title: A novel technique, dynamic intraligamentary stabilization creates optimal conditions for primary ACL healing: a preliminary biomechanical study.
abstract: BACKGROUND
  Anterior cruciate ligament (ACL) rupture is a common lesion. Current treatment emphasizes arthroscopic ACL reconstruction via a graft, although this approach is associated with potential drawbacks. A new method of dynamic intraligamentary stabilization (DIS) was subjected to biomechanical analysis to determine whether it provides the necessary knee stability for optimal ACL healing.
  
  
  METHODS
  Six human knees from cadavers were harvested. The patellar tendon, joint capsule and all muscular attachments to the tibia and femur were removed, leaving the collateral and the cruciate ligaments intact. The knees were stabilized and the ACL kinematics analyzed. Anterior-posterior (AP) stability measurements evaluated the knees in the following conditions: (i) intact ACL, (ii) ACL rupture, (iii) ACL rupture with primary stabilization, (iv) primary stabilization after 50 motion cycles, (v) ACL rupture with DIS, and (vi) DIS after 50 motion cycles.
  
  
  RESULTS
  After primary suture stabilization, average AP laxity was 3.2 mm, which increased to an average of 11.26 mm after 50 movement cycles. With primary ACL stabilization using DIS, however, average laxity values were consistently lower than those of the intact ligament, increasing from an initial AP laxity of 3.00 mm to just 3.2 mm after 50 movement cycles.
  
  
  CONCLUSIONS
  Dynamic intraligamentary stabilization established and maintained close contact between the two ends of the ruptured ACL, thus ensuring optimal conditions for potential healing after primary reconstruction. The present ex vivo findings show that the DIS technique is able to restore AP stability of the knee.
authors.affiliation: Department of Orthopaedic Surgery, Inselspital, University of Bern, Switzerland; Robert Mathys Foundation, Bettlach, Switzerland.
authors.forename: Sandro
authors.initials: S
authors.lastname: Kohl
authors.affiliation: Department of Orthopaedic Surgery, Inselspital, University of Bern, Switzerland; 3rd Department of Orthopaedic Surgery, K.A.T. Hospital, University of Athens, Greece. Electronic address: ds.evangelopoulos@gmail.com.
authors.forename: Dimitrios S
authors.initials: DS
authors.lastname: Evangelopoulos
authors.affiliation: Department of Orthopaedic Surgery, Inselspital, University of Bern, Switzerland.
authors.forename: Sufian S
authors.initials: SS
authors.lastname: Ahmad
authors.affiliation: Department of Orthopaedic Surgery, Inselspital, University of Bern, Switzerland.
authors.forename: Heindrik
authors.initials: H
authors.lastname: Kohlhof
authors.affiliation: Institute of Anatomy, University of Bern, Switzerland.
authors.forename: Gudrun
authors.initials: G
authors.lastname: Herrmann
authors.affiliation: Department of Radiology, Inselspital, University of Bern, Switzerland.
authors.forename: Harald
authors.initials: H
authors.lastname: Bonel
authors.affiliation: Department of Orthopaedic Surgery, Inselspital, University of Bern, Switzerland.
authors.forename: Stefan
authors.initials: S
authors.lastname: Eggli
mesh_terms: D016118:Anterior Cruciate Ligament / Q000503:physiopathology / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D001696:Biomechanical Phenomena; D001863:Bone Screws; D001864:Bone Wires; D002102:Cadaver; D005260:Female; D005269:Femur / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D007593:Joint Instability / Q000601:surgery*; D007719:Knee Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D009984:Orthopedic Fixation Devices; D019637:Orthopedic Procedures / Q000295:instrumentation / Q000379:methods*; D011859:Radiography; D012399:Rotation; D012421:Rupture; D013314:Stress, Mechanical; D013977:Tibia / Q000000981:diagnostic imaging / Q000601:surgery
keywords: ACL; AP stability; Dynamic intraligamentary stabilization