic Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, 663-8501 Nishinomiya City, Hyogo, Japan
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16
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Mallett KF, Arruda EM. Digital image correlation-aided mechanical characterization of the anteromedial and posterolateral bundles of the anterior cruciate ligament. Acta Biomater 2017; 56:44-57. [PMID: 28366841 DOI: 10.1016/j.actbio.2017.03.045] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 03/10/2017] [Accepted: 03/27/2017] [Indexed: 01/12/2023]
Abstract
The anterior cruciate ligament (ACL) is one of the most commonly injured soft tissue structures in the articular knee joint, often requiring invasive surgery for patients to restore pre-injury knee kinematics. There is a pressing need to understand the role of the ACL in knee function, in order to select proper replacements. Digital image correlation (DIC), a non-contact full field displacement measurement technique, is an established tool for evaluating non-biological materials. The application of DIC to soft tissues has been in the nascent stages, largely due to patterning challenges of such materials. The ACL is notoriously difficult to mechanically characterize, due to the complex geometry of its two bundles and their insertions. This paper examines the use of DIC to determine the tensile mechanical properties of the AM and PL bundles of ovine ACLs in a well-known loading state. Homogenous loading in the mid-substance of the bundles provides for accurate development of stress/strain curves using DIC. Animal to animal variability is reduced, and the bundles are stiffer than previously thought when tissue-level strains are accurately measured. STATEMENT OF SIGNIFICANCE The anterior cruciate ligament (ACL), a major stabilizing ligament of the articular knee joint, is one of the most commonly injured soft tissue structures in the knee. Often, invasive surgery is required to restore pre-injury knee kinematics, and there are several long-term consequences of ACL reconstructions, including early-onset osteoarthritis. The role of the ACL in knee stability and motion has received much attention in the biomechanics community. This paper examines the use of a non-contact full-field displacement measurement technique, digital image correlation, to determine the tensile mechanical properties of the ACL. The focus of this work is to investigate the intrinsic mechanical properties of the ACL, as new knowledge in these areas will aid clinicians in selecting ACL replacements.
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Affiliation(s)
- Kaitlyn F Mallett
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI 48109, United States.
| | - Ellen M Arruda
- Department of Mechanical Engineering, Department of Biomedical Engineering, Program in Macromolecular Science and Engineering, University of Michigan, Ann Arbor, MI 48109, United States.
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17
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Peeler J, Anderson J, Piotrowski S, Stranges G. Motion of the anterior cruciate ligament during internal and external rotation at the knee: A cadaveric study. Clin Anat 2017; 30:861-867. [DOI: 10.1002/ca.22896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 04/20/2017] [Accepted: 04/24/2017] [Indexed: 01/13/2023]
Affiliation(s)
- J. Peeler
- Department of Human Anatomy & Cell Science; University of Manitoba; Winnipeg Manitoba Canada
- Pan Am Clinic, Winnipeg, Manitoba, Canada Pan Am Clinic; Winnipeg Manitoba Canada
| | - J. Anderson
- Department of Biological Sciences; University of Manitoba; Winnipeg Manitoba Canada
| | - S. Piotrowski
- Department of Human Anatomy & Cell Science; University of Manitoba; Winnipeg Manitoba Canada
| | - G. Stranges
- Pan Am Clinic, Winnipeg, Manitoba, Canada Pan Am Clinic; Winnipeg Manitoba Canada
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18
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Irarrázaval S, Albers M, Chao T, Fu FH. Gross, Arthroscopic, and Radiographic Anatomies of the Anterior Cruciate Ligament. Clin Sports Med 2017; 36:9-23. [DOI: 10.1016/j.csm.2016.08.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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19
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Farraro KF, Sasaki N, Woo SLY, Kim KE, Tei MM, Speziali A, McMahon PJ. Magnesium ring device to restore function of a transected anterior cruciate ligament in the goat stifle joint. J Orthop Res 2016; 34:2001-2008. [PMID: 26916011 PMCID: PMC9583724 DOI: 10.1002/jor.23210] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 02/18/2016] [Indexed: 02/04/2023]
Abstract
A bioresorbable, mono-crystalline magnesium (Mg) ring device and suture implantation technique were designed to connect the ends of a transected anterior cruciate ligament (ACL) to restabilize the knee and load the ACL to prevent disuse atrophy of its insertion sites and facilitate its healing. To test its application, cadaveric goat stifle joints were evaluated using a robotic/universal force-moment sensor testing system in three states: Intact, ACL-deficient, and after Mg ring repair, at 30°, 60°, and 90° of joint flexion. Under a 67-N anterior tibial load simulating that used in clinical examinations, the corresponding anterior tibial translation (ATT) and in-situ forces in the ACL and medial meniscus for 0 and 100 N of axial compression were obtained and compared with a control group treated with suture repair. In all cases, Mg ring repair reduced the ATT by over 50% compared to the ACL-deficient joint, and in-situ forces in the ACL and medial meniscus were restored to near normal levels, showing significant improvement over suture repair. These findings suggest that Mg ring repair could successfully stabilize the joint and load the ACL immediately after surgery, laying the framework for future in vivo studies to assess its utility for ACL healing. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:2001-2008, 2016.
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Affiliation(s)
- Kathryn F. Farraro
- Department of Bioengineering, Musculoskeletal Research Center; Swanson School of Engineering, University of Pittsburgh; 405 Center for Bioengineering, 300 Technology Drive Pittsburgh Pennsylvania 15219
| | - Norihiro Sasaki
- Department of Bioengineering, Musculoskeletal Research Center; Swanson School of Engineering, University of Pittsburgh; 405 Center for Bioengineering, 300 Technology Drive Pittsburgh Pennsylvania 15219
| | - Savio L-Y. Woo
- Department of Bioengineering, Musculoskeletal Research Center; Swanson School of Engineering, University of Pittsburgh; 405 Center for Bioengineering, 300 Technology Drive Pittsburgh Pennsylvania 15219
| | - Kwang E. Kim
- Department of Bioengineering, Musculoskeletal Research Center; Swanson School of Engineering, University of Pittsburgh; 405 Center for Bioengineering, 300 Technology Drive Pittsburgh Pennsylvania 15219
| | - Matteo M. Tei
- Department of Bioengineering, Musculoskeletal Research Center; Swanson School of Engineering, University of Pittsburgh; 405 Center for Bioengineering, 300 Technology Drive Pittsburgh Pennsylvania 15219
| | - Andrea Speziali
- Department of Bioengineering, Musculoskeletal Research Center; Swanson School of Engineering, University of Pittsburgh; 405 Center for Bioengineering, 300 Technology Drive Pittsburgh Pennsylvania 15219
| | - Patrick J. McMahon
- Department of Bioengineering, Musculoskeletal Research Center; Swanson School of Engineering, University of Pittsburgh; 405 Center for Bioengineering, 300 Technology Drive Pittsburgh Pennsylvania 15219
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20
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Guenoun D, Vaccaro J, Le Corroller T, Barral PA, Lagier A, Pauly V, Coquart B, Coste J, Champsaur P. A dynamic study of the anterior cruciate ligament of the knee using an open MRI. Surg Radiol Anat 2016; 39:307-314. [PMID: 27515305 DOI: 10.1007/s00276-016-1730-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 08/03/2016] [Indexed: 10/21/2022]
Abstract
Recent anatomical and radiological studies of the anterior cruciate ligament (ACL) suggest the ACL length and orientation change during knee flexion, and an open MRI sequencing during knee flexion enables a dynamic ACL analysis. This study's goal is to describe a normal ACL using a 1T open MRI and, in particular, variations in length and insertion angles at different degrees of flexion. Twenty-one volunteers with clinically healthy knees received a dynamic MRI with their knees in hyperextension, neutral position, and flexed at 45° and 90° angles. For each position, two radiologists measured the ACL lengths and angles of the proximal insertion between the ACL's anterior edge and the roof of the inter-condylar notch. Additionally, we measured the ACL's and the tibial plateau's distal angle insertion between their anterior edges and then compared these with the nonparametric Wilcoxon test. The ACL had a significant extension between the 90° flexion and all other positions (hyperextension: 31.75 ± 2.5 mm, neutral position: 32.5 ± 2.6 mm, 45°: 35.6 ± 1.6 mm, 90°: 35.6 ± 1.6 mm). There was also a significant increase of the angle insertion between the proximal 90° flexion and all other positions, as well as between hyperextension and bending to 45° (hyperextension: 2.45° ± 3.7°, neutral: 13.4° ± 9.7°, 45°: 33 25 ± 9.3, 90: 51.85° ± 9.3°). Additionally, there is a significant increase in the distal angle insertion for all positions (hyperextension: 133.2° ± 5.4°, neutral position: 134.95° ± 4.4°, 45°: 138.35° ± 5.9°, 90°: 149.15° ± 8.6°). Our study is the first to exhibit that a dynamic MRI has a significant ACL extension in vivo during bending. This concept opens the way for further studies to improve the diagnosis of traumatic ACL injuries using a dynamic MRI.
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Affiliation(s)
- Daphne Guenoun
- Department of Radiology, Sainte-Marguerite Hospital, Institute for Locomotion, APHM, 13009, Marseille, France.
| | - Julien Vaccaro
- Department of Radiology, Sainte-Marguerite Hospital, Institute for Locomotion, APHM, 13009, Marseille, France
| | - Thomas Le Corroller
- Department of Radiology, Sainte-Marguerite Hospital, Institute for Locomotion, APHM, 13009, Marseille, France
| | - Pierre-Antoine Barral
- Department of Radiology, Sainte-Marguerite Hospital, Institute for Locomotion, APHM, 13009, Marseille, France
| | - Aude Lagier
- Department of Anatomy, Aix Marseille Université, 13005, Marseille, France
| | - Vanessa Pauly
- Unité de Recherche EA3279, Santé Publique et Maladies Chroniques: Qualité de vie Concepts, Usages et Limites, Déterminants, Aix Marseille Université, 13005, Marseille, France
| | - Benjamin Coquart
- Department of Radiology, Sainte-Marguerite Hospital, Institute for Locomotion, APHM, 13009, Marseille, France
| | - Joel Coste
- Department of Rheumatology, Sainte-Marguerite Hospital, Institute for Locomotion, APHM, 13009, Marseille, France
| | - Pierre Champsaur
- Department of Radiology, Sainte-Marguerite Hospital, Institute for Locomotion, APHM, 13009, Marseille, France
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21
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McLean SG, Mallett KF, Arruda EM. Deconstructing the Anterior Cruciate Ligament: What We Know and Do Not Know About Function, Material Properties, and Injury Mechanics. J Biomech Eng 2015; 137:020906. [DOI: 10.1115/1.4029278] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Indexed: 12/20/2022]
Abstract
Anterior cruciate ligament (ACL) injury is a common and potentially catastrophic knee joint injury, afflicting a large number of males and particularly females annually. Apart from the obvious acute injury events, it also presents with significant long-term morbidities, in which osteoarthritis (OA) is a frequent and debilitative outcome. With these facts in mind, a vast amount of research has been undertaken over the past five decades geared toward characterizing the structural and mechanical behaviors of the native ACL tissue under various external load applications. While these efforts have afforded important insights, both in terms of understanding treating and rehabilitating ACL injuries; injury rates, their well-established sex-based disparity, and long-term sequelae have endured. In reviewing the expanse of literature conducted to date in this area, this paper identifies important knowledge gaps that contribute directly to this long-standing clinical dilemma. In particular, the following limitations remain. First, minimal data exist that accurately describe native ACL mechanics under the extreme loading rates synonymous with actual injury. Second, current ACL mechanical data are typically derived from isolated and oversimplified strain estimates that fail to adequately capture the true 3D mechanical response of this anatomically complex structure. Third, graft tissues commonly chosen to reconstruct the ruptured ACL are mechanically suboptimal, being overdesigned for stiffness compared to the native tissue. The net result is an increased risk of rerupture and a modified and potentially hazardous habitual joint contact profile. These major limitations appear to warrant explicit research attention moving forward in order to successfully maintain/restore optimal knee joint function and long-term life quality in a large number of otherwise healthy individuals.
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Affiliation(s)
- Scott G. McLean
- Human Performance Innovation Laboratory, School of Kinesiology, University of Michigan, Ann Arbor, MI 48109 e-mail:
| | - Kaitlyn F. Mallett
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI 48109 e-mail:
| | - Ellen M. Arruda
- Department of Mechanical Engineering, Department of Biomedical Engineering, Program in Macromolecular Science and Engineering, University of Michigan, Ann Arbor, MI 48109 e-mail:
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22
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Sasaki N, Farraro KF, Kim KE, Woo SLY. Biomechanical evaluation of the quadriceps tendon autograft for anterior cruciate ligament reconstruction: a cadaveric study. Am J Sports Med 2014; 42:723-30. [PMID: 24401682 PMCID: PMC4144981 DOI: 10.1177/0363546513516603] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Recently, many surgeons have chosen the quadriceps tendon (QT) as an autograft for anterior cruciate ligament (ACL) reconstruction. However, there have not been biomechanical studies that quantitatively evaluated knee function after reconstruction using a QT autograft. PURPOSE To measure the 6 degrees of freedom knee kinematics and in situ graft forces after reconstruction with a QT autograft compared with a quadrupled semitendinosus and gracilis (QSTG) tendon autograft. STUDY DESIGN Controlled laboratory study. METHODS Ten human cadaveric knees (age, 54-64 years) were tested in 3 conditions: (1) intact, (2) ACL deficient, and (3) after ACL reconstruction using a QT or QSTG autograft. With use of a robotic/universal force-moment sensor testing system, knee kinematics and in situ forces in the ACL and autografts were obtained at 5 knee flexion angles under externally applied loads: (1) 134-N anterior tibial load, (2) 134-N anterior tibial load with 200-N axial compression, and (3) 10-N·m valgus and 5-N·m internal tibial torque. RESULTS Under the anterior tibial load, both autografts restored anterior tibial translation to within 2.5 mm of the intact knee and in situ forces to within 20 N of the intact ACL at 15°, 30°, and 60°. Adding compression did not change these findings. With the combined rotatory load, the anterior tibial translation and graft in situ forces were again not significantly different from the intact ACL. There were no significant differences between the grafts under any experimental condition. CONCLUSION Reconstruction of the ACL with a QT autograft restored knee function to similar levels as that reconstructed with a QSTG autograft under loads simulating clinical examinations. CLINICAL RELEVANCE The positive biomechanical results of this cadaveric study lend support to the use of a QT autograft for ACL reconstruction, as it could restore knee function immediately after surgery under applied loads that mimic clinical examinations.
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Affiliation(s)
- Norihiro Sasaki
- Musculoskeletal Research Center, Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kathryn F. Farraro
- Musculoskeletal Research Center, Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kwang E. Kim
- Musculoskeletal Research Center, Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Savio L-Y. Woo
- Musculoskeletal Research Center, Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA,Address correspondence to Savio L-Y. Woo, PhD, DSc (Hon), DEng (Hon), Musculoskeletal Research Center, Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, 405 Center for Bioengineering, 300 Technology Drive, Pittsburgh, PA 15219 (
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23
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Revolutionizing orthopaedic biomaterials: The potential of biodegradable and bioresorbable magnesium-based materials for functional tissue engineering. J Biomech 2013; 47:1979-86. [PMID: 24373510 DOI: 10.1016/j.jbiomech.2013.12.003] [Citation(s) in RCA: 143] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 11/18/2013] [Accepted: 12/01/2013] [Indexed: 02/08/2023]
Abstract
In recent years, there has been a surge of interest in magnesium (Mg) and its alloys as biomaterials for orthopaedic applications, as they possess desirable mechanical properties, good biocompatibility, and biodegradability. Also shown to be osteoinductive, Mg-based materials could be particularly advantageous in functional tissue engineering to improve healing and serve as scaffolds for delivery of drugs, cells, and cytokines. In this paper, we will present two examples of Mg-based orthopaedic devices: an interference screw to accelerate ACL graft healing and a ring to aid in the healing of an injured ACL. In vitro tests using a robotic/UFS testing system showed that both devices could restore function of the goat stifle joint. Under a 67-N anterior tibial load, both the ACL graft fixed with the Mg-based interference screw and the Mg-based ring-repaired ACL could restore anterior tibial translation (ATT) to within 2mm and 5mm, respectively, of the intact joint at 30°, 60°, and 90° of flexion. In-situ forces in the replacement graft and Mg-based ring-repaired ACL were also similar to those of the intact ACL. Further, early in vivo data using the Mg-based interference screw showed that after 12 weeks, it was non-toxic and the joint stability and graft function reached similar levels as published data. Following these positive results, we will move forward in incorporating bioactive molecules and ECM bioscaffolds to these Mg-based biomaterials to test their potential for functional tissue engineering of musculoskeletal and other tissues.
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24
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Pujol N, Queinnec S, Boisrenoult P, Maqdes A, Beaufils P. Anatomy of the anterior cruciate ligament related to hamstring tendon grafts. A cadaveric study. Knee 2013; 20:511-4. [PMID: 23157968 DOI: 10.1016/j.knee.2012.10.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Revised: 10/09/2012] [Accepted: 10/11/2012] [Indexed: 02/02/2023]
Abstract
BACKGROUND The aim of modern techniques for anatomic reconstruction of the ACL is to reproduce ACL footprints, in order to restore anatomy and therefore normal biomechanics. Is there an oversizing of the hamstring grafts related to ACL dimensions? METHODS Twenty-two paired cadaver knees were dissected. ACL dimensions at mid-portion and ACL footprints were measured after removing the synovial membrane. Hamstrings were harvested and prepared in a quadruple strand graft in order to measure the mean circumference. RESULTS The average ACL tibial and femoral insertion site areas of the ACL were 117.9mm(2) (range, 90 to 130mm) and 96.8mm(2) (range, 80 to 121mm), respectively. The average diameter and cross sectional area of the ACL tendon at mid-portion were 6.1mm (range, 5 to 7mm) and 29.2mm(2) (range, 20 to 38.9), respectively. The average diameter and cross-sectional area of the 4-stranded hamstring tendons were 6.7 (range, 5 to 8) and 35.3mm(2) (range, 20 to 50), respectively. There was a correlation between the 4-stranded hamstring grafts and ACL dimensions (footprints, ligament at mid substance, p<0.01). The cross sectional area of hamstring tendon was significantly larger than the ACL area at mid-portion (mean 20.9%, p<0.05). CONCLUSION With current ACL reconstruction techniques, the graft is oversized at a mean of 21%, despite a good correlation between the ACL and the hamstring tendon, especially among small subjects and women. The question arises whether the anatomic reconstruction of the ACL should fill ACL footprints or mimic the ligament itself. CLINICAL RELEVANCE Hamstrings grafts are significantly larger than native ACL.
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Affiliation(s)
- Nicolas Pujol
- Orthopedic Department, Centre Hospitalier de Versailles, Versailles-Saint Quentin University, 177, rue de Versailles, 78157 Le Chesnay, France.
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25
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CHEN WEI, XIE BING, ZU GUOHONG, LARS GERIGK, TAN LIWEN, WANG JIAN, ZHANG SHAOXIANG, WEN YAMING, ZHANG YONGKE, CHEN LING. Oblique coronal view of the ACL double-bundle: Comparison of the Chinese Visible Human dataset and low-field MRI. Exp Ther Med 2013; 6:606-610. [PMID: 24137235 PMCID: PMC3786830 DOI: 10.3892/etm.2013.1169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Accepted: 06/06/2013] [Indexed: 11/26/2022] Open
Abstract
The aim of this study was to distinguish the individual bundles of the anterior cruciate ligament (ACL) using the Chinese Visible Human (CVH) dataset and images obtained by low-field routine magnetic resonance imaging (MRI) in the oblique and coronal planes. Sectional anatomical data of the knee were selected from the CVH dataset and reconstructed in 3D. MRI of normal knees was performed with a low-field-strength magnet in the coronal plane. The shape of the ACL was clearly displayed. Using the oblique coronal plane, the anteromedial (AM) and posterolateral (PL) bundles of the ACL were distinguished in the reconstructed anatomical data and the MR images. The double-bundle structure of the ACL was evaluated in the CVH 3D reconstructions and MR images. Using the oblique coronal plane, it was possible to review the ACL structure in the knee. The study demonstrated the feasibility of distinguishing the two bundles in the ACL with CVH 3D reconstruction and low-field strength MRI. The accuracy in the grading of ACL injury in presurgical planning may be improved.
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26
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Affiliation(s)
- P Christel
- Institut de l'Appareil Locomoteur Nollet, 23, rue Brochant, 75017 Paris
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27
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Mauntel TC, Begalle RL, Cram TR, Frank BS, Hirth CJ, Blackburn T, Padua DA. The Effects of Lower Extremity Muscle Activation and Passive Range of Motion on Single Leg Squat Performance. J Strength Cond Res 2013; 27:1813-23. [DOI: 10.1519/jsc.0b013e318276b886] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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28
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Wan C, Hao Z, Wen S. The Effect of the Variation in ACL Constitutive Model on Joint Kinematics and Biomechanics Under Different Loads: A Finite Element Study. J Biomech Eng 2013; 135:041002. [DOI: 10.1115/1.4023696] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2012] [Accepted: 02/19/2013] [Indexed: 11/08/2022]
Abstract
The biomechanics and function of the anterior cruciate ligament (ACL) have been widely studied using both experimental and simulation methods. It is known that a constitutive model of joint tissue is a critical factor in the numerical simulation. Some different ligament constitutive models have been presented to describe the ACL material behavior. However, the effect of the variation in the ligament constitutive model on joint kinematics and biomechanics has still not been studied. In this paper, a three-dimensional finite element model of an intact tibiofemoral joint was reconstructed. Three ACL constitutive models were compared under different joint loads (such as anterior tibial force, varus tibial torque, and valgus tibial torque) to investigate the effect of the change of the ACL constitutive model. The three constitutive models corresponded to an isotropic hyperelasticity model, a transversely isotropic hyperelasticity model with neo-Hookean ground substance description, and a transversely isotropic hyperelastic model with nonlinear ground substance description. Although the material properties of these constitutive equations were fitted on the same uniaxial tension stress-strain curve, the change of the ACL material constitutive model was found to induce altered joint kinematics and biomechanics. The effect of different ACL constitutive equations on joint kinematics depended on both deformation direction and load type. The variation in the ACL constitutive models would influence the joint kinematic results greatly in both the anterior and internal directions under anterior tibial force as well as some other deformations such as the anterior and medial tibial translations under valgus tibial torque, and the medial tibial translation and internal rotation under varus torque. It was revealed that the transversely isotropic hyperelastic model with nonlinear ground substance description (FE model III) was the best representation of the realistic ACL property by a linear regression between the simulated and the experiment deformation results. But the comparison of the predicted and experiment force of ligaments showed that all the three ACL constitutive models represented similar force results. The stress value and distribution of ACL were also altered by the change in the constitutive equation. In brief, although different ACL constitutive models have been fitted using the same uniaxial tension curve and have the similar longitudinal material property, the ACL constitutive equation should still be carefully chosen to investigate joint kinematics and biomechanics due to the different transverse material behavior.
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Affiliation(s)
| | | | - Shizhu Wen
- State Key Laboratory of Tribology, Tsinghua University, Beijing 100084, PRC
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Zhu J, Zhang X, Ma Y, Zhou C, Ao Y. Ultrastructural and morphological characteristics of human anterior cruciate ligament and hamstring tendons. Anat Rec (Hoboken) 2012; 295:1430-6. [PMID: 22807249 DOI: 10.1002/ar.22527] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Accepted: 06/14/2012] [Indexed: 01/12/2023]
Abstract
Hamstring tendons are a commonly used substitute for anterior cruciate ligament (ACL) reconstruction. Ligaments and tendons are similar in composition but the ACL is more complex than hamstring tendons in function and gross morphology, which are highly dependent on its structure and ultrastructure. The purpose of this study was to compare the morphology and ultrastructure of normal human ACL and hamstring tendons, including the cell type and arrangement, expression level of proteoglycans, diameter, and density of collagen fibrils. Twenty semitendinosus or gracilis tendons and 20 ACL specimens were harvested from patients with ACL rupture or osteoarthritis undergoing routine total knee arthroplasty. The specimens were examined histologically and the ultrastructure was observed using scanning and transmission electron microscopy. Semitendinosus and gracilis tendons showed a homogeneous arrangement of collagen fibers and cell type. They had lower fibril density and more widely distributed fibril diameters. In the ACL, there was a more complex arrangement of collagen fibers, distribution of proteoglycans and different cell types. Electronic microscopy demonstrated a combination of parallel, helical and nonlinear networks of ACL fibrils, and fibril diameters were smaller and more nonuniform. This study compared the anatomy of normal human ACL and hamstring tendons, which may provide a standard for evaluating hamstring tendons grafts after ACL reconstruction and may facilitate the application of hamstring tendons in clinical applications.
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Affiliation(s)
- Jingxian Zhu
- Institute of Sports Medicine, Third Hospital of Peking University, Beijing, People's Republic of China
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Stability evaluation after isolated reconstruction of anteromedial or posterolateral bundle in symptomatic partial tears of anterior cruciate ligament. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2012; 23:471-80. [DOI: 10.1007/s00590-012-1018-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Accepted: 05/13/2012] [Indexed: 12/18/2022]
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Bergamini E, Pillet H, Hausselle J, Thoreux P, Guerard S, Camomilla V, Cappozzo A, Skalli W. Tibio-femoral joint constraints for bone pose estimation during movement using multi-body optimization. Gait Posture 2011; 33:706-11. [PMID: 21458992 DOI: 10.1016/j.gaitpost.2011.03.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Revised: 02/18/2011] [Accepted: 03/07/2011] [Indexed: 02/02/2023]
Abstract
When using skin markers and stereophotogrammetry for movement analysis, bone pose estimation may be performed using multi-body optimization with the intent of reducing the effect of soft tissue artefacts. When the joint of interest is the knee, improvement of this approach requires defining subject-specific relevant kinematic constraints. The aim of this work was to provide these constraints in the form of plausible values for the distances between origin and insertion of the main ligaments (ligament lengths), during loaded healthy knee flexion, taking into account the indeterminacies associated with landmark identification during anatomical calibration. Ligament attachment sites were identified through virtual palpation on digital bone templates. Attachments sites were estimated for six knee specimens by matching the femur and tibia templates to low-dose stereoradiography images. Movement data were obtained using stereophotogrammetry and pin markers. Relevant ligament lengths for the anterior and posterior cruciate, lateral collateral, and deep and superficial bundles of the medial collateral ligaments (ACL, PCL, LCL, MCLdeep, MCLsup) were calculated. The effect of landmark identification variability was evaluated performing a Monte Carlo simulation on the coordinates of the origin-insertion centroids. The ACL and LCL lengths were found to decrease, and the MCLdeep length to increase significantly during flexion, while variations in PCL and MCLsup length was concealed by the experimental indeterminacy. An analytical model is given that provides subject-specific plausible ligament length variations as functions of the knee flexion angle and that can be incorporated in a multi-body optimization procedure.
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Affiliation(s)
- E Bergamini
- Locomotor Apparatus Bioengineering Laboratory, Department of Human Movement and Sport Sciences, University of Rome Foro Italico, piazza Lauro De Bosis 15, 00135 Rome, Italy
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Bicer EK, Lustig S, Servien E, Selmi TAS, Neyret P. Current knowledge in the anatomy of the human anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc 2010; 18:1075-84. [PMID: 19956929 DOI: 10.1007/s00167-009-0993-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2009] [Accepted: 11/04/2009] [Indexed: 01/28/2023]
Abstract
The anterior cruciate ligament (ACL) is one of the most frequently studied structures of the musculoskeletal system and continues to stimulate debate and challenges among researchers and surgeons. The ultimate goal of anatomic reconstruction surgery is to restore the native anatomy as much as possible. However, this requires thorough knowledge of its anatomy. The aim of this article is to review the current knowledge of the anatomy of ACL along with its macrostructural and ultrastructural properties.
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Affiliation(s)
- Elcil Kaya Bicer
- Centre Albert Trillat, Groupe Hospitalier Nord, Hospices Civils de Lyon, 8 Rue Margnolles, 69300, Lyon-Caluire, France.
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GEISER CHRISTOPHERF, O'CONNOR KRISTIANM, EARL JENNIFERE. Effects of Isolated Hip Abductor Fatigue on Frontal Plane Knee Mechanics. Med Sci Sports Exerc 2010; 42:535-45. [DOI: 10.1249/mss.0b013e3181b7b227] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Steckel H, Musahl V, Fu FH. The femoral insertions of the anteromedial and posterolateral bundles of the anterior cruciate ligament: a radiographic evaluation. Knee Surg Sports Traumatol Arthrosc 2010; 18:52-5. [PMID: 19565218 PMCID: PMC3085733 DOI: 10.1007/s00167-009-0852-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2009] [Accepted: 06/11/2009] [Indexed: 12/03/2022]
Abstract
The aim of this radiographic study was to visualize the femoral insertion sites of the anteromedial (AM) and posterolateral (PL) bundle of the anterior cruciate ligament (ACL) on lateral radiographs in different angles of knee flexion to gain better understanding for arthroscopic femoral tunnel placement in ACL double bundle reconstruction. Four fresh cadaveric knees with an intact ACL were dissected to isolate the AM and PL bundle of the ACL. We obtained lateral radiographs of each knee over the range of 0 degrees -90 degrees flexion in 30 degrees increments after painting the bundles with a radiopaque tantalum powder. The center of the radiographically marked femoral insertion was defined for each bundle on the lateral roentgenogram. We analyzed the relationship of knee flexion and the projection of the relative position of the femoral insertion sites of both bundles of the ACL on the lateral roentgenogram. The centre of the PL bundle visualized more anterior and distal than the centre of the AM bundle with the knee held in 90 degrees flexion. The centers of the AM and PL bundle were horizontally aligned when the knee was flexed over 90 degrees . The resulting images allow a radiographic description of the femoral insertion sites of both bundles in different angles of knee flexion. It is essential to be aware of the degree of knee flexion when drilling the femoral tunnels.
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Affiliation(s)
- Hanno Steckel
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA.
| | - Volker Musahl
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Suite 1011, Pittsburgh, PA 15213 USA
| | - Freddie H. Fu
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Suite 1011, Pittsburgh, PA 15213 USA
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Cohen SB, VanBeek C, Starman JS, Armfield D, Irrgang JJ, Fu FH. MRI measurement of the 2 bundles of the normal anterior cruciate ligament. Orthopedics 2009; 32:orthopedics.42856. [PMID: 19750997 DOI: 10.3928/01477447-20090728-35] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Anatomical studies have shown that the normal anterior cruciate ligament (ACL) consists of 2 distinct functional bundles: the anteromedial and posterolateral bundles. To date, no study has assessed the magnetic resonance imaging (MRI) appearance of the anteromedial and posterolateral bundles. The purpose of this study was to measure the anteromedial and posterolateral bundles using high-field digital MRI. Fifty MRIs of the knees of 50 patients were prospectively collected using a 1.5-T magnet. The length and width of each ACL bundle was measured on sagittal and coronal digital MRIs, independently performed by 2 observers blinded to each other's measurements. The average length and width of the anteromedial and posterolateral bundles were determined for all patients. Intraclass correlation coefficients were calculated to determine intertester test-retest reliability. In the sagittal plane, the anteromedial bundle averaged 36.9+/-2.8 mm in length and 5.1+/-0.7 mm in width. The posterolateral bundle, by contrast, averaged 20.5+/-2.4 mm in length and 4.4+/-0.8 mm in width. In the coronal plane, the width of the anteromedial bundle averaged 4.2+/-0.8 mm and of the posterolateral bundle averaged 3.7+/-0.8 mm. Interobserver reliability for length of the ACL in the sagittal plane was 0.85, with a 95% CI of 0.75 to 0.91 for the anteromedial bundle and 0.75 with a 95% CI of 0.60 to 0.85 for the posterolateral bundle. Providing precise measurement of the ACL anteromedial and posterolateral bundles on MRI may improve the ability to detect damage to 1 or both of the bundles following injury.
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Affiliation(s)
- Steven B Cohen
- Rothman Institute Orthopaedics and Department of Orthopedic Surgery, Thomas Jefferson University, 925 Chestnut Street, Philadelphia, PA 19107, USA
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Lam MH, Fong DT, Yung PS, Ho EP, Chan WY, Chan KM. Knee stability assessment on anterior cruciate ligament injury: Clinical and biomechanical approaches. BMC Sports Sci Med Rehabil 2009; 1:20. [PMID: 19712449 PMCID: PMC2744659 DOI: 10.1186/1758-2555-1-20] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2008] [Accepted: 08/27/2009] [Indexed: 01/12/2023]
Abstract
Anterior cruciate ligament (ACL) injury is common in knee joint accounting for 40% of sports injury. ACL injury leads to knee instability, therefore, understanding knee stability assessments would be useful for diagnosis of ACL injury, comparison between operation treatments and establishing return-to-sport standard. This article firstly introduces a management model for ACL injury and the contribution of knee stability assessment to the corresponding stages of the model. Secondly, standard clinical examination, intra-operative stability measurement and motion analysis for functional assessment are reviewed. Orthopaedic surgeons and scientists with related background are encouraged to understand knee biomechanics and stability assessment for ACL injury patients.
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Affiliation(s)
- Mak-Ham Lam
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, PR China.
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Nikolaou VS, Efstathopoulos N, Sourlas I, Pilichou A, Papachristou G. Anatomic double-bundle versus single-bundle ACL reconstruction: a comparative biomechanical study in rabbits. Knee Surg Sports Traumatol Arthrosc 2009; 17:895-906. [PMID: 19290508 DOI: 10.1007/s00167-009-0754-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2008] [Accepted: 02/06/2009] [Indexed: 01/29/2023]
Abstract
Thirty New Zealand white rabbits underwent anterior cruciate ligament (ACL) reconstruction in their right knees; 15 animals underwent a double-bundle anatomic ACL reconstruction using the medial third of the patellar tendon and the semitendinosus tendon. Additionally, 15 animals underwent ACL reconstruction, using a single-bundle semitendinosus tendon autograft. The knees of both groups were evaluated with a device similar to the KT1000 arthrometer onto which a dial indicator was attached (Mitutoyo dial indicator 2050) in 30 degrees and 90 degrees of flexion, preoperatively, after ACL resection and 3 months postoperatively. Statistical analysis of the results revealed that for 90 degrees of knee flexion, the mean estimated anterior shift for the double-bundle technique was 1.92 mm lesser than that of the single-bundle technique (P = 0.006). For 30 degrees of knee flexion, the mean anterior shift was again lesser than that of the single-bundle technique by 0.66 mm, but this difference was not statistically significant. The described double-bundle ACL reconstruction technique resulted in a more stable knee as far as the anterior tibial shift was concerned as compared to a single-bundle ACL reconstruction. This animal model may be potentially useful in the future for the study of other parameters influencing the outcome of the double-bundle ACL reconstruction.
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Affiliation(s)
- Vassilios S Nikolaou
- 2nd Academic Department of Trauma and Orthopaedics, School of Medicine, Athens University, Megalou Alexandrou 54, 15124 Maroussi, Athens, Greece.
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Steckel H, Fu FH, Baums MH, Klinger HM. Arthroscopic evaluation of the ACL double bundle structure. Knee Surg Sports Traumatol Arthrosc 2009; 17:782-5. [PMID: 19333575 PMCID: PMC3085755 DOI: 10.1007/s00167-009-0783-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2008] [Accepted: 03/07/2009] [Indexed: 11/29/2022]
Abstract
In order to describe the arthroscopic presence of the double bundle structure and to evaluate the value of different portals in knee arthroscopy, we assessed the AM and PL bundle anatomy. We prospectively examined the knees of 60 patients undergoing arthroscopic surgery for pathology unrelated to the ACL. Arthroscopy was performed in a two portal technique using an anterolateral (ALP) and an anteromedial (AMP) portal. With the arthroscope in the ALP, we could distinguish an AM and PL bundle in 28%. Switching the arthroscope to the AMP, differentiation of the bundles was possible in 67%. In all remaining cases visualization of the PL bundle was possible after retraction of the AM bundle. Use of AMP increased visualization of the PL bundle. It seems reasonable to perform arthroscopy for ACL reconstruction with the arthroscope in the AMP and to establish an additional medial working portal to increase the visualization of the femoral ACL insertion sites for optimal femoral tunnel placement.
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Affiliation(s)
- Hanno Steckel
- Department of Orthopaedic Surgery, University of Göttingen, Robert-Koch-Strasse 40, 37073, Göttingen, Germany.
| | - F. H. Fu
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Suite 1011, Pittsburgh, PA 15213 USA
| | - M. H. Baums
- Department of Orthopaedic Surgery, University of Göttingen, Robert-Koch-Straße 40, 37073 Göttingen, Germany
| | - H. M. Klinger
- Department of Orthopaedic Surgery, University of Göttingen, Robert-Koch-Straße 40, 37073 Göttingen, Germany
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Quatman CE, Hewett TE. The anterior cruciate ligament injury controversy: is "valgus collapse" a sex-specific mechanism? Br J Sports Med 2009; 43:328-35. [PMID: 19372087 DOI: 10.1136/bjsm.2009.059139] [Citation(s) in RCA: 154] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) injury is a devastating injury that puts an athlete at high risk of future osteoarthritis. Identification of risk factors and development of ACL prevention programmes likely decrease injury risk. Although studies indicate that sagittal plane biomechanical factors contribute to ACL loading mechanisms, it is unlikely that non-contact ACL injuries occur solely in a sagittal plane. Some authors attempt to ascribe the solely sagittal plane injury mechanism to both female and male ACL injuries and rebuff the concept that knee "valgus" is associated with isolated ACL injury. Prospective studies that utilise coupled biomechanical and epidemiological approaches demonstrated that frontal knee motions and torques are strong predictors of future non-contact ACL injury risk in female athletes. Video analysis studies also indicate a frontal plane "valgus collapse" mechanism of injury in women. As load sharing between knee ligaments is complex, frontal as well as sagittal and transverse plane loading mechanisms likely contribute to non-contact ACL injury. The purpose of this review is to summarise existing evidence regarding ACL injury mechanisms and to propose that sex-specific mechanisms of ACL injury may occur, with women sustaining injuries by a predominantly "valgus collapse" mechanism. CONCLUSION Prevention programmes and interventions that only target high-risk sagittal plane landing mechanics, especially in the female athlete, are likely to be less effective in ameliorating important frontal and transverse plane contributions to ACL injury mechanisms and could seriously hamper ACL injury prevention efforts. Programmes that target the reduction of high-risk valgus and sagittal plane movements will probably prove to be superior for ACL injury prevention.
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Affiliation(s)
- C E Quatman
- Cincinnati Children's Hospital Research Foundation, Sports Medicine Biodynamics Center and Human Performance Laboratory, Cincinnati, Ohio, USA
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Tsuda E, Ishibashi Y, Fukuda A, Tsukada H, Toh S. Comparable results between lateralized single- and double-bundle ACL reconstructions. Clin Orthop Relat Res 2009; 467:1042-55. [PMID: 18989731 PMCID: PMC2650066 DOI: 10.1007/s11999-008-0604-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2008] [Accepted: 10/17/2008] [Indexed: 01/31/2023]
Abstract
UNLABELLED Patellar tendon autografts are not suitable for multibundle ACL reconstruction, a procedure that reportedly enhances postoperative knee stability. Biomechanical studies recommend lateral placement of the femoral tunnel for single-bundle reconstruction to improve postoperative knee kinematics. We asked whether a lateralized single-bundle patellar tendon graft (LSBP) would provide good short-term results of ACL reconstruction comparable to double-bundle hamstring tendon grafts (DBH). We prospectively followed 144 patients with unilateral ACL rupture treated with either LSBP or DBH in a nonrandomized fashion. Twenty-four female and 31 male patients with LSBP and 44 female and 26 male patients with DBH were followed for a minimum of 24 months (average, 38 months; range, 24-56 months). The patients with LSBP recovered knee extension better at 1 month compared with the patients with DBH, but extension was similar after 3 months. We observed no differences in the side-to-side difference of KT1000 measurement, pivot shift test, or anterior drawer test between LSBP and DBH. Although better recovery of hamstring strength in LSBP and better recovery of quadriceps strength in DBH were observed in the early postoperative period, these differences disappeared after 12 months. There was no difference in International Knee Documentation Committee objective evaluation between LSBP and DBH at the final followup. LEVEL OF EVIDENCE Level II, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Eiichi Tsuda
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Zaifu-cho 5, Hirosaki, Aomori 036-8562, Japan.
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Maestro A, Álvarez A, Del Valle M, Rodríguez L, Meana A, García P, Suárez E, Rodríguez C. Double-bundle anterior cruciate ligament reconstruction. Rev Esp Cir Ortop Traumatol (Engl Ed) 2009. [DOI: 10.1016/s1988-8856(09)70135-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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42
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Reconstrucción anatómica bifascicular del ligamento cruzado anterior. Rev Esp Cir Ortop Traumatol (Engl Ed) 2009. [DOI: 10.1016/j.recot.2008.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Shin CS, Chaudhari AM, Andriacchi TP. The effect of isolated valgus moments on ACL strain during single-leg landing: a simulation study. J Biomech 2008; 42:280-5. [PMID: 19100550 DOI: 10.1016/j.jbiomech.2008.10.031] [Citation(s) in RCA: 107] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2008] [Revised: 10/30/2008] [Accepted: 10/31/2008] [Indexed: 10/21/2022]
Abstract
Valgus moments on the knee joint during single-leg landing have been suggested as a risk factor for anterior cruciate ligament (ACL) injury. The purpose of this study was to test the influence of isolated valgus moment on ACL strain during single-leg landing. Physiologic levels of valgus moments from an in vivo study of single-leg landing were applied to a three-dimensional dynamic knee model, previously developed and tested for ACL strain measurement during simulated landing. The ACL strain, knee valgus angle, tibial rotation, and medial collateral ligament (MCL) strain were calculated and analyzed. The study shows that the peak ACL strain increased nonlinearly with increasing peak valgus moment. Subjects with naturally high valgus moments showed greater sensitivity for increased ACL strain with increased valgus moment, but ACL strain plateaus below reported ACL failure levels when the applied isolated valgus moment rises above the maximum values observed during normal cutting activities. In addition, the tibia was observed to rotate externally as the peak valgus moment increased due to bony and soft-tissue constraints. In conclusion, knee valgus moment increases peak ACL strain during single-leg landing. However, valgus moment alone may not be sufficient to induce an isolated ACL tear without concomitant damage to the MCL, because coupled tibial external rotation and increasing strain in the MCL prevent proportional increases in ACL strain at higher levels of valgus moment. Training that reduces the external valgus moment, however, can reduce the ACL strain and thus may help athletes reduce their overall ACL injury risk.
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Affiliation(s)
- Choongsoo S Shin
- Biomechanical Engineering Group, Department of Mechanical Engineering, Stanford University, Stanford, CA 94305-4038, USA
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44
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Checa S, Taylor M, New A. Influence of an interpositional spacer on the behaviour of the tibiofemoral joint: a finite element study. Clin Biomech (Bristol, Avon) 2008; 23:1044-52. [PMID: 18499317 DOI: 10.1016/j.clinbiomech.2008.04.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2007] [Revised: 01/15/2008] [Accepted: 04/03/2008] [Indexed: 02/07/2023]
Abstract
BACKGROUND Interpositional arthroplasty is considered by many surgeons for the treatment of isolated medial compartment osteoarthritis of the knee. In this procedure, an interpositional spacer is inserted into the medial compartment of the joint with no bone resection and no mechanical fixation. Major problems such as implant dislocation, severe pain or need for revision have been reported post-operatively. METHODS In this study, the kinematics of a knee implanted with an interpositional spacer made of either polyurethane or cobalt-chrome during walking, stair ascent and squatting cycles have been predicted and compared to the normal knee using finite element analysis. In addition, articular cartilage stress histories have been examined to obtain distributions of cumulative stress, a measure of the likelihood of articular cartilage degeneration. FINDINGS The insertion of a polyurethane interpositional spacer in the medial side of the knee did not affect knee kinematics as compared to the normal knee, but caused an increase of articular cartilage cumulative contact stress exposures in the medial compartment of the joint. The knee implanted with the Co-Cr spacer exhibited similar trends in knee kinematics, however significantly different ranges of motion were observed during some periods of the activity cycles, specifically during the first half of the walking cycle where lower ranges of motion were predicted. In addition, higher articular cartilage cumulative contact stress exposures were observed in both compartments of the knee. In both cases, cumulative contact stress exposures of the tibial articular cartilage were more affected than those of the femoral articular cartilage. INTERPRETATION These results suggest implant material as an important parameter in the design phase of interpositional spacers.
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Affiliation(s)
- S Checa
- Trinity Centre for Bioengineering, School of Engineering, Parsons Building, Trinity College, Dublin 2, Ireland.
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Montoy M, Euvrard T, Moyen B, Roy P, Rollier JC, Cotton F. Inter-observer agreement in the identification of the two bundles of the anterior cruciate ligament using magnetic resonance imaging. Surg Radiol Anat 2008; 30:557-62. [PMID: 18523716 DOI: 10.1007/s00276-008-0370-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2008] [Accepted: 05/15/2008] [Indexed: 10/22/2022]
Abstract
BACKGROUND Magnetic resonance imaging has become the method of choice to diagnose meniscal and ligament lesions of the knee. New approaches to the surgical treatment of partial anterior cruciate ligament tears led us to try to distinguish the two bundles of that ligament with MRI and to evaluate inter-observer agreement in different viewing planes. METHODS Images of 50 right and 50 left ligament-intact knees were examined in the coronal and axial viewing planes. Each sequence was independently read by a radiologist and a medical student to note, in each viewing plane, the number of images in which the two-bundle structure of the ligament was clearly seen. Cohen's Kappa coefficients were used to determine inter-observer agreements. RESULTS The percentage of sequences in which the two bundles were distinguished by the radiologist and the student on one image at least were 82 versus 73% in the coronal plane and 90 versus 93% in the axial plane, respectively. The average number of successive images with clear bundles was higher in the axial (2.7 vs. 1.7) than in the coronal plane (2.2 vs. 1). There was a poor inter-observer agreement in the coronal plane (k=0.176) but an intermediate agreement in the axial plane (k=0.385 or 0.522 depending on number pooling). CONCLUSIONS The axial viewing plane seems more favourable to distinguish the two bundles of the anterior cruciate ligament with the best possible reproducibility. An oblique-axial plane is deemed to insure a clearer diagnosis of partial tears.
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Affiliation(s)
- M Montoy
- Laboratoire d'Anatomie de Rockefeller, Université Claude Bernard Lyon 1, 69312, Lyon Cedex 08, France
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Pua YH, Bryant AL, Steele JR, Newton RU, Wrigley TV. Isokinetic Dynamometry in Anterior Cruciate Ligament Injury and Reconstruction. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2008. [DOI: 10.47102/annals-acadmedsg.v37n4p330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
The use of isokinetic dynamometry has often been criticised based on the face-validity argument that isokinetic movements poorly resemble the everyday multi-segmented, dynamic activities of human movements. In the anterior cruciate ligament (ACL) reconstruction or deficiency population where muscle deficits are ubiquitous, this review paper has made a case for using isokinetic dynamometry to isolate and quantify these deficits in a safe and controlled manner. More importantly, the usefulness of isokinetic dynamometry, as applied in individuals with ACL reconstruction or deficiency, is attested by its established known-group and convergent validity. Known-group validity is demonstrated by the extent to which a given isokinetic measure is able to identify individuals who could and could not resume pre-morbid athletic or strenuous activities with minimal functional limitations following an ACL injury. Convergent validity is demonstrated by the extent to which a given isokinetic measure closely associates with self-report measures of knee function in individuals with ACL reconstruction. A basic understanding of the measurement properties of isokinetic dynamometry will guide the clinicians in providing reasoned interventions and advancing the clinical care of their clients.
Key words: Biomechanics, Knee, Validity
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Liu-Barba D, Hull ML, Howell SM. Coupled motions under compressive load in intact and ACL-deficient knees: a cadaveric study. J Biomech Eng 2008; 129:818-24. [PMID: 18067385 DOI: 10.1115/1.2800762] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Knowledge of the coupled motions, which develop under compressive loading of the knee, is useful to determine which degrees of freedom should be included in the study of tibiofemoral contact and also to understand the role of the anterior cruciate ligament (ACL) in coupled motions. The objectives of this study were to measure the coupled motions of the intact knee and ACL-deficient knee under compression and to compare the coupled motions of the ACL-deficient knee with those of the intact knee. Ten intact cadaveric knees were tested by applying a 1600 N compressive load and measuring coupled internal-external and varus-valgus rotations and anterior-posterior and medial-lateral translations at 0 deg, 15 deg, and 30 deg of flexion. Compressive loads were applied along the functional axis of axial rotation, which coincides approximately with the mechanical axis of the tibia. The ACL was excised and the knees were tested again. In the intact knee, the peak coupled motions were 3.8 deg internal rotation at 0 deg flexion changing to -4.9 deg external rotation at 30 deg of flexion, 1.4 deg of varus rotation at 0 deg flexion changing to -1.9 deg valgus rotation at 30 deg of flexion, 1.4 mm of medial translation at 0 deg flexion increasing to 2.3 mm at 30 deg of flexion, and 5.3 mm of anterior translation at 0 deg flexion increasing to 10.2 mm at 30 deg of flexion. All changes in the peak coupled motions from 0 deg to 30 deg flexion were statistically significant (p<0.05). In ACL-deficient knees, there was a strong trend (marginally not significant, p=0.07) toward greater anterior translation (12.7 mm) than that in intact knees (8.0 mm), whereas coupled motions in the other degrees of freedom were comparable. Because the coupled motions in all four degrees of freedom in the intact knee and ACL-deficient knee are sufficiently large to substantially affect the tibiofemoral contact area, all degrees of freedom should be included when either developing mathematical models or designing mechanical testing equipment for study of tibiofemoral contact. The increase in coupled anterior translation in ACL-deficient knees indicates the important role played by the ACL in constraining anterior translation during compressive loading.
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Affiliation(s)
- David Liu-Barba
- Biomedical Engineering Graduate Group, University of California, One Shields Avenue, Davis, CA 95616, USA
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Papachristou G, Sourlas J, Plessas S, Papachristou K. Arthroscopic ACL reconstruction with Delta plasty: an innovative approach with hamstrings' transfer and double tibial tunnel. Knee Surg Sports Traumatol Arthrosc 2008; 16:420-6. [PMID: 17934715 DOI: 10.1007/s00167-007-0426-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2007] [Accepted: 09/20/2007] [Indexed: 01/11/2023]
Abstract
We propose a new technique, with double bundle, double tibial tunnels with a bridge between them, using the hamstrings as auto-grafts, retaining either their central or peripheral attachment. A prospective series of 41 patients underwent primary reconstruction of the anterior cruciate ligament by one surgeon, arthroscopically and electronically assisted; 37 were men and 4 were women with a mean age of 24.7 years. The mean follow-up was 19.05 (12-30) months. Normal function and joint stability was achieved. The patients returned to full occupational activities within 3-6 months after the operation. The function of hamstrings was not disturbed. Two patients have sustained a new injury without rupture of the grafts. The Noulis-Lachman test was negative in 35 knees. Positive Pivot shift, post-operatively, was present in 15.45% of patients. The IKDC score was 84.55. In the proposed ACL reconstruction technique, the two tendons are transferred and used as grafts, with gracillis and semitendinosus retaining their distal and central attachment, respectively; the former superimposed upon the latter while entering the femoral tunnel. The tibial tunnels leave a bone bridge ranging between 12 and 15 mm within the footprints of ACL. The two bundles are tensioned, each at different angle. This configuration imitates both the anatomy and the function of ACL and controls not only the anterior translation, but also the rotatory stability. With this innovative technique, the final outcome is improved, thus being closer to normal, as evidenced from previous experiments and the present prospective series.
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Affiliation(s)
- George Papachristou
- 2nd Department of Orthopaedics, University of Athens, Constantopoulion Hospital, N. Ionia, Greece.
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Hagins M, Pappas E, Kremenic I, Orishimo KF, Rundle A. The effect of an inclined landing surface on biomechanical variables during a jumping task. Clin Biomech (Bristol, Avon) 2007; 22:1030-6. [PMID: 17826875 PMCID: PMC2699559 DOI: 10.1016/j.clinbiomech.2007.07.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2007] [Revised: 06/13/2007] [Accepted: 07/18/2007] [Indexed: 02/07/2023]
Abstract
BACKGROUND Professional dancers sustain a high number of injuries. Epidemiological studies have suggested that performing on inclined "raked" stages increases the likelihood of injury. However, no studies have examined if biomechanical differences exist between inclined and flat surfaces during functional tasks, such as landing from a jump. Such differences may provide a biomechanical rationale for differences in injury risk for raked stages. METHODS Eight professional dancers performed drop jumps from a 40cm platform on flat and inclined surfaces while forces, lower extremity kinematics, and electromyographic activity were collected in a controlled laboratory environment. FINDINGS Dancers landed on the laterally inclined surface with significantly higher knee valgus (4 degrees ), peak knee flexion (9 degrees ), and medial-lateral ground reaction force (GRF) (13.4% body weight) compared to the flat condition. The posterior GRF was higher in the anterior inclined condition compared to the flat condition. In the anterior inclined condition, subjects landed with 1.4 degrees higher knee valgus, 4 degrees more plantarflexion at initial contact, and 3 degrees less dorsiflexion at the end of landing. INTERPRETATION Biomechanical variables that have been suggested to contribute to injury in previous studies are increased in the inclined floor conditions. These findings provide a preliminary biomechanical rationale for differences in injury rates found in observational studies of raked stages.
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Affiliation(s)
- Marshall Hagins
- Long Island University, Division of Physical Therapy, One University Plaza, Brooklyn, NY 11201, USA.
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Belisle AL, Bicos J, Geaney L, Andersen MH, Obopilwe E, Rincon L, Nyland J, Morgan C, Caborn DNM, Arciero RA. Strain pattern comparison of double- and single-bundle anterior cruciate ligament reconstruction techniques with the native anterior cruciate ligament. Arthroscopy 2007; 23:1210-7. [PMID: 17986409 DOI: 10.1016/j.arthro.2007.06.021] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2006] [Revised: 06/21/2007] [Accepted: 06/21/2007] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to dynamically assess the native strain patterns of the anteromedial bundle (AMB) and posterolateral bundle (PLB) of the anterior cruciate ligament (ACL) and compare these findings with graft bundle strain patterns after double-bundle (DB) ACL reconstruction with tibial fixation under 40 N of tension at 75 degrees knee flexion (AMB) and under 20 N of tension at 20 degrees knee flexion (PLB) and after single-bundle (SB) reconstruction with tibial fixation under 40 N of tension at 20 degrees knee flexion. METHODS The mean strain pattern of the AMB and PLB of the native ACL of 4 cadaveric knees was measured via differential variable reluctance transducers and 2-dimensional kinematic analysis during passive manual knee flexion-extension under a constant axial compression load. Measurements were repeated after DB and SB ACL reconstruction. Celeration line assessments with a split-middle technique were performed to quantify percent strain/knee flexion-extension angle change at reciprocating bundle function transition points. RESULTS The DB ACL reconstruction technique displayed reciprocating AMB and PLB strain patterns that more closely replicated those of the native ACL. The SB ACL reconstruction technique tended to replicate AMB strain patterns, suggesting poor bundle function differentiation. CONCLUSIONS The DB ACL reconstruction with differential AMB and PLB tensioning more closely replicated native ACL strain patterns than the SB ACL reconstruction. The SB ACL reconstruction that we used closely simulated native ACL AMB strain patterns; however, PLB function was not restored. CLINICAL RELEVANCE The DB ACL reconstruction more closely replicated the AMB and PLB strain patterns of the native ACL.
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Affiliation(s)
- Adelle L Belisle
- University of Connecticut Health Center, Farmington, Connecticut, USA
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