title: Posterior cruciate ligament graft fixation angles, part 1: biomechanical evaluation for anatomic single-bundle reconstruction.
abstract: BACKGROUND
  Currently, no consensus exists for the optimal graft fixation angle for anatomic single-bundle (SB) posterior cruciate ligament reconstructions (PCLRs). Additionally, direct graft forces have not been measured. Alternative graft fixation angles and the resultant graft forces should be investigated to optimize the stability of SB PCLRs without overconstraining the knee.
  
  
  OBJECTIVE
  Graft fixation angles of 75°, 90°, and 105° for SB PCLR were hypothesized to improve knee stability compared with the sectioned posterior cruciate ligament state with no evidence of knee overconstraint.
  
  
  METHODS
  Controlled laboratory study.
  
  
  METHODS
  Nine fresh-frozen human cadaveric knees were biomechanically evaluated for the intact, sectioned, and SB PCLR states with the anterolateral bundle graft fixed at 75°, 90°, and 105°. A 6 degrees of freedom robotic system assessed knee laxity with a 134-N posterior load applied at 0° to 120° and 5-N·m external, 5-N·m internal, and 10-N·m valgus rotation torques applied at 60° to 120°. By securing the graft to an external load cell, graft forces were measured throughout kinematic testing.
  
  
  RESULTS
  No significant kinematic differences were found among the 3 fixation angles. Each fixation angle resulted in significantly less posterior translation than in the sectioned state at all flexion angles (P < .05), with 4.1 mm of average residual laxity during an applied posterior loading. For all graft fixation angles, internal rotation was significantly increased between 60° and 120° of flexion, and external rotation was significantly increased at 90°, 105°, and 120° of flexion compared with the intact state. Graft forces were not significantly different among the 3 fixation angles and remained below reported loads observed during activities of daily living.
  
  
  CONCLUSIONS
  All tested SB PCLR graft fixation angles restored knee laxity to similar levels; however, persistent laxity resulted in significant increases in knee laxity compared with the intact state during posterior tibial loading at all flexion angles, internal rotation at flexion angles ≥60°, and external rotation at ≥75° of flexion.
  
  
  CONCLUSIONS
  The results of this study suggest that SB PCL graft fixation angles of 75°, 90°, and 105° were comparable in restoring knee kinematics and exposed the graft to similar time-zero loads. However, SB PCLRs did not fully reduce knee laxity to the intact state.
authors.affiliation: Steadman Philippon Research Institute, Vail, Colorado, USA.
authors.forename: Nicholas I
authors.initials: NI
authors.lastname: Kennedy
authors.affiliation: Steadman Philippon Research Institute, Vail, Colorado, USA The Steadman Clinic, Vail, Colorado, USA.
authors.forename: Robert F
authors.initials: RF
authors.lastname: LaPrade
authors.affiliation: Steadman Philippon Research Institute, Vail, Colorado, USA.
authors.forename: Mary T
authors.initials: MT
authors.lastname: Goldsmith
authors.affiliation: Steadman Philippon Research Institute, Vail, Colorado, USA.
authors.forename: Scott C
authors.initials: SC
authors.lastname: Faucett
authors.affiliation: Steadman Philippon Research Institute, Vail, Colorado, USA.
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Rasmussen
authors.affiliation: Steadman Philippon Research Institute, Vail, Colorado, USA.
authors.forename: Garrett A
authors.initials: GA
authors.lastname: Coatney
authors.affiliation: Department of Orthopaedic Surgery, Oslo University Hospital and Faculty of Medicine, University of Oslo, Oslo, Norway.
authors.forename: Lars
authors.initials: L
authors.lastname: Engebretsen
authors.affiliation: Steadman Philippon Research Institute, Vail, Colorado, USA cwijdicks@sprivail.org.
authors.forename: Coen A
authors.initials: CA
authors.lastname: Wijdicks
mesh_terms: D000125:Achilles Tendon / Q000637:transplantation*; D000328:Adult; D002102:Cadaver; D002111:Calcaneus / Q000637:transplantation; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000503:physiopathology / Q000601:surgery; D007719:Knee Joint / Q000503:physiopathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D019637:Orthopedic Procedures / Q000379:methods*; D016119:Posterior Cruciate Ligament / Q000601:surgery*; D016059:Range of Motion, Articular / Q000502:physiology; D012371:Robotics; D012399:Rotation; D013314:Stress, Mechanical; D013537:Sutures; D019415:Torque; D016474:Weight-Bearing / Q000502:physiology*
keywords: anterolateral bundle (ALB); graft fixation angles; graft forces; knee kinematics; posterior cruciate ligament (PCL); single-bundle PCL reconstruction