Anterior laxity, graft-tunnel interaction and surgical design variations during anterior cruciate ligament reconstruction: A probabilistic simulation of the surgery.

Anterior cruciate ligament (ACL) reconstructive surgeries, employing a total of 48 models, were conducted by virtually removing the ACL and then modeling the surgical preparation, tunnel architecture, graft pre-tensioning and fixation angle of a bone-patellar-tendon-bone autograft. Multifactorial sensitivity analyses were performed to assess the relative influence of these surgical factors on the intraoperative joint laxity, graft-tunnel contact mechanics and graft forces. The sensitivity results indicated that the combined variation in tunnel architecture and graft pre-tension at the time of fixation accounts for most of the estimated variance of the three outcomes.

A phenomenological contact model: Understanding the graft-tunnel interaction in anterior cruciate ligament reconstructive surgery.

In this paper, we sought to expand the fidelity of a validated model of the anterior cruciate ligament reconstruction (ACL-R) procedure by incorporating a stick-slip contact model with linear pressure-overclosure relationship at the interface. The suggested model is characterized by three unknown parameters, friction coefficient, shear stress softening and contact stiffness. In the absence of any isolated experiments exploring the graft-tunnel interactions during an aggregate joint load, the calibration data used in this study are derived from a reported biomechanical study.

A model of articular cruciate ligament reconstructive surgery: a validation construct and computational insights.

This study sought to develop a computational framework that emulates the articular cruciate ligament reconstruction surgery using transtibial portal technique. The proposed model included the tibia-femoral and patella-femoral joints, articular cartilage and menisci. Key surgical parameters were incorporated including bone-patellar-tendon-bone graft excision and pre-tensioning, tunnel morphology, bone plugs, and bone plug fixation.