Reconstruction of the anterior cruciate- and anterolateral ligament deficient knee with a modified iliotibial graft reduces instability more than with an intra-articular hamstring graft

Purpose To compare knee kinematics before and after anterior cruciate ligament ACL reconstruction (ACL-R) using hamstring graft (HG) and a double-stranded iliotibial tract graft attached to Gerdy’s tubercle (providing an extra-articular anterolateral tenodesis) (named the modified iliotibial tract g...

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Published in:Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA sports traumatology, arthroscopy : official journal of the ESSKA, 2020-08, Vol.28 (8), p.2526-2534
Main Authors: Eljaja, Salameh Belal, Konradsen, Lars, Siersma, Volkert Dirk, Athwal, Kiron, Amis, Andrew Arthur, Krogsgaard, Michael Rindom
Format: Article
Language:English
Subjects:
Anterior cruciate ligament
Anterior Cruciate Ligament - surgery
Anterior Cruciate Ligament Injuries - surgery
Anterior Cruciate Ligament Reconstruction - methods
Biomechanical Phenomena
Cadaver
Cadavers
Fascia Lata - transplantation
Grafting
Hamstring Tendons - transplantation
Humans
Joint Instability - surgery
Kinematics
Knee
Ligaments
Male
Medial Collateral Ligament, Knee - injuries
Medial Collateral Ligament, Knee - surgery
Medicine
Medicine & Public Health
Middle Aged
Optical tracking
Orthopedics
Range of Motion, Articular
Rotation
Tenodesis - methods
Tracking systems
Translation
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container_issue 8
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container_title Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA
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creator Eljaja, Salameh Belal
Konradsen, Lars
Siersma, Volkert Dirk
Athwal, Kiron
Amis, Andrew Arthur
Krogsgaard, Michael Rindom
description Purpose To compare knee kinematics before and after anterior cruciate ligament ACL reconstruction (ACL-R) using hamstring graft (HG) and a double-stranded iliotibial tract graft attached to Gerdy’s tubercle (providing an extra-articular anterolateral tenodesis) (named the modified iliotibial tract graft = MIT). Method Eighteen cadaveric knees were tested in a 6 degree of freedom kinematics rig. An optical tracking system recorded kinematics of the knee from 0 to 80 degrees of flexion applying no load, internal/external rotation (IR/ER), valgus/varus rotation (VGR/VRR), simulated pivot shift (SPS), anterior translation (AT) and posterior translation loads. The knee was tested before and after resection of the ACL and the anterolateral ligament (ALL), respectively; then after HG-ACL-R and MIT-ACL-R. Grafts were fixed at 20° of flexion. Results were compared to the intact knee. Results ACL resection resulted in a significant increase in AT ( p  
doi_str_mv 10.1007/s00167-020-05850-8
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Method Eighteen cadaveric knees were tested in a 6 degree of freedom kinematics rig. An optical tracking system recorded kinematics of the knee from 0 to 80 degrees of flexion applying no load, internal/external rotation (IR/ER), valgus/varus rotation (VGR/VRR), simulated pivot shift (SPS), anterior translation (AT) and posterior translation loads. The knee was tested before and after resection of the ACL and the anterolateral ligament (ALL), respectively; then after HG-ACL-R and MIT-ACL-R. Grafts were fixed at 20° of flexion. Results were compared to the intact knee. Results ACL resection resulted in a significant increase in AT ( p  &lt; 0.05) over the entire range of motion, peaking at 20° of flexion, mean difference 6.6 ± 2.25 mm ( p  = 0.0007). ACL-R with HG-ACL and MIT-ACL restored AT. Resection of the ALL increased IR in the fully extended knee, mean difference 2.4 ± 2.1° ( p  = 0.024). When compared to the intact knee and the knee after HG-ACL-R, MIT-ACL-R knee reduced IR/SPS significantly ( p  &lt; 0.05) in deep flexion angles (60°–80°), peaking at 80° of flexion. The MIT-ACL-R caused significantly less VRR at 80° flexion ( p  = 0.02). Conclusion MIT-ACL-R restored AT equally to the HG-ACL-R. The MIT-ACL-R reduced IR and SPS in deep flexion, resulting in overconstraint. MIT-ACL-R can be used as an alternative to standard reconstruction methods.</description><identifier>ISSN: 0942-2056</identifier><identifier>EISSN: 1433-7347</identifier><identifier>DOI: 10.1007/s00167-020-05850-8</identifier><identifier>PMID: 32040678</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Anterior cruciate ligament ; Anterior Cruciate Ligament - surgery ; Anterior Cruciate Ligament Injuries - surgery ; Anterior Cruciate Ligament Reconstruction - methods ; Biomechanical Phenomena ; Cadaver ; Cadavers ; Fascia Lata - transplantation ; Grafting ; Hamstring Tendons - transplantation ; Humans ; Joint Instability - surgery ; Kinematics ; Knee ; Ligaments ; Male ; Medial Collateral Ligament, Knee - injuries ; Medial Collateral Ligament, Knee - surgery ; Medicine ; Medicine &amp; Public Health ; Middle Aged ; Optical tracking ; Orthopedics ; Range of Motion, Articular ; Rotation ; Tenodesis - methods ; Tracking systems ; Translation</subject><ispartof>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2020-08, Vol.28 (8), p.2526-2534</ispartof><rights>European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2020</rights><rights>European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2020.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c419t-583246b3148ba83bd6fc657b082eb69dfd5141d3e45a3cc39c23c71899eb6a873</citedby><cites>FETCH-LOGICAL-c419t-583246b3148ba83bd6fc657b082eb69dfd5141d3e45a3cc39c23c71899eb6a873</cites><orcidid>0000-0002-0140-5443</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32040678$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Eljaja, Salameh Belal</creatorcontrib><creatorcontrib>Konradsen, Lars</creatorcontrib><creatorcontrib>Siersma, Volkert Dirk</creatorcontrib><creatorcontrib>Athwal, Kiron</creatorcontrib><creatorcontrib>Amis, Andrew Arthur</creatorcontrib><creatorcontrib>Krogsgaard, Michael Rindom</creatorcontrib><title>Reconstruction of the anterior cruciate- and anterolateral ligament deficient knee with a modified iliotibial graft reduces instability more than with an intra-articular hamstring graft</title><title>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA</title><addtitle>Knee Surg Sports Traumatol Arthrosc</addtitle><addtitle>Knee Surg Sports Traumatol Arthrosc</addtitle><description>Purpose To compare knee kinematics before and after anterior cruciate ligament ACL reconstruction (ACL-R) using hamstring graft (HG) and a double-stranded iliotibial tract graft attached to Gerdy’s tubercle (providing an extra-articular anterolateral tenodesis) (named the modified iliotibial tract graft = MIT). Method Eighteen cadaveric knees were tested in a 6 degree of freedom kinematics rig. An optical tracking system recorded kinematics of the knee from 0 to 80 degrees of flexion applying no load, internal/external rotation (IR/ER), valgus/varus rotation (VGR/VRR), simulated pivot shift (SPS), anterior translation (AT) and posterior translation loads. The knee was tested before and after resection of the ACL and the anterolateral ligament (ALL), respectively; then after HG-ACL-R and MIT-ACL-R. Grafts were fixed at 20° of flexion. Results were compared to the intact knee. Results ACL resection resulted in a significant increase in AT ( p  &lt; 0.05) over the entire range of motion, peaking at 20° of flexion, mean difference 6.6 ± 2.25 mm ( p  = 0.0007). ACL-R with HG-ACL and MIT-ACL restored AT. Resection of the ALL increased IR in the fully extended knee, mean difference 2.4 ± 2.1° ( p  = 0.024). When compared to the intact knee and the knee after HG-ACL-R, MIT-ACL-R knee reduced IR/SPS significantly ( p  &lt; 0.05) in deep flexion angles (60°–80°), peaking at 80° of flexion. The MIT-ACL-R caused significantly less VRR at 80° flexion ( p  = 0.02). Conclusion MIT-ACL-R restored AT equally to the HG-ACL-R. The MIT-ACL-R reduced IR and SPS in deep flexion, resulting in overconstraint. 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Method Eighteen cadaveric knees were tested in a 6 degree of freedom kinematics rig. An optical tracking system recorded kinematics of the knee from 0 to 80 degrees of flexion applying no load, internal/external rotation (IR/ER), valgus/varus rotation (VGR/VRR), simulated pivot shift (SPS), anterior translation (AT) and posterior translation loads. The knee was tested before and after resection of the ACL and the anterolateral ligament (ALL), respectively; then after HG-ACL-R and MIT-ACL-R. Grafts were fixed at 20° of flexion. Results were compared to the intact knee. Results ACL resection resulted in a significant increase in AT ( p  &lt; 0.05) over the entire range of motion, peaking at 20° of flexion, mean difference 6.6 ± 2.25 mm ( p  = 0.0007). ACL-R with HG-ACL and MIT-ACL restored AT. Resection of the ALL increased IR in the fully extended knee, mean difference 2.4 ± 2.1° ( p  = 0.024). When compared to the intact knee and the knee after HG-ACL-R, MIT-ACL-R knee reduced IR/SPS significantly ( p  &lt; 0.05) in deep flexion angles (60°–80°), peaking at 80° of flexion. The MIT-ACL-R caused significantly less VRR at 80° flexion ( p  = 0.02). Conclusion MIT-ACL-R restored AT equally to the HG-ACL-R. The MIT-ACL-R reduced IR and SPS in deep flexion, resulting in overconstraint. MIT-ACL-R can be used as an alternative to standard reconstruction methods.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>32040678</pmid><doi>10.1007/s00167-020-05850-8</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0002-0140-5443</orcidid><oa>free_for_read</oa></addata></record>
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subjects Anterior cruciate ligament
Anterior Cruciate Ligament - surgery
Anterior Cruciate Ligament Injuries - surgery
Anterior Cruciate Ligament Reconstruction - methods
Biomechanical Phenomena
Cadaver
Cadavers
Fascia Lata - transplantation
Grafting
Hamstring Tendons - transplantation
Humans
Joint Instability - surgery
Kinematics
Knee
Ligaments
Male
Medial Collateral Ligament, Knee - injuries
Medial Collateral Ligament, Knee - surgery
Medicine
Medicine & Public Health
Middle Aged
Optical tracking
Orthopedics
Range of Motion, Articular
Rotation
Tenodesis - methods
Tracking systems
Translation
title Reconstruction of the anterior cruciate- and anterolateral ligament deficient knee with a modified iliotibial graft reduces instability more than with an intra-articular hamstring graft
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