Quantified kinematics of the injury to the posterior cruciate ligament: a computer-aided design simulation study.
OBJECTIVE
To quantify the kinematics of the injury to the posterior cruciate and the other major knee ligaments as a function of the knee flexion angle at the moment of impact.


METHODS
Computer-aided design modelling was used to investigate the strain response of all major knee ligaments during antero-posterior abnormal tibio-femoral translation at 0-90 degrees knee flexion.


BACKGROUND
It is generally believed that the likelihood of injury to the posterior cruciate ligament following anterior impact is higher in the flexed knee. However, there are no kinematical studies to quantify this clinical observation or investigate the role of the other knee ligaments in the above situation.


METHODS
Computer calculations of the individual ligament strain were plotted against the magnitude of posterior tibial translation. Additionally, the strain rate for each ligament (defined as the ligament strain produced per mm of posterior tibial linear translation) was calculated as the slope of the strain-displacement curve for all tested degrees of knee flexion.


RESULTS
The posterior cruciate ligament has been shown to be the primary restraint to posterior tibial translation in all degrees of knee flexion. However, at 90 degrees of knee flexion the strain rate of the posterior cruciate ligament is approximately half that in the fully extended knee and the posterior cruciate ligament is the only ligament to resist posterior tibial translation.


CONCLUSIONS
The strain behaviour of the posterior cruciate ligament during injury is highly dependent on the knee flexion during the moment of impact. Forced posterior tibial translation in the 90 degrees flexed knee may result in isolated posterior cruciate ligament deficit rather than a complex ligament disruption. The strain rate of a ligament as introduced in the present study is a quantified parameter related to the resistance that the ligament imposes to an abnormal joint movement. Relevance. This study provides insight into the differential strain of the knee ligaments during impacts that result in posterior cruciate ligament injury. Studies that quantify the strain behaviour of individual knee ligaments are important to the understanding, diagnosis and prevention of injuries sustained during contact sports and high-energy road traffic accidents.
Karnezis
I A
IA
Department of Orthopaedic Surgery, University of Bristol, UK. i.a.karnezis@bristol.ac.uk
Fragkiadakis
E G
EG
Webb
J M
JM
Hardy
J R
JR
D001696:Biomechanical Phenomena; D003198:Computer Simulation; D006801:Humans; D015601:Injury Severity Score; D007718:Knee Injuries / Q000175:diagnosis*; D008953:Models, Anatomic; D016119:Posterior Cruciate Ligament / Q000293:injuries*; D016059:Range of Motion, Articular / Q000502:physiology; D012680:Sensitivity and Specificity