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Sequential analysis of three-dimensional tibiofemoral relationship through anatomic anterior cruciate ligament reconstruction with gravity-assisted radiographic technique in prone position.

ABSTRACT: Background/objectives:It is important to restore the tibiofemoral relationship as well as the anterior knee laxity for more successful anterior cruciate ligament (ACL) reconstruction, since a residual abnormality in the tibiofemoral relationship would lead an abnormal stress on the articular cartilages/menisci and consequently increase the risk of osteoarthritis in the future. This study aimed to sequentially clarify the three-dimensional tibiofemoral relationship before and after anatomic anterior cruciate ligament (ACL) reconstruction under an anterior tibial load with a gravity-assisted radiographic technique in the prone position. Methods:Fifteen patients with unilateral ACL injury participated in the study. Anatomic triple-bundle ACL reconstruction was performed using semitendinosus tendon autografts. During the computed tomography scans that were performed preoperatively, and those performed at 3 weeks and at 6 months postoperatively, the patients lay in the prone position with the knee flexed at 15°, wherein the calf weight could exert an anterior drawer force on the tibia due to gravity. Three-dimensional the tibial position relative to the femur were evaluated for each time point, followed by calculation of side-to-side differences in the parameters between the ACL-deficient/ACL-reconstructed knees and the contralateral intact knees. Seven healthy volunteers were enrolled in the control group and the side-to-side differences (right minus left) in these parameters were calculated. Results:The tibia in the ACL-deficient knee was located anteriorly by 3.5?±?1.1?mm and rotated internally by 2.4° ± 2.3°; these values were significantly larger than the corresponding values of -0.2?±?1.5?mm and 0.1° ± 2.2° in the control group. However, at 3 weeks postoperatively, the tibia in the ACL-reconstructed knee was over-constrained as compared to that in the control group; it was located posteriorly by 2.5?±?1.4?mm and rotated externally by 3.4° ± 3.4°. At 6 months postoperatively, no significant difference was observed in the tibial displacements/rotations between the patient and control groups. The side-to-side difference in the anterior knee laxity at the manual maximum anterior load was 0.1?±?1.2?mm?at 6 months postoperatively, with a significant improvement over the preoperative value of 7.4?±?2.5?mm. Conclusions:Anatomic ACL reconstruction could restore not only the normal anterior knee laxity, but also the normal tibiofemoral relationship even under an anterior tibial load.

SUBMITTER: Tachibana Y

PROVIDER: S-EPMC6796590 | biostudies-literature | 2019 Oct

REPOSITORIES: biostudies-literature

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Sequential analysis of three-dimensional tibiofemoral relationship through anatomic anterior cruciate ligament reconstruction with gravity-assisted radiographic technique in prone position.

Tachibana Yuta Y Mae Tatsuo T Shino Konsei K Matsuo Tomohiko T Sugamoto Kazuomi K Yoshikawa Hideki H Nakata Ken K

Asia-Pacific journal of sports medicine, arthroscopy, rehabilitation and technology 20190919

<h4>Background/objectives</h4>It is important to restore the tibiofemoral relationship as well as the anterior knee laxity for more successful anterior cruciate ligament (ACL) reconstruction, since a residual abnormality in the tibiofemoral relationship would lead an abnormal stress on the articular cartilages/menisci and consequently increase the risk of osteoarthritis in the future. This study aimed to sequentially clarify the three-dimensional tibiofemoral relationship before and after anatom ...[more]

PMID: 31641617

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Project description:BackgroundThe mechanisms of noncontact anterior cruciate ligament injury remain undefined. The purpose of this study was to identify the tibiofemoral alignment in the lateral compartment of the knee for three variations of a one-limb landing in noncontact sports activities: the safe, provocative, and exaggerated provocative positions. These positions were chosen on the basis of a previous study that measured the average joint angles of the limb at the point of ground contact for athletes who landed without injury (safe) and those who sustained an anterior cruciate ligament injury (provocative). It was hypothesized that, in the provocative positions, altered tibiofemoral alignment predisposes the knee to possible subluxation, potentially leading to an anterior cruciate ligament injury.MethodsMagnetic resonance images were acquired for a single knee in twenty-five noninjured athletes for the three landing positions. The angle between the posterior tibial slope and the femur along with three distances (from the tibiofemoral point of contact to [1] the femoral sulcus point, [2] the posterior tibial point, and [3] the most anterior point of the circular posterior aspect of the condyle) were measured for each acquisition.ResultsThe tibial slope relative to the femur was directed significantly more inferior to superior in the provocative and exaggerated positions than in the safe landing position. Similarly, as the limb transitioned from the safe to the provocative positions, the tibiofemoral joint contact point was significantly closer to the femoral sulcus point and to the most anterior point of the circular posterior portion of the lateral femoral condyle.ConclusionsAs the limb moves toward the provocative landing position, the anatomical alignment based on slope and contact characteristics places the knee at possible risk for noncontact anterior cruciate ligament injury. An enhanced understanding of the mechanism of anterior cruciate ligament injury may lead to improved preventative strategies.

Dataset Information

Sequential analysis of three-dimensional tibiofemoral relationship through anatomic anterior cruciate ligament reconstruction with gravity-assisted radiographic technique in prone position.

Publications

Sequential analysis of three-dimensional tibiofemoral relationship through anatomic anterior cruciate ligament reconstruction with gravity-assisted radiographic technique in prone position.

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