ACL reconstruction and the implication of its tibial attachment for stability of the joint: anthropometric and biomechanical study.
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ABSTRACT:
SUBMITTER: Papachristou G
PROVIDER: S-EPMC2267636 | biostudies-other | 2007 Aug
REPOSITORIES: biostudies-other
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Project description:IntroductionAfter anterior cruciate ligament reconstruction surgery, returning the knee to previous levels of strength and function is challenging, with the failure to do so associated with an increased risk of reinjury and long-term degenerative problems. Blood flow restriction (BFR) is gaining popularity as a rehabilitation technique; however, its effects on the mechanics of these exercises have not been fully explored. In this study, we aimed to determine the acute effects of BFR on the performance of a step-up exercise protocol and to assess the acceptability of the technique.MethodsTwenty individuals (12 female/8 male; mean age, 30.6 yr) who had recently undergone anterior cruciate ligament reconstruction and 20 controls (11 female/9 male, mean age 28.0 yr) performed a step-up exercise protocol with and without BFR. Lower limb kinematics and kinetics were measured and compared between groups and conditions. Testing was completed in June 2019.ResultsParticipants in both groups had increased external rotation of the tibia of 2° (P < 0.001) and reductions in knee flexion and rotation torques around the joint of around 50% (P < 0.001) when using BFR compared with nonrestricted step-up exercise. The intervention was found to increase the difficulty of the exercise and induce moderate levels of discomfort (P < 0.001).ConclusionThe present study provides cautious support for the use of BFR, showing that there are minimal changes in knee joint mechanics when performing the same exercise without BFR, and that the changes do not increase joint torques at the knee. From an acute biomechanical perspective, the intervention appears safe to use under qualified supervision; however, effects of repetitive use and long-term outcomes should be monitored.
| S-EPMC8191295 | biostudies-literature
Project description:BackgroundFemoral suspensory fixation for anterior cruciate ligament (ACL) reconstruction has evolved from fixed- to adjustable-loop devices. However, there are still controversies regarding undesired lengthening of adjustable-loop devices.HypothesisAdjustable-loop fixation will achieve similar elongation to that of fixed-loop devices, and intraoperative preconditioning will reduce initial elongation for adjustable-loop constructs.Study designControlled laboratory study.MethodsThree adjustable-loop devices (GraftMax, TightRope, and Ultrabutton) and 2 fixed-loop devices (Endobutton and RetroButton) were used in an intraoperative surgical technique workflow according to an in vitro model with porcine bone and bovine tendons (8 specimens per device; N = 40 constructs tested). Each construct underwent 1000 cycles of position- and force-controlled dynamic loading, whereby a total elongation threshold of 3 mm was defined as clinical failure. Constructs were finally pulled to failure at 50 mm/min.ResultsThere were no statistically significant differences among the devices for total or dynamic elongation. Total elongation (mean ± SD) for adjustable-loop constructs was 4.13 ± 1.46 mm for GraftMax, 2.78 ± 0.85 mm for TightRope, and 2.76 ± 0.45 mm for Ultrabutton; for the fixed-loop devices, total elongation was 2.85 ± 0.74 mm for Endobutton and 2.85 ± 1.03 mm for RetroButton. The GraftMax had a significantly lower initial force (95.5 ± 58.0 N) after retensioning, with the highest initial elongation (0.99 ± 0.60 mm). The Ultrabutton showed the greatest force loss (-105.9 ± 13.5 N) during position control cycling, which was significantly different from the GraftMax (-22.3 ± 28.2 N), with the smallest force loss (P < .001). The TightRope construct had a significantly smaller initial elongation (-0.36 ± 0.22 mm) and the greatest pull-to-failure load (958 ± 40 N) as compared with all of the other devices.ConclusionAdjustable- and fixed-loop configurations achieved statistically comparable fixation strength for total elongation. However, the GraftMax construct exceeded the total elongation threshold of clinical failure. The Ultrabutton produced the greatest loss of force during position control cycling, and the GraftMax button design prevented proper retensioning. The TightRope had a significant greater ultimate strength when compared with all other devices.Clinical relevanceBiomechanical testing according to a surgical technique workflow suggests that adjustable-loop devices can be considered a safe alternative to fixed-loop devices in ACL reconstruction.
| S-EPMC5954336 | biostudies-literature
Project description:Patellofemoral joint (PFJ) osteoarthritis is common following anterior cruciate ligament reconstruction (ACLR) and may be linked with altered joint loading. However, little is known about the cross-sectional and longitudinal relationship between PFJ loading and osteoarthritis post-ACLR. This study tested if altered PFJ loading is associated with prevalent and worsening early PFJ osteoarthritis post-ACLR. Forty-six participants (mean ± 1 SD age 26 ± 5 years) approximately 1-year post-ACLR underwent magnetic resonance imaging (MRI) and biomechanical assessment of their reconstructed knee. Trunk and lower-limb kinematics plus ground reaction forces were recorded during the landing phase of a standardized forward hop. These data were input into a musculoskeletal model to calculate the PFJ contact force. Follow-up MRI was completed on 32 participants at 5-years post-ACLR. Generalized linear models (Poisson regression) assessed the relationship between PFJ loading and prevalent early PFJ osteoarthritis (i.e., presence of a PFJ cartilage lesion at 1-year post-ACLR) and worsening PFJ osteoarthritis (i.e., incident/progressive PFJ cartilage lesion between 1- and 5-years post-ACLR). A lower peak PFJ contact force was associated with prevalent early PFJ osteoarthritis at 1-year post-ACLR (n = 14 [30.4%]; prevalence ratio: 1.37; 95% confidence interval [CI]: 1.02-1.85) and a higher risk of worsening PFJ osteoarthritis between 1- and 5-years post-ACLR (n = 9 [28.1%]; risk ratio: 1.55, 95% CI: 1.13-2.11). Young adults post-ACLR who exhibited lower PFJ loading during hopping were more likely to have early PFJ osteoarthritis at 1-year and worsening PFJ osteoarthritis between 1- and 5-years. Clinical interventions aimed at mitigating osteoarthritis progression may be beneficial for those with signs of lower PFJ loading post-ACLR.
| S-EPMC10946851 | biostudies-literature
Project description:BackgroundTo better restore the anatomy of the native anterior cruciate ligament (ACL) attachment and fiber arrangement, researchers have developed techniques for changing the shape of the ACL bone tunnel during ACL reconstruction.PurposeTo compare the coverage of the ACL tibial footprint and influence on the anterior root of lateral meniscus (ARLM) between a rounded-rectangular tibial tunnel and a conventional round tibial tunnel for ACL reconstruction.Study designControlled laboratory study.MethodsA total of 16 (8 matched-paired) fresh-frozen human cadaveric knees were distributed randomly into 2 groups: a rounded-rectangular tunnel (RRT) group and a round tunnel (RT) group. One of the knees from each pair was reamed with rounded-rectangular tibial tunnel, whereas the other was reamed with round tibial tunnel. Coverage of the ACL tibial footprint and areas of ARLM attachment before and after reaming were measured using 3-dimensional isotropic magnetic resonance imaging.ResultsIn the RRT group, the average percentage of ACL tibial footprint covered by the tunnel was 70.8% ± 2.5%, which was significantly higher than that in the RT group (48.2% ± 6.4%) (P = .012). As for the ARLM attachment area, in the RT group, there was a significant decrease (22.5% ± 5.9%) in ARLM attachment area after tibial tunnel reaming compared with the intact state (P < .001). Conversely, in the RRT group, the ARLM attachment area was not significantly affected by tibial tunnel reaming.ConclusionRounded-rectangular tibial tunnel was able to better cover the native ACL tibial footprint and significantly lower the risk of iatrogenic injury to the ARLM attachment than round tibial tunnel during ACL reconstruction.
| S-EPMC8949746 | biostudies-literature
Project description:PurposeTo biomechanically evaluate the use of the suture augmentation construct at time 0 of ACL reconstruction.MethodsEighty porcine knees underwent ACL reconstruction using 2 techniques for graft fixation: a single suspensory construct (SSC), performed with a femoral button and tibial interference screw; and a double suspensory construct (DSC), with a femoral and tibial button. Each fixation technique was performed on 40 porcine knees divided into 4 subgroups. The first group had a nonaugmented ACL reconstruction, the second group had an ACL reconstruction with suture augmentation, and the third and fourth groups were the same as the first and second groups, with the graft resected 80% to simulate graft weakening. Ultimate load, yield load, stiffness, cyclic displacement values, and mode of failure were recorded for each graft.ResultsIn a weakened graft model with 80% graft resection, there was a significant increase in ultimate strength (P < .001), yield strength (P < .001), and cyclic displacement (P < .001) with suture augmentation. There was no significant increase in stiffness with suture augmentation with either construct (P = .278). In the setting of an intact graft, there were no differences in either SSC or DCS groups with or without suture augmentation.ConclusionsThe addition of a suture to ACL reconstruction techniques resulted in minimal changes in baseline biomechanical characteristics while improving ultimate load, yield load, and cyclic displacement in a weakened graft model.Clinical relevanceSuture augmentation of ACL reconstruction may confer improved integrity of the graft and is worth consideration and future clinical study.
| S-EPMC7879175 | biostudies-literature
Project description:BackgroundPrevious research indicates that subjects with anterior cruciate ligament reconstruction exhibit abnormal knee joint movement patterns during functional activities like walking. While the sagittal plane mechanics have been studied extensively, less is known about the secondary planes, specifically with regard to more demanding tasks. This study explored the influence of task complexity on functional joint mechanics in the context of graft-specific surgeries.MethodsIn 25 participants (10 hamstring tendon graft, 6 patellar tendon graft, 9 matched controls), three-dimensional joint torques were calculated using a standard inverse dynamics approach during level walking and stair descent. The stair descent task was separated into two functionally different sub-tasks-step-to-floor and step-to-step. The differences in external knee moment profiles were compared between groups; paired differences between the reconstructed and non-reconstructed knees were also assessed.FindingsThe reconstructed knees, irrespective of graft type, typically exhibited significantly lower peak knee flexion moments compared to control knees during stair descent, with the differences more pronounced in the step-to-step task. Frontal plane adduction torque deficits were graft specific and limited to the hamstring tendon knees during the step-to-step task. Internal rotation torque deficits were also primarily limited to the hamstring tendon graft group during stair descent. Collectively, these results suggest that task complexity was a primary driver of differences in joint mechanics between anterior cruciate ligament reconstructed individuals and controls, and such differences were more pronounced in individuals with hamstring tendon grafts.InterpretationThe mechanical environment experienced in the cartilage during repetitive, cyclical tasks such as walking and other activities of daily living has been argued to contribute to the development of degenerative changes to the joint and ultimately osteoarthritis. Given the task-specific and graft-specific differences in joint mechanics detected in this study, care should be taken during the rehabilitation process to mitigate these changes.
| S-EPMC4568131 | biostudies-literature
Project description:BackgroundThe efficacy of a neuromuscular training (NMT) program to ameliorate known hip biomechanical risk factors for athletes with anterior cruciate ligament reconstruction (ACLR) is currently unknown. Purpose/Hypothesis: The purpose was to quantify the effects of an NMT program on hip biomechanics among athletes with ACLR and to compare posttraining hip biomechanics with a control group. The hypotheses were that known hip biomechanical risk factors of anterior cruciate ligament (ACL) injury would be significantly reduced among athletes with ACLR after the NMT program and that posttraining hip biomechanics between the ACLR and control cohorts would not differ.Study designControlled laboratory study.MethodsTwenty-eight athletes (n = 18, ACLR; n = 10, uninjured) completed a 12-session NMT program. Biomechanical evaluation of a jump-landing task was done before and after completion of the program. Repeated measures analysis of variance was performed to understand the effect of NMT within the ACLR cohort. Two-way analysis of variance was used to compare both groups. Post hoc testing was done for significant interactions. Hip biomechanical variables at initial contact are reported.ResultsThe athletes with ACLR who completed the NMT program had a significant session × limb interaction ( P = .01) for hip external rotation moment and a significant main effect of session for hip flexion angle ( P = .049) and moment ( P < .001). There was a significant change for the involved ( P = .04; 528% increase) and uninvolved ( P = .04; 57% decrease) limbs from pre- to posttraining for hip rotation moment. The ACLR cohort had an increase in hip flexion angle (14% change) and a decrease in hip flexion moment (65% change) from pre- to posttraining. Posttraining comparison for these same hip biomechanical variables of interest revealed no significant interactions ( P > .05) between the ACLR and control cohorts. There was a significant main effect of group ( P = .02) for hip flexion angle, as the ACLR cohort demonstrated greater hip flexion angle than that of the control group.ConclusionFor athletes with ACLR, hip biomechanical measures of ACL injury risk show significant improvements after completion of an NMT program.Clinical relevanceAthletes with ACLR who are participating in an NMT program may ameliorate known hip biomechanical risk factors for an ACL injury.
| S-EPMC6667182 | biostudies-literature
Project description:Recurrent patellar instability can be very debilitating and may require surgical intervention. A thorough workup must be completed in this subset of patients. Risk factors for recurrent instability include patella alta, trochlear dysplasia, an increased tibial tubercle-trochlear groove distance, and insufficiencies in the medial retinacular structures. Necessary treatment of these risk factors, once identified, should be addressed surgically. Patellofemoral reconstruction must be individually tailored to each patient's anatomy and may necessitate medial patellofemoral ligament reconstruction, tibial tubercle osteotomy, or trochleoplasty in any combination or as a standalone procedure. This article details our technique for surgical treatment of recurrent patellar instability with a medial patellofemoral ligament reconstruction, an open trochleoplasty, and a tibial tubercle osteotomy for patients with severe trochlear dysplasia, an increased tibial tubercle-trochlear groove distance, or patella alta.
| S-EPMC4885951 | biostudies-literature
Project description:BACKGROUND:Multiple anatomic features of the femoral condyles and tibial plateau have been shown to influence knee biomechanics and risk of anterior cruciate ligament (ACL) injury. However, it remains unclear how these anatomic factors affect the midterm outcomes of ACL reconstruction. HYPOTHESIS:Decreased femoral notch width, increased posterior and coronal slopes, and decreased concavity of the tibial plateau are associated with inferior clinical, patient-reported, and osteoarthritis-related outcomes 7 years after ACL reconstruction. STUDY DESIGN:Cohort study; Level of evidence, 3. METHODS:Prospectively collected data from 44 patients who did not have a subsequent graft or contralateral ACL failure within 7 years after unilateral ACL reconstruction were reviewed (mean ± SD age, 23.7 ± 9.2 years; 64% women). Notch width (after notchplasty), posterior slopes of the medial and lateral tibial plateau, maximum depth of the medial tibial plateau, and coronal tibial slope were measured from magnetic resonance images. Anatomic predictors of side-to-side differences in anterior-posterior knee laxity, Knee injury and Osteoarthritis Outcome Score (KOOS), medial joint space width, and side-to-side differences in Osteoarthritis Research Society International (OARSI) x-ray score, measured at 7 years, were identified with linear regression (bivariate) and stepwise regression (multivariate). RESULTS:Increased posterior slope of the lateral tibial plateau was associated with increased side-to-side difference in knee laxity (bivariate model only), increased side-to-side difference in the OARSI score, and decreased KOOS subscores ( R2 > .10, P < .05). Increased posterior slope of the medial tibial plateau was associated with a higher side-to-side difference in the OARSI x-ray score (bivariate model only) and lower KOOS subscores ( R2 > .11, P < .03). Increased coronal tibial slope was associated with lower KOOS subscores ( R2 > .11, P < .03). Decreased medial tibial depth was associated with increased knee laxity as well as decreased KOOS subscores (ie, quality of life and symptoms; R2 > .12, P < .03). Postoperative notch width was not a significant predictor for any surgical outcome. None of the anatomic features were predictive of medial joint space width narrowing. CONCLUSION:Results partially support the hypothesis and highlight the importance of knee anatomy on several outcomes of ACL reconstruction among patients without subsequent graft or contralateral ACL injures. Increasing slopes in the coronal and sagittal planes with decreasing concavity of the medial tibial plateau lead to less favorable outcomes 7 years after surgery.
| S-EPMC6382545 | biostudies-literature
Project description:Patellofemoral pain syndrome is one of the most common chronic knee injuries; however, little research has been done to determine the risk factors for this injury.Altered lower extremity kinematics and kinetics, decreased strength, and altered postural measurements will be risk factors.Cohort study (prognosis); Level of evidence, 2.A total of 1597 participants were enrolled in this investigation and prospectively followed from the date of their enrollment (July 2005, July 2006, or July 2007) through January 2008, a maximum of 2.5 years of follow-up. Each participant underwent baseline data collection during their pre-freshman summer at the United States Naval Academy. Baseline data collection included 3-dimensional motion analysis during a jump-landing task, 6 lower extremity isometric strength tests, and postural alignment measurements (navicular drop and Q angle).Risk factors for the development of patellofemoral pain syndrome included decreased knee flexion angle, decreased vertical ground-reaction force, and increased hip internal rotation angle during the jump-landing task. Additionally, decreased quadriceps and hamstring strength, increased hip external rotator strength, and increased navicular drop were risk factors for the development of patellofemoral pain syndrome.Multiple modifiable risk factors for patellofemoral pain syndrome pain have been identified in this investigation. To decrease the incidence of this chronic injury, the risk factors for patellofemoral pain syndrome need to be targeted in injury prevention programs.Prevention programs should focus on increasing strength of the lower extremity musculature along with instructing proper mechanics during dynamic movements to decrease the incidence of patellofemoral pain syndrome.
| S-EPMC2860575 | biostudies-literature