Using Robotic Testing System to Investigate ACL Reconstructions in Restoring the Normal Knee Joint Biomechanics: Experience at Harvard Medical School

2011 ◽  
Author(s):  
Guoan Li ◽  
Hemanth R. Gadikota ◽  
Thomas J. Gill
Keyword(s):  
Knee Joint ◽  
Acl Reconstruction ◽  
Degrees Of Freedom ◽  
Cruciate Ligament ◽  
Surgical Techniques ◽  
Standard Of Care ◽  
Axial Rotation ◽  
Anatomical Reconstruction ◽  
Single Bundle ◽  
Normal Knee

Rupture of the anterior cruciate ligament (ACL) is a debilitating injury associated with various complications such as joint instability, meniscal injury and chronically may lead to osteoarthritis. ACL is believed to be the primary restraint to anterior translation and axial rotation. However, few studies have investigated the alterations to the other degrees of freedom kinematics due to ACL deficiency. ACL reconstruction has been widely accepted to be the standard of care for patients who sustain an ACL rupture to minimize the risk of the complications mentioned above. Widely practiced surgical techniques have yet to prove their efficacy in comprehensively restoring the normal knee joint function. Sub-optimal performance of the conventional single bundle ACL reconstruction has sparked a renewed interest in anatomical reconstruction and alterations to the conventional techniques.

scholarly journals Biomechanical Evaluation of Knee Joint Laxities and Graft Forces After Anterior Cruciate Ligament Reconstruction by Anteromedial Portal, Outside-In, and Transtibial Techniques

2011 ◽  
Vol 39 (12) ◽  
pp. 2604-2610 ◽  
Author(s):  
Jae Ang Sim ◽  
Hemanth R. Gadikota ◽  
Jing-Sheng Li ◽  
Guoan Li ◽  
Thomas J. Gill
Keyword(s):  
Anterior Cruciate Ligament ◽  
Knee Joint ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Joint Laxity ◽  
Normal Knee ◽  
Anterior Tibial ◽  
Anterior Cruciate ◽  
Tibial Translation ◽  
Reconstructed Knee

Background: Recently, anatomic anterior cruciate ligament (ACL) reconstruction is emphasized to improve joint laxity and to potentially avert initiation of cartilage degeneration. There is a paucity of information on the efficacy of ACL reconstructions by currently practiced tunnel creation techniques in restoring normal joint laxity. Study Design: Controlled laboratory study. Hypothesis: Anterior cruciate ligament reconstruction by the anteromedial (AM) portal technique, outside-in (OI) technique, and modified transtibial (TT) technique can equally restore the normal knee joint laxity and ACL forces. Methods: Eight fresh-frozen human cadaveric knee specimens were tested using a robotic testing system under an anterior tibial load (134 N) at 0°, 30°, 60°, and 90° of flexion and combined torques (10-N·m valgus and 5-N·m internal tibial torques) at 0° and 30° of flexion. Knee joint kinematics, ACL, and ACL graft forces were measured in each knee specimen under 5 different conditions (ACL-intact knee, ACL-deficient knee, ACL-reconstructed knee by AM portal technique, ACL-reconstructed knee by OI technique, and ACL-reconstructed knee by TT technique). Results: Under anterior tibial load, no significant difference was observed between the 3 reconstructions in terms of restoring anterior tibial translation ( P > .05). However, none of the 3 ACL reconstruction techniques could completely restore the normal anterior tibial translations ( P < .05). Under combined tibial torques, both AM portal and OI techniques closely restored the normal knee anterior tibial translation ( P > .05) at 0° of flexion but could not do so at 30° of flexion ( P < .05). The ACL reconstruction by the TT technique was unable to restore normal anterior tibial translations at both 0° and 30° of flexion under combined tibial torques ( P < .05). Forces experienced by the ACL grafts in the 3 reconstruction techniques were lower than those experienced by normal ACL under both the loading conditions. Conclusion: Anterior cruciate ligament reconstructions by AM portal, OI, and modified TT techniques are biomechanically comparable with each other in restoring normal knee joint laxity and in situ ACL forces. Clinical Relevance: Anterior cruciate ligament reconstructions by AM portal, OI, and modified TT techniques result in similar knee joint laxities. Technical perils and pearls should be carefully considered before choosing a tunnel creating technique.

Anteromedial Tibial Attachment in Single-Bundle Anterior Cruciate Ligament Reconstruction Can Represent Normal Kinematics in Computer Simulation

2022 ◽  
Author(s):  
Shinichiro Nakamura ◽  
Yoshihisa Tanaka ◽  
Shinichi Kuriyama ◽  
Kohei Nishitani ◽  
Mutsumi Watanabe ◽  
...  
Keyword(s):  
Computer Simulation ◽  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Knee Kinematics ◽  
Axial Rotation ◽  
Single Bundle ◽  
Tunnel Position ◽  
Anterior Cruciate

AbstractTunnel position during anterior cruciate ligament (ACL) reconstruction is considered as an important factor to restore normal knee kinematics and to gain better clinical outcomes. It is still unknown where the optimal femoral and tibial tunnel position is located in single-bundle (SB) ACL reconstruction. The purposes of this study were to analyze the knee kinematics with various graft positions and to propose the optimal graft position during SB ACL reconstruction. A musculoskeletal computer simulation was used to analyze knee kinematics. Four attachments on the femoral side (anteromedial [AM], mid, posterolateral [PL], and over-the-top positions) and three attachments on the tibial side (AM, middle, and PL positions) were determined. The middle-bundle attachment was placed at the midpoint of the AM and PL bundle attachments for the femoral and tibial attachments. SB ACL reconstruction models were constructed to combine each of the four femoral attachments with each of three tibial attachments. Kinematic comparison was made among a double-bundle (DB) model and 12 SB reconstruction models during deep knee bend and stair descent activity. The tunnel position of the tibia had greater effect of knee kinematics than that of the femur. AM tibial attachment models showed similar medial and lateral anteroposterior positions to the DB model for both activities. Axial rotation in the AM tibial attachment models was similar to the DB model regardless of the femoral attachment, whereas greater maximum axial rotation was exhibited in the PL tibial attachment models, especially during stair descent activity. AM tibial attachment can represent normal knee kinematics, whereas the PL tibial attachment can induce residual rotational instability during high-demand activities. The AM tibial tunnel is recommended for SB ACL reconstruction.

scholarly journals Single Bundle ACL Reconstruction: Step by Step

2019 ◽  
Vol 7 (11_suppl6) ◽  
pp. 2325967119S0046
Author(s):  
Isa An Nagib
Keyword(s):  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Tibial Tunnel ◽  
Insertion Site ◽  
Surgical Techniques ◽  
Patient Positioning ◽  
Posterior Wall ◽  
Single Bundle ◽  
Graft Harvest ◽  
Anterior Cruciate

An Anterior Cruciate Ligament (ACL) tear is the most common ligamentous injury of the knees. ACL reconstruction restore stability and kinematics of the knee joint, by improving knee stability. There are so many surgical techniques in ACL reconstruction. One of the most common technique is Single Bundle ACL reconstruction with the hamstring autograft. A good knowledge about operating technique and step by step approach are crucial for successfully procedure. The first step is patient positioning, including the leg holder should be placed proximal enough to allow full knee flexion and extension during procedure, it should be checked before starting the procedure. The second step is graft harvest, the autograft is prepared from the affected knee hamstring muscles, make a proper identification of the Gracilis and Semitendinosus tendon. The third step is portal placement, make a good native ACL attachment identification. Fourth step is femoral tunnel creation, avoid posterior wall blowout. Fifth step is tibial tunnel creation, remaining ACL fibers should be a landmark of the native ACL insertion site. Preserve the meniscal root insertion to prevent iatrogenic meniscus root avulsion. Sixth step is fixation, cycle the knee several times while applying traction to remove any slack out of the graft and to make sure there is non-impingement when fix the graft.

scholarly journals Comparison of hamstring and quadriceps strength after anatomical versus non-anatomical anterior cruciate ligament reconstruction: a retrospective cohort study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Hai Jiang ◽  
Lei Zhang ◽  
Rui-Ying Zhang ◽  
Qiu-Jian Zheng ◽  
Meng-Yuan Li
Keyword(s):  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Quadriceps Strength ◽  
Anatomical Reconstruction ◽  
Single Bundle ◽  
Knee Stability ◽  
Cruciate Ligament Reconstruction ◽  
Anterior Cruciate ◽  
Reconstruction Group

Abstract Background Strength recovery of injured knee is an important parameter for patients who want to return to sport after anterior cruciate ligament reconstruction (ACLR). Comparison of muscle strength between anatomical and non-anatomical ACLR has not been reported. Purpose To evaluate the difference between anatomical and non-anatomical single-bundle ACLR in hamstring and quadriceps strength and clinical outcomes. Methods Patients received unilateral primary single-bundle hamstring ACLR between January 2017 to January 2018 were recruited in this study. Patients were divided into anatomical reconstruction group (AR group) and non-anatomical reconstruction group (NAR group) according to femoral tunnel aperture position. The hamstring and quadriceps isokinetic strength including peak extension torque, peak flexion torque and H/Q ratio were measured at an angular velocity of 180°/s and 60°/s using an isokinetic dynamometer. The isometric extension and flexion torques were also measured. Hamstring and quadriceps strength were measured preoperatively and at 3, 6, and 12 months after surgery. Knee stability including Lachman test, pivot-shift test, and KT-1000 measurement and subjective knee function including International Knee Documentation Committee (IKDC) and Lysholm scores were evaluated during the follow-up. Results Seventy-two patients with an average follow-up of 30.4 months (range, 24–35 months) were included in this study. Thirty-three were in AR group and 39 in NAR group. The peak knee flexion torque was significant higher in AR group at 180°/s and 60°/s (P < 0.05 for both velocity) at 6 months postoperatively and showed no difference between the two groups at 12 months postoperatively. The isometric knee extension torque was significant higher in AR group at 6 months postoperatively (P < 0.05) and showed no difference between the two groups at 12 months postoperatively. No significant differences between AR group and NAR group were found regarding knee stability and subjective knee function evaluations at follow-up. Conclusions Compared with non-anatomical ACLR, anatomical ACLR showed a better recovery of hamstring and quadriceps strength at 6 months postoperatively. However, the discrepancy on hamstring and quadriceps strength between the two groups vanished at 1 year postoperatively.

Biomechanical Evaluation of Anterolateral Ligament Repair augmented with Internal Brace

2021 ◽  
Author(s):  
Ryan P. Roach ◽  
David P. Beason ◽  
Jonathan S. Slowik ◽  
A. Ryves Moore ◽  
Ajay C. Lall ◽  
...  
Keyword(s):  
Internal Rotation ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Surgical Techniques ◽  
Anterolateral Ligament ◽  
Torsional Stiffness ◽  
Rotational Stability ◽  
Gap Formation ◽  
Internal Brace ◽  
Acl Deficient

AbstractInjuries to the anterolateral ligament (ALL) of the knee are commonly associated with anterior cruciate ligament (ACL) ruptures. Biomechanical studies have demonstrated conflicting results with regard to the role of the ALL in limiting tibial internal rotation. Clinically, residual pivot shift following ACL reconstruction has been reported to occur up to 25% and has been correlated with poor outcomes. As such, surgical techniques have been developed to enhance rotational stability. Recent biomechanical studies have demonstrated restoration of internal rotational control following ALL reconstruction. The purpose of our study was to understand the biomechanical effects of ACL reconstruction with an ALL internal brace augmentation. We hypothesized that (1) sectioning of the ALL while preserving other lateral extra-articular structures would lead to significant internal rotation laxity and gap formation and (2) ALL repair with internal brace augmentation would lead to reduction in internal rotation instability and gap formation. In total, 10 fresh-frozen cadaveric knees were thawed and biomechanically tested in internal rotation for 10 cycles of normal physiologic torque in the intact, ACL-deficient, ACL/ALL-deficient, ACL-reconstructed, and ALL-repaired conditions. Each condition was tested at 30, 60, and 90 degrees of flexion. Following the final ALL-repaired condition, specimens were additionally subjected to a final internal rotation to failure at 1 degree at the last-tested degree of flexion. Kinematic measurements of angle and linear gap between the femur and tibia were calculated in addition to torsional stiffness and failure torque. As hypothesized, ALL repair with internal brace augmentation significantly reduced internal rotation angular motion and gap formation at flexion angles greater than 30 degrees. Additionally, ALL sectioning produced nonsignificant increases in internal rotation laxity and gap formation compared with ACL-deficient and ACL-reconstructed states, which did not support our other hypothesis.

scholarly journals A New Reconstructive Technique of the Anterolateral Ligament with Iliotibial Band-Strip

2017 ◽  
Vol 11 (1) ◽  
pp. 321-326 ◽  
Author(s):  
Bart Stuyts ◽  
Elke Van den Eeden ◽  
Jan Victor
Keyword(s):  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Proximal Part ◽  
Anterolateral Ligament ◽  
Anatomical Reconstruction ◽  
Iliotibial Band ◽  
Anatomical Location ◽  
Anterior Cruciate ◽  
The Sacrifice ◽  
Insight Into

Background:Anterior cruciate ligament (ACL) reconstruction is a well-established surgical procedure for the correction of ACL ruptures. However, the incidence of instability following ACL reconstruction is substantial. Recent studies have led to greater insight into the anatomy and the radiographic characteristics of the native anterolateral ligament (ALL), along with its possible role in residual instability after ACL reconstruction.Method:The current paper describes a lateral extra-articular tenodesis to reconstruct the ALL during ACL procedures, using a short iliotibial band strip. The distal insertion of this strip is left intact on the anterolateral side of the proximal tibia, and the proximal part is fixed at the anatomic femoral insertion of the ALL.Results:Our technique avoids the sacrifice of one of the hamstring tendons for the ALL reconstruction. Additionally, there is no interference with the anatomical location or function of the LCL.Conclusion:Our technique offers a minimally invasive and nearly complete anatomical reconstruction of the ALL with minimal additional operative time.

COMPARATIVE KINEMATIC ANALYSIS OF THE RANGE OF MOVEMENT OF A NORMAL HUMAN KNEE JOINT, STANDARD ARTIFICIAL KNEE AND NOVEL ARTIFICIAL HIGH FLEXION KNEE

2010 ◽  
Vol 22 (01) ◽  
pp. 41-45
Author(s):  
Sam Prasanna Rajkumar ◽  
Sudesh Sivarasu ◽  
Lazar Mathew
Keyword(s):  
Knee Joint ◽  
Range Of Motion ◽  
Degrees Of Freedom ◽  
Range Of Movement ◽  
High Flexion ◽  
Additional Degree ◽  
Normal Knee ◽  
Standard Version ◽  
Knee Movement ◽  
Human Knee Joint

Total Knee Arthroplasty (TKA) using standard artificial knee implant has a limitation in restriction in the range of motion and freedom of movements'. This study was worked out to compare the kinematics of a reconstructed 3D knee with standard and high flexion artificial knee designs. A CT bone model reconstructed with MIMICS for a 3D normal knee joint and the simulation was done for normal knee, standard version of artificial knee as well as the high flexion knee designs. The results of the analyses, provides us an insight that high flexion designs were most suited and gives increased range of motion and also provides an additional degree of freedom so that it almost mimics the normal knee movement. The high flexion design when tested under simulated environment provided a better functionality and increased movements. It was concluded that the normal knee has 6 degrees of freedom (DOF); the standard version has 1 rotation and 1 translation. The high flexion design provides 2 rotations and 1 translation.

scholarly journals Effective Graft Preservation by Following a Standard Protocol for the Treatment of Knee Joint Infection after Anterior Cruciate Ligament Reconstruction

2018 ◽  
Vol 32 (11) ◽  
pp. 1111-1120
Author(s):  
Robin Otchwemah ◽  
Jan-Hendrik Naendrup ◽  
Frauke Mattner ◽  
Thorsten Tjardes ◽  
Holger Bäthis ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Knee Joint ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Joint Infection ◽  
Standard Protocol ◽  
Standardized Protocol ◽  
Graft Preservation ◽  
Knee Joint Infection ◽  
Anterior Cruciate

AbstractKnee joint infections constitute a rare but devastating complication after anterior cruciate ligament (ACL) reconstruction. We hypothesized that effective infection therapy and graft preservation is possible following a standard treatment protocol. We retrospectively analyzed all patients admitted to our center with suspected infection of the knee after ACL reconstruction between 2010 and 2012. Following a standardized protocol, blood samples were drawn and synovial fluid was analyzed. Furthermore, the protocol consisted of arthroscopic lavages and debridements of the anterior and posterior joint compartments over three incisions, and targeted antibiotic therapy over a period of 6 weeks. Surgeries were repeated every 2 days until clinical signs of infections resolved, but at least two times. Mean observation period was 10 months. Forty-one patients aged 31 ( ±  9.9) years and admitted 14 ( ±  7.5) days after ACL reconstruction were included. Pathogens were found in 34 patients and coagulase-negative staphylococci were isolated most commonly (31 isolates in 28 patients). Quinolones were the most commonly used antibiotic agents. Mean number of operations was 3.8 ( ± 1.4). Following the standard protocol, primary successful infection treatment with graft preservation was possible in 37 of the included 41 patients. Graft preservation was achieved in 100% of the included patients with Gaechter stage 1 and 2 infections. Knee joint infection after ACL reconstruction was successfully treated following a standardized protocol, and graft preservation was reliably achieved especially in cases with infections at an early stage.

scholarly journals Evaluation of Knee Joint after Open Reduction and Internal Fixation Surgery of Posterior Cruciate Ligament in Patients with Avulsion Fracture

2019 ◽  
Vol 7 (6) ◽  
pp. 982-986
Author(s):  
Navid Salehi ◽  
Faeze Azarifar ◽  
Arman Jahanshahi ◽  
Hamidreza Mohammadi
Keyword(s):  
Knee Joint ◽  
Internal Fixation ◽  
Posterior Cruciate Ligament ◽  
Open Reduction ◽  
Avulsion Fracture ◽  
Cruciate Ligament ◽  
Common Mechanism ◽  
Knee Score ◽  
Normal Knee ◽  
Lysholm Knee Score

BACKGROUND: The posterior cruciate ligament is one of the important tissues and structures sustaining the knee joint, and its rupture or detachment may lead to joint instability or destruction. AIM: The present study aimed at investigating the Open Reduction and Internal Fixation surgery of posterior cruciate ligament and comparing it to the normal knee of the same side. METHODS: In this study, 25 patients with avulsion fracture at the PCL joint were treated with open surgery and screw fixation. The patients were followed up by Lysholm knee score for at least 12 months after surgery. RESULTS: All patients were male with an average age of 25 years over the years 2010-2018. The common mechanism of injury in these patients was motorcycle-car accident. In the study with Lysholm knee score, 21 patients (80%) obtained the good score of 60-90 while 20% of patients were placed in the fair group (30-59). The average score was 86. CONCLUSION: The obtained score of knee function questionnaire in this study had no significant difference from other similar studies, and most patients achieved a good and acceptable score after the surgery. There was no knee instability and functional impairment in the patients compared to the normal knee. Considering the clinical results after the fixation of the PCL avulsion fracture causing a significant improvement in patients, the surgery could be considered as an acceptable and effective method for treating such impairment and fracture.

Dynamic Postural Control Two Years Following Anterior Cruciate Ligament Reconstruction in a Female Collegiate Soccer Player

2015 ◽  
Vol 20 (2) ◽  
pp. 24-29 ◽  
Author(s):  
Michael A. Samaan ◽  
Eric K. Greska ◽  
Matthew C. Hoch ◽  
Joshua T. Weinhandl ◽  
Sebastian Y. Bawab ◽  
...  
Keyword(s):  
Knee Joint ◽  
Postural Control ◽  
Acl Reconstruction ◽  
Outcome Measure ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Minimal Detectable Change ◽  
Joint Stability ◽  
Compensatory Mechanisms ◽  
Main Outcome Measure

Context:ACL injury may cause a lack of knee joint proprioception and motor control due to knee joint instability. ACL reconstruction restores knee joint stability, yet dynamic postural control may still be affected while performing dynamic tasks.Objective:To examine the effects of ACL injury and reconstruction on dynamic postural control using the Star Excursion Balance Test (SEBT) and single leg hop (SLH).Participant:One Division I female athlete.Main Outcome Measure:The athlete’s dynamic postural control, both pre- and postreconstruction, was compared with preinjury data using the method of minimal detectable change using reach distances obtained from the SEBT and hop distances from the SLH.Results:ACL injury and reconstruction affected the anterior, posteromedial, and posterolateral reach distances of the SEBT. Despite restoration of joint stability, anterior reach distance in the SEBT did not return to preinjury levels 27 months after ACL reconstruction. SLH distances decreased following injury but returned to preinjury levels 27 months after ACL reconstruction.Conclusion:Dynamic postural control and performance during the SEBT and SLH were affected by ACL injury and for extended periods of time after ACL reconstruction. Quadriceps inhibition and muscle strength of the involved limb may affect dynamic postural control both after ACL injury and reconstruction while performing the SEBT. Compensatory mechanisms at the hip and ankle may aid in performance of the SLH after reconstruction. Using baseline measurements, where possible, may help researchers better understand the effects of ACL injury and reconstruction on dynamic postural control.

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