Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA最新文献

{"title":"Three-dimensional in vivo motion analysis of normal knees employing transepicondylar axis as an evaluation parameter.","authors":"Osamu Tanifuji,&nbsp;Takashi Sato,&nbsp;Koichi Kobayashi,&nbsp;Tomoharu Mochizuki,&nbsp;Yoshio Koga,&nbsp;Hiroshi Yamagiwa,&nbsp;Go Omori,&nbsp;Naoto Endo","doi":"10.1007/s00167-012-2010-x","DOIUrl":"https://doi.org/10.1007/s00167-012-2010-x","url":null,"abstract":"<p><strong>Purpose: </strong>The transepicondylar axis (TEA) has been used as a flexion axis of the knee and a reference of the rotational alignment of the femoral component. However, no study has showed dynamic normal knee kinematics employing TEA as the evaluation parameter throughout the full range of motion in vivo. The purpose of this study was to analyze dynamic kinematics of the normal knee through the full range of motion via the 3-dimensional to 2-dimensional registration technique employing TEA as the evaluation parameter.</p><p><strong>Methods: </strong>Dynamic motion of the right knee was analyzed in 20 healthy volunteers (10 female, 10 male; mean age 37.2 years). Knee motion was observed as subjects squatted from standing with knee fully extended to maximum flexion. The following parameters were determined: (1) Anteroposterior translations of the medial and lateral ends of the TEA; and (2) changes in the angle of the TEA on the tibial axial plane (rotation angle).</p><p><strong>Results: </strong>The medial end of the TEA demonstrated anterior translation (3.6 ± 3.0 mm) from full extension to 30° flexion and demonstrated posterior translation (18.1 ± 3.7 mm) after 30°, while the lateral end of the TEA demonstrated consistent posterior translation (31.1 ± 7.3 mm) throughout knee flexion. All subjects exhibited femoral external rotation (16.9 ± 6.2°) relative to the tibia throughout knee flexion.</p><p><strong>Conclusion: </strong>Compared to previously used parameters, the TEA showed bicondylar posterior translation from early flexion phase. These results provide control data for dynamic kinematic analyses of pathologic knees in the future and will be useful in the design of total knee prostheses.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":"2301-8"},"PeriodicalIF":3.8,"publicationDate":"2013-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00167-012-2010-x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40190397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Slight undercorrection following total knee arthroplasty results in superior clinical outcomes in varus knees.","authors":"Luc Vanlommel,&nbsp;Jan Vanlommel,&nbsp;Steven Claes,&nbsp;Johan Bellemans","doi":"10.1007/s00167-013-2481-4","DOIUrl":"https://doi.org/10.1007/s00167-013-2481-4","url":null,"abstract":"<p><strong>Purpose: </strong>Restoration of correct alignment is one of the main objectives of total knee arthroplasty (TKA). However, the influence of residual malalignment on clinical and functional outcomes is currently uncertain. This study was therefore undertaken to ascertain its influence in patients undergoing TKA for varus osteoarthritis of the knee.</p><p><strong>Methods: </strong>A cohort of 132 consecutive patients (143 knees) with pre-operative varus alignment was evaluated with a mean follow-up period of 7.2 years. Based upon the post-operative alignment, patients were stratified into three groups: neutral, mild varus, and severe varus. These groups were compared with respect to clinical and functional outcomes.</p><p><strong>Results: </strong>All patients had post-operative improvements in Knee Society Score (KSS). Knees that were left in mild varus scored significantly better for the KSS and the Western Ontario and McMaster Universities Arthritis Index, compared with knees that were corrected to neutral and knees that were left in severe varus exceeding 6°. No revisions occurred in any of the groups at midterm follow-up.</p><p><strong>Conclusion: </strong>The results of this study contradict the conventional assumption that correction to neutral mechanical alignment leads to the best outcome following TKA. Patients with pre-operative varus had better clinical and functional outcome scores if the alignment was left in mild varus, as compared with patients with an alignment correction to neutral.</p><p><strong>Level of evidence: </strong>Therapeutic study, Level III.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":"2325-30"},"PeriodicalIF":3.8,"publicationDate":"2013-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00167-013-2481-4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40227206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accuracy of manual instrumentation of tibial cutting guide in total knee arthroplasty.","authors":"R Iorio,&nbsp;G Bolle,&nbsp;F Conteduca,&nbsp;L Valeo,&nbsp;J Conteduca,&nbsp;D Mazza,&nbsp;A Ferretti","doi":"10.1007/s00167-012-2005-7","DOIUrl":"https://doi.org/10.1007/s00167-012-2005-7","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of this study was to evaluate the accuracy of conventional instrumentation for tibial resection in total knee arthroplasty (TKA) as assessed by a computer-based navigation system during each phase of the surgical procedure. The hypothesis is that conventional instrumentation fails to achieve optimal accuracy in final implant positioning, thus leading to surgical errors.</p><p><strong>Methods: </strong>Forty primary TKAs were performed. The resection guide was placed using an extramedullary guide. Accurate guide positioning was assessed by the navigation system prior to the osteotomy. The alignment measurement was repeated after resection and after component implantation in order to quantify the deviation caused by the manual positioning of the prosthetic components. A deviation ≥2° was considered unsatisfactory.</p><p><strong>Results: </strong>In the frontal plane, unsatisfactory results observed were as follows: 15 % with reference to manual positioning of the resection guide and 10 % with reference to definition of the resection plane with a tendency towards varus malalignment. In the sagittal plane, unsatisfactory results were as follows: 45 % with reference to manual positioning of the resection guide and 40 % with reference to definition of the resection plane with a trend of decreased tibial slope angle. The deviation between bone resection and subsequent implant placement was ≥2° in none of the cases.</p><p><strong>Conclusions: </strong>The study confirms the hypothesis that conventional instrumentation fails to achieve optimal accuracy in the positioning of the tibial component. During each phase of the surgical procedure, a tendency towards varus malalignment and a decreased tibial slope angle were observed.</p><p><strong>Levels of evidence: </strong>II.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":"2296-300"},"PeriodicalIF":3.8,"publicationDate":"2013-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00167-012-2005-7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40177306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cryopreservation with glycerol improves the in vitro biomechanical characteristics of human patellar tendon allografts.","authors":"Lovro Suhodolčan,&nbsp;Miha Brojan,&nbsp;Franc Kosel,&nbsp;Matej Drobnič,&nbsp;Armin Alibegović,&nbsp;Janez Brecelj","doi":"10.1007/s00167-012-1954-1","DOIUrl":"https://doi.org/10.1007/s00167-012-1954-1","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the in vitro biomechanical characteristics of patellar tendon ligaments (BTB) when stored as fresh frozen or as glycerol cryopreserved allografts.</p><p><strong>Methods: </strong>Seventy patellar tendons were harvested from 35 cadaveric human donors and randomly assigned into seven groups. Grafts in group FRESH were mechanically tested within 2 h of harvesting. FROZ-3, FROZ-6, and FROZ-9 were deep-frozen to -80 °C for 3, 6, and 9 months, respectively. Grafts in groups CRYO-3, CRYO-6, and CRYO-9 were initially incubated with 10% glycerol in a phosphate-buffered saline for 1 h and then stored in glycerol solution (10% glycerol in PBS) at -80 °C for 3, 6, and 9 months, respectively. Grafts were mechanically tested with two cycling modes (50-250 °N and 150-500 °N) and then loaded to failure.</p><p><strong>Results: </strong>Cryopreserved grafts demonstrated more consistent results and expressed lower elongation rates after both cycling loading protocols compared to their frozen counterparts at all storage times. During load-to-failure analysis, ultimate stiffness levels were predominantly higher (23.9-61.5%) in cryopreserved grafts compared with frozen grafts, and ultimate stress levels were 26% (13.3-47.7%) higher, regardless of the storage time. Moreover, cryopreserved grafts revealed similar ultimate elongation and uniformly higher ultimate stiffness and ultimate stress levels compared to fresh grafts.</p><p><strong>Conclusion: </strong>The results of this in vitro study demonstrated superior mechanical properties of cryopreserved grafts compared to frozen grafts within a preservation period of 9 months. Cryopreservation with glycerol solution might be used to further improve the quality of preserved soft-tissue allografts.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":"1218-25"},"PeriodicalIF":3.8,"publicationDate":"2013-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00167-012-1954-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40166718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bilateral idiopathic osteonecrosis of the major tubercle of the humerus.","authors":"Julian Dexel,&nbsp;Philip Kasten","doi":"10.1007/s00167-012-2025-3","DOIUrl":"https://doi.org/10.1007/s00167-012-2025-3","url":null,"abstract":"<p><strong>Unlabelled: </strong>Bilateral osteonecrosis of the tuberculum majus has not been reported in the literature. A case of bilateral avascular necrosis of the tuberculum majus is presented associated with smoking and occasional alcohol consumption as risk factors, which was successfully treated with non-operative treatment.</p><p><strong>Level of evidence: </strong>Case report, Level V.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":"1168-70"},"PeriodicalIF":3.8,"publicationDate":"2013-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00167-012-2025-3","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40571993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changing sagittal plane body position during single-leg landings influences the risk of non-contact anterior cruciate ligament injury.","authors":"Yohei Shimokochi,&nbsp;Jatin P Ambegaonkar,&nbsp;Eric G Meyer,&nbsp;Sae Yong Lee,&nbsp;Sandra J Shultz","doi":"10.1007/s00167-012-2011-9","DOIUrl":"https://doi.org/10.1007/s00167-012-2011-9","url":null,"abstract":"<p><strong>Purpose: </strong>To examine the effects of different sagittal plane body positions during single-leg landings on biomechanics and muscle activation parameters associated with risk for anterior cruciate ligament (ACL) injury.</p><p><strong>Methods: </strong>Twenty participants performed single-leg drop landings onto a force plate using the following landing styles: self-selected, leaning forward (LFL) and upright (URL). Lower extremity and trunk 3D biomechanics and lower extremity muscle activities were recorded using motion analysis and surface electromyography, respectively. Differences in landing styles were examined using 2-way Repeated-measures ANOVAs (sex × landing conditions) followed by Bonferroni pairwise comparisons.</p><p><strong>Results: </strong>Participants demonstrated greater peak vertical ground reaction force, greater peak knee extensor moment, lesser plantar flexion, lesser or no hip extensor moments, and lesser medial and lateral gastrocnemius and lateral quadriceps muscle activations during URL than during LFL. These modifications of lower extremity biomechanics across landing conditions were similar between men and women.</p><p><strong>Conclusions: </strong>Leaning forward while landing appears to protect the ACL by increasing the shock absorption capacity and knee flexion angles and decreasing anterior shear force due to the knee joint compression force and quadriceps muscle activation. Conversely, landing upright appears to be ACL harmful by increasing the post-impact force of landing and quadriceps muscle activity while decreasing knee flexion angles, all of which lead to a greater tibial anterior shear force and ACL loading. ACL injury prevention programmes should include exercise regimens to improve sagittal plane body position control during landing motions.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":"888-97"},"PeriodicalIF":3.8,"publicationDate":"2013-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00167-012-2011-9","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40190399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Remnant volume of anterior cruciate ligament correlates preoperative patients' status and postoperative outcome.","authors":"Takeshi Muneta,&nbsp;Hideyuki Koga,&nbsp;Young-Jin Ju,&nbsp;Masafumi Horie,&nbsp;Tomomasa Nakamura,&nbsp;Ichiro Sekiya","doi":"10.1007/s00167-012-2023-5","DOIUrl":"https://doi.org/10.1007/s00167-012-2023-5","url":null,"abstract":"<p><strong>Purpose: </strong>A cohort study was conducted to evaluate the correlation of anterior cruciate ligament (ACL) remnant volume with preoperative status and postoperative outcome of the patients after a remnant-preserving double-bundle (DB) ACL reconstruction.</p><p><strong>Methods: </strong>Eighty-eight patients of 105 unilateral DB anatomic ACL reconstructions performed between 2006 and 2008 were followed up for 24 months or more. They were evaluated with regard to preoperative knee laxity data under anaesthesia. Postoperative outcome was evaluated based on knee extension and flexion strength, manual laxity tests, KT measurements, etc. Overall knee condition and sports performance were evaluated with Lysholm knee score and subjective rating scale. Overall correlation of the remnant volume with the preoperative and postoperative evaluation was assessed. Then, the patients were divided into three subgroups based on the remnant volume (remnant volume: ≤ 30, 35-55 and ≤ 60 %). The evaluation was performed and analysed statistically among the three subgroups.</p><p><strong>Results: </strong>Generally, preoperative laxity tests showed a weak correlation with the ACL remnant volume. Postoperative knee stability also indicated a weak correlation with the ACL remnant volume. Statistical analyses revealed that there were significant differences among the three groups regarding age at surgery, preoperative period, number of giving-way and preoperative KT measurements. Postoperatively, there were significant differences in Lachman test, KT measurements, Lysholm knee scale, subjective and sports performance recovery scores. As the clinical relevance, the study suggests that the remnant volume will be important as a background of preoperative condition and a predictor of operative outcome for each patient and that a remnant preserving surgery may not be simply better than a non-preserving technique with regard to subjective evaluation and sports performance recovery.</p><p><strong>Conclusion: </strong>The preoperative condition of patients with ACL injury was different depending upon the remnant volume. The remnant volume was also weakly correlated with the postoperative outcome regarding objective stability and subjective recovery.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":"906-13"},"PeriodicalIF":3.8,"publicationDate":"2013-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00167-012-2023-5","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40190313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Size comparison of ACL footprint and reconstructed auto graft.","authors":"Takanori Iriuchishima,&nbsp;Kenji Shirakura,&nbsp;Hiroshi Yorifuji,&nbsp;Shin Aizawa,&nbsp;Freddie H Fu","doi":"10.1007/s00167-012-1949-y","DOIUrl":"https://doi.org/10.1007/s00167-012-1949-y","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study was to compare the size of native anterior cruciate ligament (ACL) footprints and the size of commonly used auto grafts. The hypothesis was that the reconstructed graft size with auto grafts might be smaller than the native ACL footprint.</p><p><strong>Methods: </strong>Fourteen non-paired human cadaver knees were used. The semitendinosus tendon (ST) and the gracilis (G) tendon were harvested and prepared for ACL grafts. Simulating an ST graft, the ST was cut in half. The bigger half was regarded as the antero-medial (AM) bundle, and the remaining half was regarded as the postero-lateral (PL) bundle. Simulating an ST-G graft, the bigger half of the ST and G were regarded as the AM bundle, and the smaller half of the ST was regarded as the PL bundle. Each graft diameter was measured, and the graft area was calculated. Simulating a rectangular bone-patella tendon-bone (BPTB) graft, a 10-mm wide BPTB graft was harvested and the area calculated. The ACL was carefully dissected, and the size of the femoral and tibial footprints was measured using Image J software (National Institution of Health).</p><p><strong>Results: </strong>The average areas of the ST, ST-G, and BPTB graft were 52.3 ± 7.3, 64.4 ± 9.2, and 32.7 ± 6.5 mm(2), respectively. The sizes of the native femoral and tibial ACL footprints were 85.4 ± 26.3 and 145.4 ± 39.8 mm(2), respectively. Only the ST-G graft showed no significant difference in graft size when compared with the femoral ACL footprint.</p><p><strong>Conclusion: </strong>Only the ST-G auto graft was able to reproduce the native size of the ACL footprint on the femoral side. None of the auto grafts could reproduce the size of the tibial ACL footprint. For clinical relevance, ST-G graft is recommended in order to reproduce the native size of the ACL in anatomical ACL reconstruction with auto graft.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":"797-803"},"PeriodicalIF":3.8,"publicationDate":"2013-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00167-012-1949-y","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40154910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of ACL reconstruction tunnels on stress in the distal femur.","authors":"P Smolinski,&nbsp;M O'Farrell,&nbsp;K Bell,&nbsp;L Gilbertson,&nbsp;F H Fu","doi":"10.1007/s00167-012-2003-9","DOIUrl":"https://doi.org/10.1007/s00167-012-2003-9","url":null,"abstract":"<p><strong>Purpose: </strong>This study examined the change in femoral stress caused by graft tunnels drilled for anterior cruciate ligament (ACL) reconstruction. Using a computational model, the number, geometry and position of the graft tunnels exits were varied to determine the effect on bone stress.</p><p><strong>Methods: </strong>A finite element model of the distal femur was developed from a CT scan of a cadaveric knee. To assess the model, the strain calculated computationally was compared to experimentally measured strains in eleven unpaired human cadaver femurs. Using the computational model, the number, geometry and position of the graft tunnel exits were varied to determine the effect on bone stress based on the stress concentration factor: the ratio of bone stress with tunnels to intact bone stress.</p><p><strong>Results: </strong>The results indicated that the second tunnel in double-bundle ACL reconstruction results in approximately a 20 % increase in the maximum femoral stress as compared to single-bundle reconstruction. The highest stresses occur at the tunnel exits. The position of the tunnel exits effects femoral stress with the stress increasing slightly (AM SCR from 0.7 to 1 and PL SCR from 1.2 to 1.3) when the AM tunnel exit is moved anteriorly and having greater increases as the posterior lateral (PL) tunnel exit is moved laterally (PL SCR from 1.2 to 1.7) or posteriorly (PL SCR from 1.2 to 2).</p><p><strong>Conclusion: </strong>In anatomical ACL reconstruction, the tunnel entrances are dictated by anatomy; however, there can be variations in tunnel exit positions. Consideration should be given when positioning tunnel exits on the effect on stress in the femur. Moving the PL tunnel exit laterally or posteriorly increases in the stress at the PL tunnel exit.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":"839-45"},"PeriodicalIF":3.8,"publicationDate":"2013-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00167-012-2003-9","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40177305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biomechanical comparison of different graft positions for single-bundle anterior cruciate ligament reconstruction.","authors":"Yuki Kato,&nbsp;Akira Maeyama,&nbsp;Pisit Lertwanich,&nbsp;Joon Ho Wang,&nbsp;Sheila J M Ingham,&nbsp;Scott Kramer,&nbsp;Cesar Q A Martins,&nbsp;Patrick Smolinski,&nbsp;Freddie H Fu","doi":"10.1007/s00167-012-1951-4","DOIUrl":"https://doi.org/10.1007/s00167-012-1951-4","url":null,"abstract":"<p><strong>Purpose: </strong>Recent reports have highlighted the importance of an anatomic tunnel placement for anterior cruciate ligament (ACL) reconstruction. The purpose of this study was to compare the effect of different tunnel positions for single-bundle ACL reconstruction on knee biomechanics.</p><p><strong>Methods: </strong>Sixteen fresh-frozen cadaver knees were used. In one group (n = 8), the following techniques were used for knee surgery: (1) anteromedial (AM) bundle reconstruction (AM-AM), (2) posterolateral (PL) bundle reconstruction (PL-PL) and (3) conventional vertical single-bundle reconstruction (PL-high AM). In the other group (n = 8), anatomic mid-position single-bundle reconstruction (MID-MID) was performed. A robotic/universal force-moment sensor system was used to test the knees. An anterior load of 89 N was applied for anterior tibial translation (ATT) at 0°, 15°, 30° and 60° of knee flexion. Subsequently, a combined rotatory load (5 Nm internal rotation and 7 Nm valgus moment) was applied at 0°, 15°, 30° and 45° of knee flexion. The ATT and in situ forces during the application of the external loads were measured.</p><p><strong>Results: </strong>Compared with the intact ACL, all reconstructed knees had a higher ATT under anterior load at all flexion angles and a lower in situ force during the anterior load at 60° of knee flexion. In the case of combined rotatory loading, the highest ATT was achieved with PL-high AM; the in situ force was most closely restored with MIDMID, and the in situ force was the highest AM-AM at each knee flexion angle.</p><p><strong>Conclusion: </strong>Among the techniques, AM-AM afforded the highest in situ force and the least ATT.</p>","PeriodicalId":520702,"journal":{"name":"Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA","volume":" ","pages":"816-23"},"PeriodicalIF":3.8,"publicationDate":"2013-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00167-012-1951-4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40166717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}