Dynamic Function of the ACL-reconstructed Knee during Running

Little is known about the three-dimensional behavior of the anterior cruciate ligament (ACL) reconstructed knee during dynamic, functional loading, or how dynamic knee function changes over time in the reconstructed knee. We hypothesized dynamic, in vivo function of the ACL-reconstructed knee is different from the contralateral, uninjured knee and changes over time. We measured knee kinematics for 16 subjects during downhill running 5 and 12 months after ACL reconstruction (bone-patellar tendon-bone or quadrupled hamstring tendon with interference screw fixation) using a 250 frame per second stereoradiographic system. We used repeated-measures ANOVA to ascertain whether there were differences between the uninjured and reconstructed limbs and over time. We found no differences in anterior tibial translation between limbs, but reconstructed knees were more externally rotated and in more adduction (varus) during the stance phase of running. Anterior tibial translation increased from 5 to 12 months after surgery in the reconstructed knees. Anterior cruciate ligament reconstruction failed to restore normal rotational knee kinematics during dynamic, functional loading and some degradation of graft function occurred over time. These abnormal motions may contribute to long-term joint degeneration associated with ACL injury and reconstruction.

[1]  G. Nuki,et al.  Experimentally-induced osteoarthritis in the dog. , 1973, Annals of the rheumatic diseases.

[2]  The so-called "isolated" anterior cruciate ligament tear or anterior cruciate ligament syndrome: a report of 32 cases with some observation on treatment and its effect on results , 1978, The American journal of sports medicine.

[3]  J. L. Marshall,et al.  The natural history and diagnosis of anterior cruciate ligament insufficiency. , 1980, Clinical orthopaedics and related research.

[4]  C. Spoor,et al.  Rigid body motion calculated from spatial co-ordinates of markers. , 1980, Journal of biomechanics.

[5]  E S Grood,et al.  A joint coordinate system for the clinical description of three-dimensional motions: application to the knee. , 1983, Journal of biomechanical engineering.

[6]  R. Greenberg,et al.  Measurement of anterior-posterior motion of the knee in injured patients using a biomechanical stress technique. , 1984, The Journal of bone and joint surgery. American volume.

[7]  K. Markolf,et al.  Measurement of knee stiffness and laxity in patients with documented absence of the anterior cruciate ligament. , 1984, The Journal of bone and joint surgery. American volume.

[8]  F. Noyes,et al.  Biomechanical analysis of human ligament grafts used in knee-ligament repairs and reconstructions. , 1984, The Journal of bone and joint surgery. American volume.

[9]  K. Oates,et al.  Low temperature and conventional scanning electron microscopic observations of dog femoral condylar cartilage surface after anterior cruciate ligament division. , 1985, Annals of the rheumatic diseases.

[10]  K. Shino,et al.  Measurement of anterior instability of the knee. A new apparatus for clinical testing. , 1987, The Journal of bone and joint surgery. British volume.

[11]  J M Medeiros,et al.  Assessment of quadriceps/hamstring strength, knee ligament stability, functional and sports activity levels five years after anterior cruciate ligament reconstruction , 1988, The American journal of sports medicine.

[12]  P. Scranton.  The Crucial Ligaments. Diagnosis and Treatment of Ligamentous Injuries About the Knee. , 1988 .

[13]  G Selvik,et al.  Three-dimensional instability of the anterior cruciate deficient knee. , 1988, The Journal of bone and joint surgery. British volume.

[14]  K. M. Singer,et al.  Long-term evaluation of knee stability and function following surgical reconstruction for anterior cruciate ligament insufficiency , 1988, The American journal of sports medicine.

[15]  J Kärrholm,et al.  Roentgen stereophotogrammetry. Review of orthopedic applications. , 1989, Acta orthopaedica Scandinavica.

[16]  F R Noyes,et al.  A rationale for assessing sports activity levels and limitations in knee disorders. , 1989, Clinical orthopaedics and related research.

[17]  S. Woo,et al.  Use of patellar tendon autograft for anterior cruciate ligament reconstruction in the rabbit: A long‐term histologic and biomechanical study , 1989, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[18]  Göran Selvik,et al.  Chronic anterolateral instability of the knee , 1989, The American journal of sports medicine.

[19]  F R Noyes,et al.  Quantitative assessment of functional limitations in normal and anterior cruciate ligament-deficient knees. , 1990, Clinical orthopaedics and related research.

[20]  G Selvik,et al.  Roentgen Stereophotogrammetric Analysis , 1990, Acta radiologica.

[21]  Scott E. Maxwell,et al.  Designing Experiments and Analyzing Data , 1991 .

[22]  K. Brandt,et al.  Osteoarthritic changes in canine articular cartilage, subchondral bone, and synovium fifty-four months after transection of the anterior cruciate ligament. , 2010, Arthritis and rheumatism.

[23]  Scott E. Maxwell,et al.  Designing Experiments and Analyzing Data , 1992 .

[24]  M. Cross,et al.  Acute repair of injury to the anterior cruciate ligament , 1993, The American journal of sports medicine.

[25]  K. Benedetto,et al.  [Development of arthrosis after rupture of the anterior cruciate ligament. A comparison of surgical and conservative therapy]. , 1994, Der Unfallchirurg.

[26]  J. Feagin,et al.  The Crucial Ligaments: Diagnosis and Treatment of Ligamentous Injuries About the Knee, Edition 2 , 1995 .

[27]  G A Wood,et al.  1994 Nicola Cerulli Young Researchers Award. Downhill walking: a stressful task for the anterior cruciate ligament? A biomechanical study with clinical implications. , 1994, Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA.

[28]  L. Snyder-Mackler,et al.  Fate of the ACL-injured patient: a prospective outcome study. , 1995, The American journal of sports medicine.

[29]  S. Arnoczky.  Biology of ACL reconstructions: what happens to the graft? , 1996, Instructional course lectures.

[30]  A. J. van den Bogert,et al.  Effect of skin movement on the analysis of skeletal knee joint motion during running. , 1997, Journal of biomechanics.

[31]  U.D. Croce,et al.  Surface-marker cluster design criteria for 3-D bone movement reconstruction , 1997, IEEE Transactions on Biomedical Engineering.

[32]  L. Snyder-Mackler,et al.  The Relationship Between Passive Joint Laxity and Functional Outcome After Anterior Cruciate Ligament Injury , 1997, The American journal of sports medicine.

[33]  F E Zajac,et al.  Using cine phase contrast magnetic resonance imaging to non-invasively study in vivo knee dynamics. , 1997, Journal of biomechanics.

[34]  Jayaram K. Udupa,et al.  A new in vivo technique for three-dimensional shoulder kinematics analysis , 1998, Skeletal Radiology.

[35]  K. Messner,et al.  Anterior Cruciate Ligament Reconstruction and the Long Term Incidence of Gonarthrosis , 1999, Sports medicine.

[36]  W E Nordt,et al.  The In Vivo Assessment of Tibial Motion in the Transverse Plane in Anterior Cruciate Ligament-Reconstructed Knees , 1999, The American journal of sports medicine.

[37]  T P Andriacchi,et al.  Correcting for deformation in skin-based marker systems. , 2001, Journal of biomechanics.

[38]  Leena Sharma,et al.  The influence of alignment on risk of knee osteoarthritis progression according to baseline stage of disease. , 2002, Arthritis and rheumatism.

[39]  Johan Kärrholm,et al.  Kinematics and Laxity of the Knee Joint after Anterior Cruciate Ligament Reconstruction , 2002, The American journal of sports medicine.

[40]  Scott A. Banks,et al.  Weight-bearing knee kinematics in subjects with two types of anterior cruciate ligament reconstructions , 2002, Knee Surgery, Sports Traumatology, Arthroscopy.

[41]  Braden C. Fleming,et al.  Anterior Cruciate Ligament Replacement: Comparison of Bone-Patellar Tendon-Bone Grafts with Two-Strand Hamstring Grafts A Prospective, Randomized Study , 2002, The Journal of bone and joint surgery. American volume.

[42]  Scott Tashman,et al.  A method to estimate in vivo dynamic articular surface interaction. , 2003, Journal of biomechanics.

[43]  Scott Tashman,et al.  In-vivo measurement of dynamic joint motion using high speed biplane radiography and CT: application to canine ACL deficiency. , 2003, Journal of biomechanical engineering.

[44]  N. Stergiou,et al.  Three-Dimensional Tibiofemoral Kinematics of the Anterior Cruciate Ligament-Deficient and Reconstructed Knee during Walking * , 2003, The American journal of sports medicine.

[45]  H. Gill,et al.  In vivo kinematics of the ACL-deficient limb during running and cutting , 2005, Knee Surgery, Sports Traumatology, Arthroscopy.

[46]  E. Roos,et al.  High prevalence of osteoarthritis 14 years after an anterior cruciate ligament tear in male soccer players: a study of radiographic and patient relevant outcomes , 2004, Annals of the rheumatic diseases.

[47]  Seungbum Koo,et al.  A Framework for the in Vivo Pathomechanics of Osteoarthritis at the Knee , 2004, Annals of Biomedical Engineering.

[48]  M. Englund,et al.  High prevalence of knee osteoarthritis, pain, and functional limitations in female soccer players twelve years after anterior cruciate ligament injury. , 2004, Arthritis and rheumatism.

[49]  F. Handelberg,et al.  The role of the Rolimeter in quantifying knee instability compared to the functional outcome of ACL-reconstructed versus conservatively-treated knees , 2004, Knee Surgery, Sports Traumatology, Arthroscopy.

[50]  Scott Tashman,et al.  Abnormal Rotational Knee Motion during Running after Anterior Cruciate Ligament Reconstruction , 2004, The American journal of sports medicine.

[51]  Angelo Cappello,et al.  Quantification of soft tissue artefact in motion analysis by combining 3D fluoroscopy and stereophotogrammetry: a study on two subjects. , 2005, Clinical biomechanics.

[52]  T. Andriacchi,et al.  Interactions between kinematics and loading during walking for the normal and ACL deficient knee. , 2005, Journal of biomechanics.

[53]  G. Blatter,et al.  Downhill walking: A stressful task for the anterior cruciate ligament? , 1994, Knee Surgery, Sports Traumatology, Arthroscopy.