Kinematic Analysis of Five Different Anterior Cruciate Ligament Reconstruction Techniques.

Several anatomical anterior cruciate ligament (ACL) reconstruction techniques have been proposed to restore normal joint kinematics. However, the relative superiorities of these techniques with one another and traditional single-bundle reconstructions are unclear. Kinematic responses of five previously reported reconstruction techniques (single-bundle reconstruction using a bone-patellar tendon-bone graft [SBR-BPTB], single-bundle reconstruction using a hamstring tendon graft [SBR-HST], single-tunnel double-bundle reconstruction using a hamstring tendon graft [STDBR-HST], anatomical single-tunnel reconstruction using a hamstring tendon graft [ASTR-HST], and a double-tunnel double-bundle reconstruction using a hamstring tendon graft [DBR-HST]) were systematically analyzed.

Effect of increased iliotibial band load on tibiofemoral kinematics and force distributions: a direct measurement in cadaveric knees.

Study Design: Controlled laboratory study using cadaveric knee specimens and a repeated-measures design.

Objectives: To investigate the effect of increased iliotibial band load (assumed to represent increased tensor fascia latae and gluteus maximus strength) on tibiofemoral kinematics and force distribution on the tibiofemoral articulation.

Background: Owing to the difficulty in measuring in vivo joint loading, there is limited evidence on the direct relationship between increased iliotibial band load and force distribution in the tibiofemoral articulation.

A combined numerical and experimental technique for estimation of the forces and moments in the lumbar intervertebral disc.

Evaluation of the loads on lumbar intervertebral discs (IVD) is critically important since it is closely related to spine biomechanics, pathology and prosthesis design. Non-invasive estimation of the loads in the discs remains a challenge. In this study, we proposed a new technique to estimate in vivo loads in the IVD using a subject-specific finite element (FE) model of the disc and the kinematics of the disc endplates as input boundary conditions.

The relationship between femoral tunnels created by the transtibial, anteromedial portal, and outside-in techniques and the anterior cruciate ligament footprint.

Background: Tunnels created for reconstruction of a torn anterior cruciate ligament (ACL) are critical determinants of joint stability and clinical outcomes. There is limited objective evidence on the ability of transtibial (TT), anteromedial (AM) portal, and outside-in (OI) operative techniques in creating anatomic tunnels.

Hypothesis: (1) Tibial tunnel-independent techniques can create tunnels more accurately at the anatomic ACL footprint center than the TT technique, and (2) femoral tunnel exit location of the OI and TT techniques on the lateral cortex will be significantly further away from the lateral epicondyle than the femoral tunnel exit location of the AM portal technique.

Anteroposterior stability of the knee during the stance phase of gait after anterior cruciate ligament deficiency.

Quadriceps avoidance and higher flexion strategies have been assumed as effects of ACL deficiency on knee joint function during gait. However, the effect of ACL deficiency on anteroposterior stability of the knee during gait is not well defined. In this study, 10 patients with unilateral acute ACL ruptures and the contralateral side intact performed gait on a treadmill.

A composite athletic tape with hyperelastic material properties improves and maintains ankle support during exercise.

Study Design: Controlled laboratory testing using a single-group, prospective, repeated-measures design.

Objectives: To compare the material properties of a hyperelastic athletic tape to a conventional tape and to compare the passive ankle support of these tapes before and after exercise.

Background: The near-linear material properties of conventional athletic tape may interfere with ankle motion, resulting in reduced athletic performance.

Biomechanical evaluation of knee joint laxities and graft forces after anterior cruciate ligament reconstruction by anteromedial portal, outside-in, and transtibial techniques.

Background: Recently, anatomic anterior cruciate ligament (ACL) reconstruction is emphasized to improve joint laxity and to potentially avert initiation of cartilage degeneration. There is a paucity of information on the efficacy of ACL reconstructions by currently practiced tunnel creation techniques in restoring normal joint laxity.

Study Design: Controlled laboratory study.

In vitro and intraoperative laxities after single-bundle and double-bundle anterior cruciate ligament reconstructions.

Purpose: The purpose of this study was to objectively evaluate whether double-bundle anterior cruciate ligament (ACL) reconstruction can better restore the normal translational and rotational laxities than the conventional single-bundle ACL reconstruction among the reported biomechanical studies.

Methods: A systematic literature search was conducted to identify in vitro and in vivo (intraoperative) biomechanical studies that compared the laxities (anterior or anteroposterior or rotational) between single- and double-bundle ACL reconstructions. Because of large variability among the loading conditions and testing methods used to determine the rotational laxities among the studies, a meta-analysis of rotational laxities was not feasible.

Do high flexion posterior stabilised total knee arthroplasty designs increase knee flexion? A meta analysis.

Purpose: This systematic literature review analysed the change in range of knee flexion from pre-operative values, following conventional posterior stabilised (PS) and high-flexion (H-F) PS total knee arthroplasty (TKA).

Methods: We calculated the weighted mean differences of pre- and postoperative flexion using meta-analysis with random effect modelling. Eighteen studies met our inclusion criteria.

In vivo length patterns of the medial collateral ligament during the stance phase of gait.

Purpose: The function of the medial collateral ligament (MCL) during gait has not been investigated. Our objective was to measure the kinematics of the medial collateral ligament during the stance phase of gait on a treadmill using a combined dual fluoroscopic imaging system (DFIS) and MRI technique.

Methods: Three-dimensional models of the knee were constructed using magnetic resonance images of 7 healthy human knees.

The effect of graft fixation sequence on force distribution in double-bundle anterior cruciate ligament reconstruction.

Purpose: This paper investigated the effect of graft fixation sequence on knee joint biomechanics after a double-bundle ACL reconstruction.

Method: Two independently published biomechanical studies that investigated the biomechanics of double-bundle ACL reconstructions using similar robotic testing systems were compared. In each study, ten human cadaveric knees were tested under three different conditions: intact, ACL deficient, and ACL reconstructed using a double-bundle technique with the anteromedial (AM) graft fixed at 60° of flexion and the posterolateral (PL) graft fixed at full extension.

Morphology of the medial collateral ligament of the knee.

Background: Quantitative knowledge on the anatomy of the medial collateral ligament (MCL) is important for treatment of MCL injury and for MCL release during total knee arthroplasty (TKA). The objective of this study was to quantitatively determine the morphology of the MCL of human knees.

Methods: 10 cadaveric human knees were dissected to investigate the MCL anatomy.

The effect of isolated popliteus tendon complex injury on graft force in anterior cruciate ligament reconstructed knees.

Failure to diagnose injury to the posterolateral structures has been found to increase the forces experienced by the anterior cruciate ligament (ACL) and ACL grafts which may cause their subsequent failure. An isolated injury to the popliteus complex (PC) consisting of the popliteus tendon and popliteofibular ligament is not uncommon. Therefore, the purpose of this study was to discover if an isolated injury to the PC can significantly affect the forces experienced by the ACL graft under external loading conditions.

Kinematics of the anterior cruciate ligament during gait.

Background: The function of the anteromedial (AM) and posterolateral (PL) bundles of the anterior cruciate ligament (ACL) during gait has not been reported.

Hypothesis: The AM and PL bundles have distinct functional behavior during the stance phase of treadmill gait.

Study Design: Descriptive laboratory study.

Comparison of single- and double-bundle anterior cruciate ligament reconstructions in restoration of knee kinematics and anterior cruciate ligament forces.

Background: Anterior cruciate ligament (ACL) deficiency alters 6 degrees of freedom knee kinematics, yet only anterior translation and internal rotation have been the primary measures in previous studies.

Purpose: To compare the 6 degrees of freedom knee kinematics and the graft forces after single- and double-bundle ACL reconstructions under various external loading conditions.

Study Design: Controlled laboratory study.

Single-tunnel double-bundle anterior cruciate ligament reconstruction with anatomical placement of hamstring tendon graft: can it restore normal knee joint kinematics?

Background: Anatomical reconstruction techniques that can restore normal joint kinematics without increasing surgical complications could potentially improve clinical outcomes and help manage anterior cruciate ligament injuries more efficiently.

Hypothesis: Single-tunnel double-bundle anterior cruciate ligament reconstruction with anatomical placement of hamstring tendon graft can more closely restore normal knee anterior-posterior, medial-lateral, and internal-external kinematics than can conventional single-bundle anterior cruciate ligament reconstruction.

Study Design: Controlled laboratory study.

In situ forces in the anteromedial and posterolateral bundles of the anterior cruciate ligament under simulated functional loading conditions.

Background: The in situ forces of the anteromedial (AM) and posterolateral bundles (PL) of the anterior cruciate ligament (ACL) under simulated functional loads such as simulated muscle loads have not been reported. These data are instrumental for improvement of the anatomical double-bundle ACL reconstruction.

Hypothesis: The load-sharing patterns of the 2 bundles are complementary under simulated muscle loads.

A clinical comparison of screw and suture fixation of anterior cruciate ligament tibial avulsion fractures.

Background: Screw and suture fixations are the most commonly used methods of fixation in treatment of anterior cruciate ligament tibial avulsion fractures. Even though a few biomechanical studies have compared the stability of the 2 fixation techniques, a clinical comparison has not yet been reported.

Hypothesis: The authors hypothesized that both fixations would be identical in all studied clinical outcome measures at a minimum 2-year follow-up.

Prospective comparative study of anterior cruciate ligament reconstruction using the double-bundle and single-bundle techniques.

Background: The intent of double-bundle anterior cruciate ligament reconstruction is to reproduce the normal anterior cruciate ligament anatomy and improve knee joint rotational stability. However, no consensus has been reached on the advantages of this technique over the single-bundle technique.

Hypothesis: We hypothesized that double-bundle anterior cruciate ligament reconstruction could provide better intraoperative stability and clinical outcome than single-bundle reconstruction.

Biomechanical comparison of single-tunnel-double-bundle and single-bundle anterior cruciate ligament reconstructions.

Background: Anatomic double-bundle reconstruction has been thought to better simulate the anterior cruciate ligament anatomy. It is, however, a technically challenging procedure, associated with longer operation time and higher cost.

Hypothesis: Double-bundle anterior cruciate ligament reconstruction using a single femoral and tibial tunnel can closely reproduce intact knee kinematics.

The effect of anterior cruciate ligament reconstruction on kinematics of the knee with combined anterior cruciate ligament injury and subtotal medial meniscectomy: an in vitro robotic investigation.

Purpose: The aims of this study were to determine: (1) the kinematic effect of subtotal medial meniscectomy on the anterior cruciate ligament (ACL)-deficient knee and (2) the effect of ACL reconstruction on kinematics of the knee with combined ACL deficiency and subtotal medial meniscectomy under anterior tibial and simulated quadriceps loads.

Methods: Eight human cadaveric knees were sequentially tested using a robotic testing system under 4 conditions: intact, ACL deficiency, ACL deficiency with subtotal medial meniscectomy, and single-bundle ACL reconstruction using a bone-patellar tendon-bone graft. Knee kinematics were measured at 0 degrees, 15 degrees, 30 degrees, 60 degrees, and 90 degrees of flexion under an anterior tibial load of 130 N and a quadriceps muscle load of 400 N.