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ACL reconstruction and biomechanics

Chao Wan, Zhixiu Hao
Graft tissues within bone tunnels remain mobile for a long time after anterior cruciate ligament (ACL) reconstruction. However, whether the graft-tunnel friction affects the finite element (FE) simulation of the ACL reconstruction is still unclear. Four friction coefficients (from 0 to 0.3) were simulated in the ACL-reconstructed joint model as well as two loading levels of anterior tibial drawer. The graft-tunnel friction did not affect joint kinematics and the maximal principal strain of the graft. By contrast, both the relative graft-tunnel motion and equivalent strain for the bone tunnels were altered, which corresponded to different processes of graft-tunnel integration and bone remodeling, respectively...
March 9, 2018: Computer Methods in Biomechanics and Biomedical Engineering
Dai Sugimoto, Benton E Heyworth, Jeffery J Brodeur, Dennis E Kramer, Mininder S Kocher, Lyle J Micheli
CONTEXT: Recent epidemiology studies indicated a steady increase of anterior cruciate ligament (ACL) injury in young athletes. ACL reconstruction (ACLR) is currently a standard of the care, but effect of ACLR graft including bone patellar tendon bone (BTB), hamstring tendon (HT), or iliotibial band (ITB) on balance and hop performance is understudied. OBJECTIVE: To compare balance and hop deficits between uninvolved and reconstructed limbs in each autograft type (aim 1) and among the three autograft groups (aim 2)...
February 21, 2018: Journal of Sport Rehabilitation
Shigehiro Asai, Donghwi Kim, Yuichi Hoshino, Chan-Woong Moon, Akira Maeyama, Monica Linde, Patrick Smolinski, Freddie H Fu
PURPOSE: Studies have found anatomic variation in the coronal position of the insertion site of anteromedial (AM) bundle of the anterior cruciate ligament (ACL) on the tibia, which can lead to questions about tunnel placement during ACL reconstruction. The purpose of this study was to determine how mediolateral placement of the tibial AM graft tunnel in double-bundle ACL reconstructions affects knee biomechanics. METHODS: Two different types of double-bundle ACL reconstructions were performed...
February 15, 2018: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
Cristian Tudor Buescu, Cristian Mircea Dudescu, Sergiu Caterev, Dan Gheorghe Osvald Lucaciu
Background and aims: Using free quadriceps tendon graft for anterior cruciate ligament (ACL) reconstruction has become more popular in the last years due to the low morbidity at the harvest site and biomechanical and structural properties similar to other types of graft (hamstring and patellar tendons). As long as the tibial tunnel fixation with interference screws is considered the standard fixation, femoral fixation is still an open subject. Even though the most common type of femoral tunnel fixation are the cortical suspension devices, the type of suture used for tying the graft to the loop is still evaluated and discussed...
2018: Clujul Medical (1957)
Asheesh Bedi
Safety belt, or cerclage, reinforcement of anterior cruciate ligament (ACL) grafts may protect against various modes of failure including creep and irreversible stretch, traumatic tearing, and slippage of the tendon-bone interface. A time-zero, biomechanical study shows that suture reinforcement may protect small and vulnerable hamstring ACL reconstruction grafts from these various modes of failure. Thus, in vivo comparative outcome analysis is indicated to determine if the benefits of reinforcement translate from the benchtop to the operating room...
February 2018: Arthroscopy: the Journal of Arthroscopic & related Surgery
M Chivot, S Harrosh, F Kelberine, M Pithioux, J-N Argenson, M Ollivier
INTRODUCTION: In reconstructions of the anterior cruciate ligament (ACL), tibial fixation can be the weak point in the assembly during the early postoperative period. The present study sought to compare pull-out strength between four tibial fixation systems used in ACL reconstruction. HYPOTHESIS: The study hypothesis was that all four devices show ≥450N pull-out strength with comparable biomechanical breakage characteristics. MATERIAL AND METHODS: An experimental study used a mechanical model to perform axial traction on a synthetic ligament (polypropylene cord folded in four) implanted in an artificial tibia (Sawbones Proximal Tibia # 1116-2: model: normal anatomy; solid foam; size: medium) using four tibial fixation systems: Ligafix® interference screw (SBM™); Bio-Intrafix® (Mitek™); Translig® (SBM™); RIGIDfix® (SBM™)...
January 31, 2018: Orthopaedics & Traumatology, Surgery & Research: OTSR
Jin Cheng, Siddhartha Venkata Paluvadi, SungJae Lee, SeungJin Yoo, Eun-Kyoo Song, Jong-Keun Seon
PURPOSE: Cortical suspensory devices are routinely used for femoral side fixation of soft tissue graft in anterior cruciate ligament (ACL) reconstruction. The purpose of this study was to evaluate the biomechanical properties of a new adjustable loop device (GraftMax®) compared with established devices (EndoButton® and TightRope®) in ACL reconstruction and to investigate whether knotting the free end of TightRope could improve biomechanical properties. METHODS: The three cortical suspensory devices (GraftMax® Button; Conmed, EndoButton® CL; Smith & Nephew, and TightRope® RT; Arthrex) were tested under cyclic load (50-250 N for 1000 cycles) and pull-to-failure conditions at 50 mm/h in a device-only setup using a tensile testing machine...
January 29, 2018: International Orthopaedics
Rachel M Frank, Jason T Hamamoto, Eamon Bernardoni, Gregory Cvetanovich, Bernard R Bach, Nikhil N Verma, Charles A Bush-Joseph
Hamstring tendon autograft remains a popular graft choice for anterior cruciate ligament (ACL) reconstruction. Although there are a variety of autograft and allograft options available for ACL reconstruction, advantages of hamstring tendon autografts include decreased postoperative knee pain and an overall easier surgical recovery compared with bone patellar tendon bone autograft. In addition, 4-stranded (quadruple) hamstring grafts are among the strongest grafts biomechanically (at time equals zero). Although the technique of hamstring autograft harvest is relatively straightforward, it is critical to pay attention to several technical steps to avoid iatrogenic neurovascular damage as well as to avoid premature amputation of the graft while using a tendon stripper...
August 2017: Arthroscopy Techniques
Assem Mohamed Noureldin Zein, Mohamed Ali, Alaa Zenhom Mahmoud, Khaled Omran
Despite the popularity of anterior cruciate ligament (ACL) reconstruction procedures, the ideal graft for reconstruction remains a matter of controversy. The ideal graft for ACL reconstruction should have histologic and biomechanical characteristics similar to those of the native ACL; should be quickly and fully incorporated within the bony tunnels; should maintain its viscoelastic properties for a long time; should have minimal donor-site morbidity; should be of sufficient length and diameter; should have minimal adverse effects on the extensor mechanism; should have no risk of rejection or disease transmission; and should be cost-effective and readily available...
August 2017: Arthroscopy Techniques
Assem Mohamed Noureldin Zein, Mohamed Elshafie, Ahmed Nady Saleh Elsaid, Mohamed Ahmed Elsaid Elrefai
The results of arthroscopic anterior cruciate ligament (ACL) reconstruction are so far satisfactory and improving over time as a result of the improved understanding of the anatomy and biomechanics of the ACL. Rotational instability confirmed by a positive pivot shift is present in more than 15% of cases who underwent successful ACL reconstruction. Persistent rotational instability interferes with performing pivoting sports, and also may lead to meniscal and chondral injuries, or re-rupture of the reconstructed ACL...
August 2017: Arthroscopy Techniques
Mark V Paterno, Bin Huang, Staci Thomas, Timothy E Hewett, Laura C Schmitt
Background: Biomechanical predictors of a second anterior cruciate ligament (ACL) injury after ACL reconstruction (ACLR) and return to sport (RTS) have been identified; however, these measures may not be feasible in a standard clinical environment. Purpose/Hypothesis: The purpose of this study was to evaluate whether standard clinical measures predicted the risk of second ACL injuries. The hypothesis tested was that a combination of strength, function, and patient-reported measures at the time of RTS would predict the risk of second ACL injuries with high sensitivity and specificity...
December 2017: Orthopaedic Journal of Sports Medicine
Patrick A Smith
Anterior cruciate ligament (ACL) graft failure rates remain unacceptably high in certain populations, and researchers are examining the effect that the anterolateral ligament (ALL) has on knee stability following ACL reconstruction. Currently, most available research examining the ALL has focused on cadaveric biomechanical kinematic studies, including the effect of surgical techniques for ALL reconstruction/lateral extra-articular tenodesis (LET). However, it is critical for ongoing and future research to focus on clinical outcome measures relating to individuals who have had ALL reconstruction or LET along with their ACL reconstructions...
January 2018: Arthroscopy: the Journal of Arthroscopic & related Surgery
Richard Ma, Michael Schär, Tina Chen, Marco Sisto, Joseph Nguyen, Clifford Voigt, Xiang-Hua Deng, Scott A Rodeo
BACKGROUND: Anterior cruciate ligament (ACL) grafts that are placed for reconstruction are subject to complex forces. Current "anatomic" ACL reconstruction techniques may result in greater in situ graft forces. The biological effect of changing magnitudes of ACL graft force on graft-tunnel osseointegration is not well understood. PURPOSE: The research objective is to determine how mechanical force on the ACL graft during knee motion affects tendon healing in the tunnel...
January 1, 2018: American Journal of Sports Medicine
Samuel Bachmaier, Patrick A Smith, Jordan Bley, Coen A Wijdicks
PURPOSE: To compare the dynamic elongation, stiffness behavior, and ultimate failure load of standard with small diameter soft tissue grafts for anterior cruciate ligament (ACL) reconstruction with and without high-strength suture tape reinforcement. METHODS: Both a tripled "small" diameter and a "standard" quadrupled tendon graft with and without suture tape reinforcement were tested using suspensory fixation (n = 8 each group). The suture tape was passed through the suspensory fixation button on the femur and tibia to ensure independent (safety belt) fixation from the graft in vitro...
December 21, 2017: Arthroscopy: the Journal of Arthroscopic & related Surgery
T Gong, X-T Su, Q Xia, J-G Wang
We introduced several variables in an animal model of anterior cruciate ligament (ACL) reconstruction to determine the best parameters for surgery in humans. We divided 130 LYD pigs into two groups depending on whether the femoral tunnel goes through the medial tibial tunnel or through the medial fossa of the knee joint. Each subgroup was further divided. Four weeks after surgery the knee specimens were examined for passive flexion and extension test. No group showed a creep effect. In the biomechanical tests, we recorded maximal strength, maximum load, and stiffness parameters...
December 1, 2017: Journal of Musculoskeletal & Neuronal Interactions
C Lutz
There is renewed interest in anterolateral reconstruction (ALR) for patients undergoing anterior cruciate ligament (ACL) reconstruction. This is the result of isolated ACL reconstruction and double-bundle reconstruction providing inadequate control over the pivot shift, and recent anatomical and biomechanical studies on the anterolateral ligament (ALL) and its role in the knee's rotational stability. From a technical point of view, ALR can be performed either as a continuity of the intra-articular ACL reconstruction or an independent procedure...
February 2018: Orthopaedics & Traumatology, Surgery & Research: OTSR
Luke G Perraton, Michelle Hall, Ross A Clark, Kay M Crossley, Yong-Hao Pua, Tim S Whitehead, Hayden G Morris, Adam G Culvenor, Adam L Bryant
PURPOSE: Poor knee function after anterior cruciate ligament reconstruction (ACLR) may increase the risk of future knee symptoms and knee osteoarthritis via abnormal knee joint loading patterns, particularly during high-impact activity. This study aimed to assess the relationship between poor self-reported or clinically measured knee function and knee moments/vertical ground reaction force (vGRF) in individuals following ACLR. METHODS: 61 participants (mean 16.5 ± 3 months following ACLR, 23 women) completed a patient-reported knee function questionnaire and three hop tests (% of uninvolved limb)...
February 2018: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
Simone Cerciello, Cécile Batailler, Nader Darwich, Philippe Neyret
Anterior cruciate ligament (ACL) reconstruction is a successful procedure with high rates of return to sport. However, some patients experience persistent instability and graft failure. These adverse events have a significant impact, especially on high-level athletes. In an effort to improve outcomes for these patients, more attention is being paid to the anatomic structures at the anterolateral aspect of the knee. The anterolateral structures of the knee have been shown to play a major role in decreasing rotatory knee instability and forces across the ACL graft following reconstruction...
January 2018: Clinics in Sports Medicine
Manoj Mathew, Aad Dhollander, Alan Getgood
Residual rotational laxity following anterior cruciate ligament (ACL) reconstruction has been identified as significant concern in many patients, despite evolution of techniques. The expanding body of knowledge on the anatomy and biomechanics of the anterolateral soft tissue restraints in rotational control of the knee has reignited an interest in extra-articular reconstruction techniques for augmenting ACL reconstruction. Reconstruction techniques currently used can be broadly categorized as either lateral extra-articular tenodesis or reconstruction of the anterolateral ligament...
January 2018: Clinics in Sports Medicine
Edoardo Monaco, Samuel Bachmaier, Mattia Fabbri, Riccardo Maria Lanzetti, Coen A Wijdicks, Andrea Ferretti
PURPOSE: To evaluate and compare the effect of preconditioning according to intraoperative workflow on the elongation behavior of single-side and fully knotted all-inside anterior cruciate ligament (ACL) reconstruction configurations in a biomechanical in vitro study. METHODS: Four full construct all-inside ACL reconstruction groups (n = 8 per group) were tested using porcine tibias and bovine tendons. Groups included both an all-inside configuration with one- (group 1) and both-side knotted adjustable loop-length devices (group 2), without and with performing intraoperative preconditioning (group 1-intraoperative preconditioned [IPC], group 2-IPC)...
November 13, 2017: Arthroscopy: the Journal of Arthroscopic & related Surgery
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