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Cheng R, Wang H, Jiang Z, Dimitriou D, Cheng CK, Tsai TY. The Femoral Tunnel Drilling Angle at 45° Coronal and 45° Sagittal Provided the Lowest Peak Stress and Strain on the Bone Tunnels and Anterior Cruciate Ligament Graft. Front Bioeng Biotechnol 2021; 9:797389. [PMID: 34900975 PMCID: PMC8661475 DOI: 10.3389/fbioe.2021.797389] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 11/08/2021] [Indexed: 12/03/2022] Open
Abstract
Purpose: The aims of this study were to 1) investigate the effects of femoral drilling angle in coronal and sagittal planes on the stress and strain distribution around the femoral and tibial tunnel entrance and the stress distribution on the graft, following anterior cruciate ligament reconstruction (ACLR), 2) identify the optimal femoral drilling angle to reduce the risk of the tunnel enlargement and graft failure. Methods: A validated three-dimensional (3D) finite element model of a healthy right cadaveric knee was used to simulate an anatomic ACLR with the anteromedial (AM) portal technique. Combined loading of 103.0 N anterior tibial load, 7.5 Nm internal rotation moment, and 6.9 Nm valgus moment during normal human walking at joint flexion of 20° was applied to the ACLR knee models using different tunnel angles (30°/45°/60° and 45°/60° in the coronal and sagittal planes, respectively). The distribution of von Mises stress and strain around the tunnel entrances and the graft was calculated and compared among the different finite element ACLR models with varying femoral drilling angles. Results: With an increasing coronal obliquity drilling angle (30° to 60°), the peak stress and maximum strain on the femoral and tibial tunnel decreased from 30° to 45° and increased from 45° to 60°, respectively. With an increasing sagittal obliquity drilling angle (45° to 60°), the peak stress and the maximum strain on the bone tunnels increased. The lowest peak stress and maximum strain at the ACL tunnels were observed at 45° coronal/45° sagittal drilling angle (7.5 MPa and 7,568.3 μ-strain at the femoral tunnel entrance, and 4.0 MPa and 4,128.7 μ-strain at the tibial tunnel entrance). The lowest peak stress on the ACL graft occurred at 45° coronal/45° sagittal (27.8 MPa) drilling angle. Conclusions: The femoral tunnel drilling angle could affect both the stress and strain distribution on the femoral tunnel, tibial tunnel, and graft. A femoral tunnel drilling angle of 45° coronal/ 45° sagittal demonstrated the lowest peak stress, maximum strain on the femoral and tibial tunnel entrance, and the lowest peak stress on the ACL graft.
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Affiliation(s)
- Rongshan Cheng
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China.,Shanghai Key Laboratory of Orthopaedic Implants & Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huizhi Wang
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China.,Shanghai Key Laboratory of Orthopaedic Implants & Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ziang Jiang
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China.,Shanghai Key Laboratory of Orthopaedic Implants & Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dimitris Dimitriou
- Department of Orthopedics Balgrist University Hospital, Forchstrasse, Zürich, Switzerland
| | - Cheng-Kung Cheng
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China.,Shanghai Key Laboratory of Orthopaedic Implants & Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tsung-Yuan Tsai
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China.,Shanghai Key Laboratory of Orthopaedic Implants & Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Yan L, Li JJ, Zhu Y, Liu H, Liu R, Zhao B, Wang B. Interference screws are more likely to perform better than cortical button and cross-pin fixation for hamstring autograft in ACL reconstruction: a Bayesian network meta-analysis. Knee Surg Sports Traumatol Arthrosc 2021; 29:1850-1861. [PMID: 32813044 DOI: 10.1007/s00167-020-06231-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 08/10/2020] [Indexed: 01/10/2023]
Abstract
PURPOSE Anterior cruciate ligament (ACL) reconstruction is widely accepted as the first choice of treatment for ACL injury, but there is disagreement in the literature regarding the optimal femoral fixation method. This meta-analysis assesses the evidence surrounding three common femoral fixation methods: cortical button (CB), cross-pin (CP) and interference screws (IS). METHODS A systematic search was conducted in Medline, EMBASE and the Cochrane Library to identify studies with evidence level I or II that compared at least two femoral fixation methods with hamstring autograft for ACL reconstruction. Ten primary outcomes were collected. Risk of bias was assessed following the Cochrane Handbook for Systematic Reviews of Interventions. Standardized mean differences (SMD) were estimated using random-effects network meta-analysis in a Bayesian framework. Probability of ranking best (ProBest) and surface under the cumulative ranking curve (SUCRA) were used to rank all treatments. Funnel plots were used to identify publication bias and small-study effects. RESULTS Sixteen clinical trials were included for analysis out of 2536 retrieved studies. Bayesian network meta-analysis showed no significant differences among the three fixation methods for the ten primary outcome measures. Based on the 10 outcome measures, the IS, CB and CP had the highest ProBest in 5, 5 and 0 outcomes, and the highest SUCRA values in 5, 4 and 1 outcomes, respectively. No substantial inconsistency between direct and indirect evidence, or publication bias was detected in the outcomes. CONCLUSION There were no statistical differences in performance among the CP, CB and IS femoral fixation methods with hamstring autograft in ACL reconstruction, although the IS was more likely to perform better than CB and CP based on the analysis of outcome measures from the included studies. LEVEL OF EVIDENCE 1.
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Affiliation(s)
- Lei Yan
- Department of Orthopaedic Surgery, Shanxi Medical University Second Affiliated Hospital, Taiyuan, China.,Shanxi Medical University, Taiyuan, China
| | - Jiao Jiao Li
- Kolling Institute, University of Sydney, Sydney, NSW, Australia.,School of Biomedical Engineering, Faculty of Engineering and IT, University of Technology Sydney (UTS), Ultimo, NSW, Australia
| | - Yuanyuan Zhu
- Department of Pharmacy, Shanxi Medical University Second Affiliated Hospital, Taiyuan, China
| | - Haifeng Liu
- Department of Orthopaedic Surgery, Shanxi Medical University Second Affiliated Hospital, Taiyuan, China
| | - Ruxing Liu
- Department of Orthopaedic Surgery, Shanxi Medical University Second Affiliated Hospital, Taiyuan, China
| | - Bin Zhao
- Department of Orthopaedic Surgery, Shanxi Medical University Second Affiliated Hospital, Taiyuan, China.
| | - Bin Wang
- Department of Orthopaedic Surgery, Shanxi Medical University Second Affiliated Hospital, Taiyuan, China. .,Department of Sports Medicine and Adult Reconstruction Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, China.
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