Biomechanical Analysis of an Anatomic Anterior Cruciate Ligament Reconstruction

• Published in: The American journal of sports medicine 2002-09, Vol.30 (5), p.660-666
• Main Authors: Yagi, Masayoshi, Wong, Eric K., Kanamori, Akihiro, Debski, Richard E., Fu, Freddie H., Woo, Savio L-Y.
• Format: Article
• Language: English
• Subjects: Analysis of Variance; Anterior cruciate ligament; Anterior Cruciate Ligament - anatomy & histology; Anterior Cruciate Ligament - surgery; Biological and medical sciences; Biomechanical Phenomena; Cadaver; Clinical outcomes; Humans; Investigative techniques, diagnostic techniques (general aspects); Knee injuries; Ligaments; Medical sciences; Orthopedic surgery; Osteoarticular system. Muscles; Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques; Physiological aspects; Sports injuries; Sports medicine; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tendon transplantation
• ISSN: 0363-5465; 1552-3365
• DOI: 10.1177/03635465020300050501

Background: The focus of most anterior cruciate ligament reconstructions has been on replacing the anteromedial bundle and not the posterolateral bundle. Hypothesis: Anatomic two-bundle reconstruction restores knee kinematics more closely to normal than does single-bundle reconstruction. Study Design: Controlled laboratory study. Methods: Ten cadaveric knees were subjected to external loading conditions: 1) a 134-N anterior tibial load and 2) a combined rotatory load of 5-N·m internal tibial torque and 10-N·m valgus torque. Resulting knee kinematics and in situ force in the anterior cruciate ligament or replacement graft were determined by using a robotic/universal force-moment sensor testing system for 1) intact, 2) anterior cruciate ligament deficient, 3) single-bundle reconstructed, and 4) anatomically reconstructed knees. Results: Anterior tibial translation for the anatomic reconstruction was significantly closer to that of the intact knee than was the single-bundle reconstruction. The in situ force normalized to the intact anterior cruciate ligament for the anatomic reconstruction was 97%± 9%, whereas the single-bundle reconstruction was only 89%± 13%. With a combined rotatory load, the normalized in situ force for the single-bundle and anatomic reconstructions at 30° of flexion was 66%± 40%and 91%± 35%, respectively. Conclusions: Anatomic reconstruction may produce a better biomechanical outcome, especially during rotatory loads. Clinical Relevance: Results may lead to the use of a two-bundle technique.