title: ACL Graft Position Affects in Situ Graft Force Following ACL Reconstruction.
abstract: BACKGROUND
  The purpose of our study was to evaluate the relationship between graft placement and in situ graft force after anterior cruciate ligament (ACL) reconstruction.
  
  
  METHODS
  Magnetic resonance imaging (MRI) was obtained for twelve human cadaveric knees. The knees, in intact and deficient-ACL states, were subjected to external loading conditions as follows: an anterior tibial load of 89 N at 0°, 15°, 30°, 45°, 60°, and 90° of flexion and a combined rotatory (simulated pivot-shift) load of 5 Nm of internal tibial torque and 7 Nm of valgus torque at 0°, 15°, and 30° of flexion. Three ACL reconstructions were performed in a randomized order: from the center of the tibial insertion site to the center of the femoral insertion site (Mid), the center of the tibial insertion site to a more vertical femoral position (S1), and the center of the tibial insertion site to an even more vertical femoral position (S2). The reconstructions were tested following the same protocol used for the intact state, and graft in situ force was calculated for the two loadings at each flexion angle. MRI was used to measure the graft inclination angle after each ACL reconstruction.
  
  
  RESULTS
  The mean inclination angle (and standard deviation) was 51.7° ± 5.0° for the native ACL, 51.6° ± 4.1° for the Mid reconstruction (p = 0.85), 58.7° ± 5.4° for S1 (p < 0.001), and 64.7° ± 6.5° for S2 (p < 0.001). At 0°, 15°, and 30° of knee flexion, the Mid reconstruction showed in situ graft force that was closer to that of the native ACL during both anterior tibial loading and simulated pivot-shift loading than was the case for S1 and S2 reconstructions. At greater flexion angles, S1 and S2 had in situ graft force that was closer to that of the native ACL than was the case for the Mid reconstruction.
  
  
  CONCLUSIONS
  Anatomic ACL reconstruction exposes grafts to higher loads at lower angles of knee flexion.
  
  
  CONCLUSIONS
  Rehabilitation and return to sports progression may need to be modified to protect an anatomically placed graft after ACL reconstruction.
authors.affiliation: SHIS QL 8 Conj 2 Casa 19, Lago Sul Brasília - DF, Brazil 71620-225.
authors.forename: Paulo H
authors.initials: PH
authors.lastname: Araujo
authors.affiliation: Department of Orthopaedic Surgery, University of Pittsburgh, Kaufmann Building, Suite 1011, 3471 Fifth Avenue, Pittsburgh, PA 15213. E-mail address for F. Fu: ffu@upmc.edu.
authors.forename: Shigehiro
authors.initials: S
authors.lastname: Asai
authors.affiliation: Department of Orthopaedic Surgery, University of Pittsburgh, Kaufmann Building, Suite 1011, 3471 Fifth Avenue, Pittsburgh, PA 15213. E-mail address for F. Fu: ffu@upmc.edu.
authors.forename: Mauricio
authors.initials: M
authors.lastname: Pinto
authors.affiliation: Department of Orthopaedic Surgery, University of Pittsburgh, Kaufmann Building, Suite 1011, 3471 Fifth Avenue, Pittsburgh, PA 15213. E-mail address for F. Fu: ffu@upmc.edu.
authors.forename: Thiago
authors.initials: T
authors.lastname: Protta
authors.affiliation: Department of Orthopaedic Surgery, University of Pittsburgh, Kaufmann Building, Suite 1011, 3471 Fifth Avenue, Pittsburgh, PA 15213. E-mail address for F. Fu: ffu@upmc.edu.
authors.forename: Kellie
authors.initials: K
authors.lastname: Middleton
authors.affiliation: Department of Orthopaedic Surgery, University of Pittsburgh, Kaufmann Building, Suite 1011, 3471 Fifth Avenue, Pittsburgh, PA 15213. E-mail address for F. Fu: ffu@upmc.edu.
authors.forename: Monica
authors.initials: M
authors.lastname: Linde-Rosen
authors.affiliation: Department of Orthopaedic Surgery, University of Pittsburgh, Kaufmann Building, Suite 1011, 3471 Fifth Avenue, Pittsburgh, PA 15213. E-mail address for F. Fu: ffu@upmc.edu.
authors.forename: James
authors.initials: J
authors.lastname: Irrgang
authors.affiliation: Department of Orthopaedic Surgery, University of Pittsburgh, Kaufmann Building, Suite 1011, 3471 Fifth Avenue, Pittsburgh, PA 15213. E-mail address for F. Fu: ffu@upmc.edu.
authors.forename: Patrick
authors.initials: P
authors.lastname: Smolinski
authors.affiliation: Department of Orthopaedic Surgery, University of Pittsburgh, Kaufmann Building, Suite 1011, 3471 Fifth Avenue, Pittsburgh, PA 15213. E-mail address for F. Fu: ffu@upmc.edu.
authors.forename: Freddie H
authors.initials: FH
authors.lastname: Fu
mesh_terms: D016118:Anterior Cruciate Ligament / Q000637:transplantation*; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods*; D001182:Arthroscopy; D002102:Cadaver; D006801:Humans; D007593:Joint Instability / Q000517:prevention & control*; D007719:Knee Joint / Q000502:physiology*; D016059:Range of Motion, Articular; D013536:Suture Techniques; D016474:Weight-Bearing / Q000502:physiology