title: Effect of femoral tunnel positions on graft stress in outside-in ACL reconstruction surgery during continuous knee motion: A simulation study.
abstract: BACKGROUND
  Previous studies regarding the optimal femoral tunnel location for an anterior cruciate ligament (ACL) reconstruction were based on static experiments at specific angles, and did not consider continuous motion of the knee.
  
  
  METHODS
  Twenty-four surgical sites were set and continuous kinematic data, obtained from motion analysis, was used to describe knee movement. The bending angle and stress of the ACL graft as well as the length of the femoral tunnel was calculated through multi-flexible body dynamics analysis.
  
  
  RESULTS
  The lowest stress was found at both 5 mm and 10 mm radius at a proximal posterior of 45°, and the highest stress was also found at a distal 15 mm radius. Relatively high stresses were also identified between the distal and anterior regions as well as the distal and posterior regions at 15 mm radius.
  
  
  CONCLUSIONS
  Considering the availability of surgery, it was identified that the optimum femoral tunnel location is at 10 mm radius locations at a proximal posterior of 45°.
authors.affiliation: Dept. of Biomedical Engineering, Jungwon University, 85, Munmu-ro, Goesan-eup, Goesan-gun, Chungcheongbuk-do, 367-805, Korea.
authors.forename: Kyungmin
authors.initials: K
authors.lastname: Kang
authors.affiliation: Dept. of Biomedical Engineering, Jungwon University, 85, Munmu-ro, Goesan-eup, Goesan-gun, Chungcheongbuk-do, 367-805, Korea.
authors.forename: Tae Soo
authors.identifier: http://orcid.org/0000-0002-8224-541X
authors.initials: TS
authors.lastname: Bae
mesh_terms: D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods*; D001696:Biomechanical Phenomena; D003198:Computer Simulation; D005269:Femur / Q000601:surgery*; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D007717:Knee / Q000502:physiology* / Q000601:surgery; D007719:Knee Joint / Q000601:surgery; D009038:Motion; D015203:Reproducibility of Results; D013977:Tibia / Q000601:surgery
keywords: anterior cruciate ligament; continuous knee motion; graft stress; reconstruction surgery