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  • 1
    ISSN: 1433-7347
    Keywords: Key words Knee ; Anterior cruciate ligament ; ACL reconstruction ; Hamstring ; Graft fixation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine , Sports Science
    Notes: Abstract The objective of this study was to determine the relative motion of a quadruple hamstring graft within the femoral bone tunnel (graft-tunnel motion) under tensile loading. Six graft constructs were prepared from the semitendinosus and gracilis tendons of human cadavers and were fixed with a titanium button and polyester tape within a bone tunnel in a cadaveric femur. Three different lengths of polyester tape (15, 25, and 35 mm loops) were evaluated. The femur was held stationary and uniaxial tensile loads were applied to the distal end of the graft using a materials testing machine. Each construct was subjected to loading for ten cycles with upper limits of 50 N, 100 N, 200 N and 300 N. Graft-tunnel motion was then determined using the distances between reflective tape markers placed on the hamstring graft and at the entrance to the femoral bone tunnel, which were tracked with a high-resolution video system. Graft-tunnel motion was found to range from 0.7 ± 0.2 mm to 3.3 ± 0.2 mm, and significant increases in graft-tunnel motion were observed with increasing tensile loads (P 〈 0.05). Shorter tape length (15 mm) resulted in significantly less motion when compared to longer tape length (35 mm) (P 〈 0.05). We conclude that graft-tunnel motion is significant and should be considered when using this fixation technique. Early stress on the graft, as seen in postoperative rehabilitation exercises and athletic activities, may cause large graft-tunnel motion before graft incorporation is complete. A shorter distance between the tendon tissue and the titanium button is recommended to minimize the amount of graft-tunnel motion. Alternative fixation materials to polyester tape, or different fixation techniques, need to be developed such that graft-tunnel motion can be reduced. Further studies are needed to evaluate the effect of graft-tunnel motion on graft incorporation in the bone tunnel.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1433-7347
    Keywords: Anterior cruciate ligament ; Knee joint ; Biomechanics
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine , Sports Science
    Notes: Abstract This study was conducted to evaluate the effect of applied load on the magnitude, direction, and point of tibial intersection of the in situ forces of the anteromedial (AM) and posterolateral (PL) bands of the human anterior cruciate ligament (ACL) at 30° and 90° of knee flexion. An Instron was used to apply a 100 N anterior shear force to 11 human cadaver knees, 6 at 30° of knee flexion and 5 at 90° of knee flexion. A Universal Force Sensor (UFS) recorded the resultant 6 degree-of freedom (DOF) forces/moments. Each specimen then underwent serial removal of the AM and PL bands. With the knee limited to 1 DOF (anteroposterior), tests were performed before and after each structure was removed. Because the path was identical in each test, the principle of superposition was applied. Thus, the difference between the resultant forces could be attributed to the force carried by the structure just removed. The magnitudes of force in the ACL at 30° and 90° of knee flexion were 114.1±7.4 N and 90.8±8.3 N, respectively (P〈0.05). At 30°, the AM and PL bundles carried 95% and 4% of the total ACL force, respectively. At 90°, the AM and PL bands carried 85% and 13%, respectively (P〈0.05). The direction of the in situ force in the whole ACL as well as its two bands correlated with the anatomic orientation of the ligament. The resultant total ACL force intersected the tibial plateau at the posterolateral aspect of the AM band's insertion at 30° of knee flexion, while at 90°, the force intersection moved posteriorly to the AM/PL border. This research provides new insight into the fundamental force relationships of the ACL and its bundles. In response to an anterior tibial shear force, the AM band of the ACL was the predominant load carrier at both 30° and 90° of knee flexion. However, contrary to carlier reports, the in situ force carried in the PL band increased as knee flexion increased. Further, the tibial intersection of the resultant ACL force moved laterally with knee flexion. These findings confirm the dynamic structure of the ACL that in itself has no isometricity and may also indicate that there is no ideal location in which to position a replacement graft. The use of this methodology with more physiologically unconstrained motion should lead to more definitive clinical conclusions.
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1433-7347
    Keywords: Key words Anterior knee stability ; Anterior cruciate ligament ; Medial ; collateral ligament
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine , Sports Science
    Notes: Abstract Ligaments and other soft tissues, as well as bony contact, all contribute to anterior stability of the knee joint. This study was designed to measure the in situ force in the medial collateral ligament (MCL), anterior cruciate ligament (ACL), posterolateral structures (PLS), and posterior cruciate ligament (PCL) in response to 110 N anterior tibial loading. The changes in knee kinematics associated with ACL deficiency and combined MCL+ACL deficiency were also evaluated. Utilizing a robotic/universal force-moment sensor system, ten human cadaveric knee joints were tested between 0° and 90° of knee flexion. This unique testing system is designed to determine the in situ forces in structures of interest without making mechanical contact with the tissue. More importantly, data for individual structures can be obtained from the same knee specimen since the robotic manipulator can reproduce the motion of the intact knee. The in situ forces in the ACL under anterior tibial loading to 110 N were highest at 15° flexion, 103 ± 14 N (mean ± SD), decreasing to 59.2 ± 30 N at 90° flexion. For the MCL, these forces were 8.0 ± 3.5 N and 38.1 ± 25 N, respectively. Forces due to bony contact were as high as 34.1 ± 23 N at 30° flexion, while those in the PLS were relatively small at all flexion angles. Combined MCL+ACL deficiency was found to significantly increase anterior tibial translation relative to the ACL-deficient knee only above 60° of knee flexion. These findings confirm the hypothesis that there is significant load sharing between various ligaments and bony contact during anterior tibial loading of the knee. For this reason, the MCL and osteochondral surfaces may also be at significant risk during ACL injury.
    Type of Medium: Electronic Resource
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