Forces in anterior cruciate ligament during simulated weight-bearing flexion with anterior and internal rotational tibial load.

This study determined in-vitro anterior cruciate ligament (ACL) force patterns and investigated the effect of external tibial loads on the ACL force patterns during simulated weight-bearing knee flexions. Nine human cadaveric knee specimens were mounted on a dynamic knee simulator, and weight-bearing knee flexions with a 100N of ground reaction force were simulated; while a robotic/universal force sensor (UFS) system was used to provide external tibial loads during the movement. Three external tibial loading conditions were simulated, including no external tibial load (termed BW only), a 50N anterior tibial force (ATF), and a 5Nm internal rotation tibial torque (ITT). The tibial and femoral kinematics was measured with an ultrasonic motion capture system. These movement paths were then accurately reproduced on a robotic testing system, and the in-situ force in the ACL was determined via the principle of superposition. The results showed that the ATF significantly increased the in-situ ACL force by up to 60% during 0-55 degrees of flexion, while the ITT did not. The magnitude of ACL forces decreased with increasing flexion angle for all loading conditions. The tibial anterior translation was not affected by the application of ATF, whereas the tibial internal rotation was significantly increased by the application of ITT. These data indicate that, in a weight-bearing knee flexion, ACL provides substantial resistance to the externally applied ATF but not to the ITT.

[1]  T W Rudy,et al.  In-situ force in the medial and lateral structures of intact and ACL-deficient knees , 2000, Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association.

[2]  Braden C. Fleming,et al.  Treatment of Anterior Cruciate Ligament Injuries, Part I , 2005, The American journal of sports medicine.

[3]  K. Shelbourne,et al.  Accelerated rehabilitation after anterior cruciate ligament reconstruction , 1990, The American journal of sports medicine.

[4]  C E Henning,et al.  An in vivo strain gage study of elongation of the anterior cruciate ligament , 1985, The American journal of sports medicine.

[5]  S Arai,et al.  The use of robotics technology to study human joint kinematics: a new methodology. , 1993, Journal of biomechanical engineering.

[6]  K. An,et al.  Comparison of tibiofemoral joint forces during open-kinetic-chain and closed-kinetic-chain exercises. , 1993, The Journal of bone and joint surgery. American volume.

[7]  F. Noyes,et al.  The symptomatic anterior cruciate deficient knee. , 1983 .

[8]  G A Livesay,et al.  A combined robotic/universal force sensor approach to determine in situ forces of knee ligaments. , 1996, Journal of biomechanics.

[9]  S. Woo,et al.  Tensile properties of the human femur-anterior cruciate ligament-tibia complex , 1991, The American journal of sports medicine.

[10]  Dale M. Daniel,et al.  The Anterior Cruciate Ligament in Controlling Axial Rotation , 1994, The American journal of sports medicine.

[11]  S. Woo,et al.  The forces in the anterior cruciate ligament and knee kinematics during a simulated pivot shift test: A human cadaveric study using robotic technology. , 2000, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[12]  R J Johnson,et al.  The Effect of Anterior Cruciate Ligament Graft Elongation at the Time of Implantation on the Biomechanical Behavior of the Graft and Knee , 1996, The American journal of sports medicine.

[13]  E Y Chao,et al.  Hamstrings cocontraction reduces internal rotation, anterior translation, and anterior cruciate ligament load in weight‐bearing flexion , 1999, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[14]  F. Noyes,et al.  The symptomatic anterior cruciate-deficient knee. Part II: the results of rehabilitation, activity modification, and counseling on functional disability. , 1983, The Journal of bone and joint surgery. American volume.

[15]  F. Noyes,et al.  The symptomatic anterior cruciate-deficient knee. Part I: the long-term functional disability in athletically active individuals. , 1983, The Journal of bone and joint surgery. American volume.

[16]  B. Fleming,et al.  Effect of knee musculature on anterior cruciate ligament strain in vivo. , 1991, Journal of electromyography and kinesiology : official journal of the International Society of Electrophysiological Kinesiology.

[17]  K. Kaneda,et al.  Mechanical properties of the anterior cruciate ligament chronically relaxed by elevation of the tibial insertion , 1996, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[18]  D. Dandy,et al.  Meniscal lesions and chronic anterior cruciate ligament deficiency. Meniscal tears occurring before and after reconstruction. , 1989, The Journal of bone and joint surgery. British volume.

[19]  Guoan Li,et al.  Comparison of the ACL and ACL graft forces before and after ACL reconstruction an in-vitro robotic investigation , 2006, Acta orthopaedica.

[20]  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.

[21]  Freddie H. Fu,et al.  Effect of knee flexion on the in situ force distribution in the human anterior cruciate ligament , 2005, Knee Surgery, Sports Traumatology, Arthroscopy.

[22]  N Zheng,et al.  Biomechanics of the knee during closed kinetic chain and open kinetic chain exercises. , 1998, Medicine and science in sports and exercise.

[23]  E Y Chao,et al.  Kinetic Chain Exercise in Knee Rehabilitation , 1991, Sports medicine.

[24]  S. Woo,et al.  The importance of quadriceps and hamstring muscle loading on knee kinematics and in-situ forces in the ACL. , 1999, Journal of biomechanics.

[25]  S L Woo,et al.  Hamstrings—an anterior cruciate ligament protagonist , 1993, The American journal of sports medicine.

[26]  Freddie H. Fu,et al.  In situ forces in the anterior cruciate ligament and its bundles in response to anterior tibial loads , 1997, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[27]  Poul Dyhre-Poulsen,et al.  The anterior cruciate ligament does play a role in controlling axial rotation in the knee , 1997, Knee Surgery, Sports Traumatology, Arthroscopy.

[28]  F. Noyes,et al.  Ligamentous restraints to anterior-posterior drawer in the human knee. A biomechanical study. , 1980, The Journal of bone and joint surgery. American volume.

[29]  J D Reuben,et al.  Three-dimensional dynamic motion analysis of the anterior cruciate ligament deficient knee joint , 1989, The American journal of sports medicine.

[30]  S L Woo,et al.  Quadriceps/anterior cruciate graft interaction. An in vitro study of joint kinematics and anterior cruciate ligament graft tension. , 1993, Clinical orthopaedics and related research.

[31]  R J Johnson,et al.  The Effect of Functional Knee Bracing on the Anterior Cruciate Ligament in the Weightbearing and Nonweightbearing Knee , 1997, The American journal of sports medicine.

[32]  R. Warren,et al.  An in vitro biomechanical evaluation of anterior-posterior motion of the knee. Tibial displacement, rotation, and torque. , 1982, The Journal of bone and joint surgery. American volume.

[33]  M. Pandy,et al.  Determinants of cruciate-ligament loading during rehabilitation exercise. , 1998, Clinical biomechanics.

[34]  A Leardini,et al.  Cruciate ligament forces in the human knee during rehabilitation exercises. , 2000, Clinical biomechanics.