title: Changes in the length of virtual anterior cruciate ligament fibers during stability testing: a comparison of conventional single-bundle reconstruction and native anterior cruciate ligament.
abstract: BACKGROUND
  Conventional tunnel positions for single-bundle (SB) transtibial anterior cruciate ligament (ACL) reconstruction are located in the posterolateral (PL) tibial footprint and the anteromedial (AM) femoral footprint, resulting in an anatomic mismatch graft that is more vertical than native fibers. This vertical mismatch position may significantly influence the ability of an ACL graft to stabilize the knee.
  
  
  OBJECTIVE
  Anatomic ACL fibers undergo a greater change in length during anterior translation and internal rotation than a conventional SB reconstruction from the PL tibial footprint to the AM femoral footprint.
  
  
  METHODS
  Controlled laboratory study.
  
  
  METHODS
  The Praxim ACL Surgetics navigation system was used to acquire kinematic data during a flexion/extension cycle and to register all points within the ACL footprint from 5 fresh-frozen cadaveric knees. Virtual fibers were placed in the center of the AM and PL bundles as well as central and conventional SB positions. After transection of the ACL, the absolute length change and apparent strain of the fibers were computed for each knee during the Lachman and anterior drawer tests and internal rotation at 0 degrees and 30 degrees of flexion.
  
  
  RESULTS
  Each of the anatomic fibers (AM, PL, and central) had more elongation and apparent strain than the conventional SB fiber during the Lachman maneuver. During the anterior drawer test, the AM and central (but not the PL) fibers lengthened significantly more and the AM had more apparent strain than the conventional SB fiber. During internal rotation at 0 degrees and 30 degrees of flexion, anatomic fibers elongated significantly more than the conventional fiber. Except for the AM fiber with the knee at full extension, apparent strain was greater in all anatomic fibers than in the conventional SB fiber during internal rotation maneuvers.
  
  
  CONCLUSIONS
  In ACL-deficient cadaveric knees, anatomic fibers undergo greater elongation and apparent strain in response to anterior translation and internal rotation maneuvers than a conventional SB graft. Because of their optimal orientation, anatomic fibers may resist pathologic anterior translation and internal rotation more than the conventional SB position.
  
  
  CONCLUSIONS
  Conventional placement of a single-bundle graft results in suboptimal changes in fiber length and strain, suggesting that alternatives such as anatomic placement of an SB graft or double-bundle reconstruction may result in greater control of translation and rotation.
authors.affiliation: Hospital for Special Surgery, New York, NY, USA. brophyr@wudosis.wustl.edu
authors.forename: Robert H
authors.initials: RH
authors.lastname: Brophy
authors.forename: James E
authors.initials: JE
authors.lastname: Voos
authors.forename: Fintan J
authors.initials: FJ
authors.lastname: Shannon
authors.forename: Carinne C
authors.initials: CC
authors.lastname: Granchi
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Wickiewicz
authors.forename: Russell F
authors.initials: RF
authors.lastname: Warren
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Pearle
mesh_terms: D016118:Anterior Cruciate Ligament / Q000502:physiology* / Q000601:surgery*; D001696:Biomechanical Phenomena; D006801:Humans; D007593:Joint Instability; D007719:Knee Joint / Q000601:surgery; D019637:Orthopedic Procedures / Q000379:methods; D013314:Stress, Mechanical; D025321:Surgery, Computer-Assisted