Biomechanical Analysis of Ideal Knee Flexion Angle for ACL Graft Tensioning Utilizing Multiple Femoral and Tibial Tunnel Locations

التفاصيل البيبلوغرافية
العنوان: Biomechanical Analysis of Ideal Knee Flexion Angle for ACL Graft Tensioning Utilizing Multiple Femoral and Tibial Tunnel Locations
المؤلفون: Alexander Kharlamov, Mark C Miller, Jon E. Hammarstedt, Patrick J. DeMeo, Patrick J. Schimoler, J. Jared Guth, Sam Akhavan
المصدر: The journal of knee surgery.
سنة النشر: 2021
مصطلحات موضوعية: musculoskeletal diseases, Orthodontics, 030222 orthopedics, business.industry, Anterior cruciate ligament, Excursion, 030229 sport sciences, Isometric exercise, musculoskeletal system, 03 medical and health sciences, surgical procedures, operative, 0302 clinical medicine, medicine.anatomical_structure, Suture (anatomy), medicine, Orthopedics and Sports Medicine, Surgery, Femur, Tibia, Cadaveric spasm, Range of motion, business, human activities
الوصف: Anterior cruciate ligament (ACL) graft failure rate has been reported to be greater than 5% at 5 years. Our study evaluated ACL excursion with anatomic and nonanatomic femoral and tibial tunnels to determine optimal flexion angle to tension the ACL to minimize excursion. Ten cadaveric knee specimens were used. The ACL was sectioned and the femoral and tibial attachments were marked. A 1/16-inch drill created a tunnel in the center of the ACL footprint on the tibia and femur and additional tunnels were made 5 mm from this. A suture was passed through each tunnel combination and attached to a string potentiometer. The knee was ranged from full extension to 120 degrees of flexion for 10 cycles while mounted in a custom fixture. The change in length (excursion) of the suture during movement was recorded for each combination of femoral and tibial tunnels. Anatomic reconstruction of the ACL with tunnel placement in the center of the femoral and tibial footprint did not result in an isometric graft, with excursion of the ACL during knee motion of 7.46 mm (standard deviation [SD]: 2.7mm), greatest at 2.84 degrees of flexion (SD: 4.22). The tunnel combination that resulted in the least excursion was a femoral footprint 5 mm anterior to the femoral and 5 mm posterior to the tibial footprint (4. 2mm, SD: 1.37 mm). The tunnel combination that resulted in the most excursion utilized femoral footprint 5 mm proximal to the femoral and 5 mm posterior to the tibial footprint (9.81 mm, SD: 2.68 mm). Anatomic ACL reconstruction results in significant excursion of the ACL throughout motion. If not tensioned properly, the ACL can stretch during range of motion, potentially leading to rerupture. To prevent stretching of the graft, the current biomechanical study recommends tensioning an anatomic ACL reconstruction at its point of maximal excursion, or between 0 and 5 degrees of flexion. The level of evidence is IV.
تدمد: 1938-2480
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::5803b7513aa362352de1a0c647a2839f
https://pubmed.ncbi.nlm.nih.gov/34327694
رقم الانضمام: edsair.doi.dedup.....5803b7513aa362352de1a0c647a2839f
قاعدة البيانات: OpenAIRE