Changes in knee kinematics from applied external Tibial torque: Implications for stabilizing an anterior cruciate ligament deficient knee.

Background: Changes in knee kinematics from internal tibial torque under tibiofemoral compression force have been studied, but the potentially stabilizing effects of external tibial torque have not been reported. We hypothesized that for a given knee flexion angle, 1) external torque would significantly reduce anterior tibial translation, internal tibial rotation, and valgus tibial rotation before and after sectioning the anterior cruciate ligament and 2) changes in kinematics from applied external torque would be significantly greater with the cruciate cut.

Methods: A robotic test system was used to flex intact human knees continuously from 0° to 50° under 200 N compression, without and with 5 Nm external torque. Tests were repeated after cruciate section.

Findings: With the cruciate intact, external torque had no significant effect on anterior translation, and significantly reduced internal and valgus rotations at all flexion angles. With the cruciate cut, external torque significantly reduced anterior translation beyond 25° flexion, significantly reduced internal rotation at all flexion angles, and significantly reduced valgus rotation beyond 15° flexion. Although external torque had no significant effect on anterior translation with the ACL intact, external torque produced relatively large decreases in anterior translation with the cruciate sectioned (-11.6 mm at 50° flexion). Reductions in valgus rotation from applied external torque were significantly greater for cruciate deficient knees beyond 25° flexion.

Interpretation: We conclude that external tibial torque may be important for controlling the abnormal kinematics associated with an anterior cruciate ligament deficient knee, and possibly help stabilize the knee during in vivo activities.