ACL mismatch reconstructions: influence of different tunnel placement strategies in single-bundle ACL reconstructions on the knee kinematics.
To evaluate the influence of tibial and femoral tunnel position in ACL reconstruction on knee kinematics, we compared ACL reconstruction with a tibial and femoral tunnel in anteromedial (AM-AM reconstruction) and in posterolateral footprint (PL-PL reconstruction) with a reconstruction technique with tibial posterolateral and femoral anteromedial tunnel placement (PL-AM reconstruction). In 9 fresh-frozen human cadaveric knees, the knee kinematics under simulated Lachman (134 N anterior tibial load) and a simulated pivot shift test (10 N/m valgus and 4 N/m internal tibial torque) were determined at 0°, 30°, 60°, and 90° of flexion. Kinematics were recorded for intact, ACL-deficient, and single-bundle ACL reconstructed knees using three different reconstruction strategies in randomized order: (1) PL-AM, (2) AM-AM and (3) PL-PL reconstructions. Under simulated Lachman test, single-bundle PL-AM reconstruction and PL-PL reconstructions both showed significantly increased anterior tibial translation (ATT) at 60° and 90° when compared to the intact knee. At all flexion angles, AM-AM reconstruction did not show any statistical significant differences in ATT compared to the intact knee. Under simulated pivot shift, PL-AM reconstruction resulted in significantly higher ATT at 0°, 30°, and 60° knee flexion and AM-AM reconstructions showed significantly higher ATT at 30° compared to the intact knee. PL-PL reconstructions did not show any significant differences to the intact knee. AM-AM reconstructions restore the intact knee kinematics more closely when compared to a PL-AM technique resembling a transtibial approach. PL-PL reconstructions showed increased ATT at higher flexion angles, however, secured the rotational stability at all flexion angles. Due to the independent tibial and femoral tunnel location, a medial portal technique may be superior to a transtibial approach.
Herbort
Mirco
M
Department of Trauma, Hand and Reconstructive Surgery, Weatfaelian Wilhelms University Muenster, Waldeyer Strasse 1, Muenster, Germany. mirco.herbort@ukmuenster.de
Lenschow
Simon
S
Fu
Freddie H
FH
Petersen
Wolf
W
Zantop
Thore
T
D000368:Aged; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D001696:Biomechanical Phenomena; D002102:Cadaver; D005260:Female; D005269:Femur / Q000601:surgery; D006801:Humans; D007593:Joint Instability / Q000517:prevention & control; D007719:Knee Joint / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D012680:Sensitivity and Specificity; D013314:Stress, Mechanical; D013718:Tensile Strength; D013977:Tibia / Q000601:surgery
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