title: Dynamic in vitro analysis of tractile forces of the anterior cruciate ligament (ACL) transplant using patellar and semitendinosus muscle tendon: a cadaver study.
abstract: OBJECTIVE
  The presented biomechanical study focused on the in vitro analysis of tractile forces working on the anterior cruciate ligament (ACL) and the ACL transplants, respectively, using a semitendinosus and/or patellar tendon during a passive flexion-extension movement (150-0°).
  
  
  METHODS
  Overall, 15 fresh frozen human knee joint pairs were examined. At first during arthroscopy, the tibial insertion of the ACL was drilled using a special hollow drill. Thereby, a bone cylinder was exposed at which a dynamometer was attached to enable for direct registration of tractile forces on the ACL via the connection between ACL-dynamometer and computer. The ACL transplant was fixed at the femur using a so-called endo-button, whereas the dynamometer was attached to the tibial end of the ACL transplant. The dynamic part of the examination was performed using the knee kinemator device developed by Plitz and Wirth et al. using different preload.
  
  
  RESULTS
  The curves of the tractile forces of the ACL were qualitatively homogeneous with only low force values in the middle flexion position, whereas during maximum flexion and extension the forces increased reaching a maximum in the 0° position. Also, in testing the ACL transplants a force decrease between 0 and 50° flexion was recognized with even greater forces resulting at the 150° position depending on the anterior position of the femoral drill channel for implanting the ACL transplant. The amount of pre-loading showed no influence on the form of the tractile force curve. However, by enhancing the preload to 70 N, the maximal force in the ACL transplant increased significantly.
  
  
  CONCLUSIONS
  The tractile forces assessed within the ACL during passive flexion movements between 10 and 90° were not greater than the forces measured in the ACL transplants. Thus, the clinical consequence is that in the early postoperative phase passive mobilization might be performed in this motion range without putting the ACL transplant at risk for damage.
authors.affiliation: Department of Orthopedic Surgery, Klinikum der Universität München Großhadern, Ludwig Maximilians Universität München, Marchioninistrasse 15, 81377, Munich, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Schmitt-Sody
authors.forename: C
authors.initials: C
authors.lastname: Kirchhoff
authors.forename: E
authors.initials: E
authors.lastname: Luciani
authors.forename: W
authors.initials: W
authors.lastname: Plitz
authors.forename: S
authors.initials: S
authors.lastname: Kirchhoff
mesh_terms: D000328:Adult; D000368:Aged; D016118:Anterior Cruciate Ligament / Q000503:physiopathology* / Q000601:surgery*; D001182:Arthroscopy; D001696:Biomechanical Phenomena; D002102:Cadaver; D005260:Female; D005269:Femur / Q000601:surgery; D006801:Humans; D007719:Knee Joint / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D053581:Muscle Strength Dynamometer; D017847:Patellar Ligament / Q000503:physiopathology / Q000637:transplantation; D016059:Range of Motion, Articular; D013710:Tendons / Q000503:physiopathology / Q000637:transplantation*; D013977:Tibia / Q000601:surgery; D055815:Young Adult