Evaluation of rotational instability in the anterior cruciate ligament deficient knee using triaxial accelerometer: a biomechanical model in porcine knees

PurposeTo measure the acceleration in multiple directions of the rotational instability in ACL deficient models using porcine knees.MethodsTen porcine knees were tested with ACL intact and tear models. The pivot shift test was performed manually, and the acceleration of the pivot shift phenomenon was recorded by the use of a triaxial accelerometer. Tests were repeated in four different ACL states: (1) intact; (2) partial AM deficient; (3) complete AM deficient, and (4) complete ACL (AM and PL) deficient. The acceleration in three directions and the magnitude of acceleration were measured to evaluate rotational instability and compare between different ACL conditions.ResultsSignificantly increased accelerations were observed in the complete deficient ACL model, while the partial ACL tear models demonstrated a slight increase without statistical significance. The accelerometer detected stepwise increases in the acceleration with the extent of ACL tear. Additionally, the PL bundle exhibited the largest contribution for rotational instability (80.4%) when compared with the AM (19.5%) bundles.ConclusionTriaxial accelerometer could serve as a quantitative evaluation of rotational instability. The present study demonstrated that PL bundle has the most important contribution for rotational instability (80.4%) when compared to IM bundle (0.01%) and AM bundle (19.5%) in porcine knee model.

[1]  H. Matsumoto Mechanism of the pivot shift. , 1990, The Journal of bone and joint surgery. British volume.

[2]  Freddie H Fu,et al.  Three-portal technique for anterior cruciate ligament reconstruction: use of a central medial portal. , 2007, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[3]  J. Andrews,et al.  Classification of knee ligament instabilities. Part I. The medial compartment and cruciate ligaments. , 1976, The Journal of bone and joint surgery. American volume.

[4]  S. Woo,et al.  Biomechanical evaluation of using one hamstrings tendon for ACL reconstruction: a human cadaveric study , 2009, Knee Surgery, Sports Traumatology, Arthroscopy.

[5]  F. Giron,et al.  Comparison between Single- and Double-Bundle Anterior Cruciate Ligament Reconstruction , 2010, The American journal of sports medicine.

[6]  A A Amis,et al.  Intraoperative measurement of knee kinematics in reconstruction of the anterior cruciate ligament. , 2002, The Journal of bone and joint surgery. British volume.

[7]  T. A. Blackburn,et al.  Classification of knee ligament instabilities. , 1980, Physical therapy.

[8]  R. E. Losee,et al.  Concepts of the pivot shift. , 1983, Clinical orthopaedics and related research.

[9]  William I. Sterett,et al.  Relationships between Objective Assessment of Ligament Stability and Subjective Assessment of Symptoms and Function after Anterior Cruciate Ligament Reconstruction , 2004, The American journal of sports medicine.

[10]  P. Jokl,et al.  Implications of the Pivot Shift in the ACL-Deficient Knee , 2005, Clinical orthopaedics and related research.

[11]  Shigeaki Moriyama,et al.  Evaluation of dynamic instability of the dysplastic hip with use of triaxial accelerometry. , 2008, The Journal of bone and joint surgery. American volume.

[12]  Freddie H. Fu,et al.  Biomechanical Analysis of an Anatomic Anterior Cruciate Ligament Reconstruction , 2002, The American journal of sports medicine.

[13]  G. Brüggemann,et al.  Tension degradation of anterior cruciate ligament grafts with dynamic flexion-extension loading: a biomechanical model in porcine knees. , 2009, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[14]  Galway Hr,et al.  The lateral pivot shift: a symptom and sign of anterior cruciate ligament insufficiency. , 1980 .

[15]  A. Amis,et al.  Functional anatomy of the anterior cruciate ligament. Fibre bundle actions related to ligament replacements and injuries. , 1991, The Journal of bone and joint surgery. British volume.

[16]  A. Maeyama,et al.  Periacetabular osteotomy reduces the dynamic instability of dysplastic hips. , 2009, The Journal of bone and joint surgery. British volume.

[17]  Stefano Zaffagnini,et al.  Pivot‐shift test: Analysis and quantification of knee laxity parameters using a navigation system , 2009, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[18]  Freddie H. Fu,et al.  The effect of anterior cruciate ligament graft fixation site at the tibia on knee stability: evaluation using a robotic testing system. , 1997, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[19]  Makoto Hashizume,et al.  Quantitative Assessment of Rotatory Instability after Anterior Cruciate Ligament Reconstruction , 2009, The American journal of sports medicine.

[20]  A. Amis,et al.  Incidence and mechanism of the pivot shift. An in vitro study. , 1999, Clinical orthopaedics and related research.

[21]  J. Lysholm,et al.  The long-term course after treatment of acute anterior cruciate ligament ruptures , 1991, The American journal of sports medicine.

[22]  Freddie H. Fu,et al.  Effect of tunnel position for anatomic single-bundle ACL reconstruction on knee biomechanics in a porcine model , 2009, Knee Surgery, Sports Traumatology, Arthroscopy.

[23]  Kouki Nagamune,et al.  In Vivo Measurement of the Pivot-Shift Test in the Anterior Cruciate Ligament—Deficient Knee Using an Electromagnetic Device , 2007, The American journal of sports medicine.

[24]  Mary T. Gabriel,et al.  Distribution of in situ forces in the anterior cruciate ligament in response to rotatory loads , 2004, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[25]  Tomonori Yagi,et al.  Prospective Clinical Comparisons of Anatomic Double-Bundle versus Single-Bundle Anterior Cruciate Ligament Reconstruction Procedures in 328 Consecutive Patients , 2008, The American journal of sports medicine.

[26]  E S Grood,et al.  An analysis of the pivot shift phenomenon , 1991, The American journal of sports medicine.

[27]  Freddie H. Fu,et al.  Intercondylar roof impingement pressure after anterior cruciate ligament reconstruction in a porcine model , 2009, Knee Surgery, Sports Traumatology, Arthroscopy.

[28]  Thore Zantop,et al.  Anterolateral rotational knee instability: role of posterolateral structures , 2007, Archives of Orthopaedic and Trauma Surgery.

[29]  J. L. Marshall,et al.  Injury to the anterior cruciate ligament producing the pivot-shift sign. , 1979, The Journal of bone and joint surgery. American volume.

[30]  Andrew A. Amis,et al.  The pivot-shift phenomenon: a clinical and biomechanical perspective , 1998 .

[31]  Freddie H. Fu,et al.  Primary Anatomic Double-Bundle Anterior Cruciate Ligament Reconstruction , 2008, The American journal of sports medicine.

[32]  Daniel Kendoff,et al.  In vivo analysis of the pivot shift phenomenon during computer navigated ACL reconstruction , 2008, Knee Surgery, Sports Traumatology, Arthroscopy.

[33]  Freddie H. Fu,et al.  Clinical relevance of static and dynamic tests after anatomical double-bundle ACL reconstruction , 2009, Knee Surgery, Sports Traumatology, Arthroscopy.

[34]  V. Musahl,et al.  Lateral compartment translation predicts the grade of pivot shift: a cadaveric and clinical analysis , 2010, Knee Surgery, Sports Traumatology, Arthroscopy.

[35]  K. M. Singer,et al.  Clinical test for anterolateral rotary instability of the knee. , 1976, Clinical orthopaedics and related research.