Influence of Bundle Diameter and Attachment Point on Kinematic Behavior in Double Bundle Anterior Cruciate Ligament Reconstruction Using Computational Model

A protocol to choose the graft diameter attachment point of each bundle has not yet been determined since they are usually dependent on a surgeon's preference. Therefore, the influence of bundle diameters and attachment points on the kinematics of the knee joint needs to be quantitatively analyzed. A three-dimensional knee model was reconstructed with computed tomography images of a 26-year-old man. Based on the model, models of double bundle anterior cruciate ligament (ACL) reconstruction were developed. The anterior tibial translations for the anterior drawer test and the internal tibial rotation for the pivot shift test were investigated according to variation of bundle diameters and attachment points. For the model in this study, the knee kinematics after the double bundle ACL reconstruction were dependent on the attachment point and not much influenced by the bundle diameter although larger sized anterior-medial bundles provided increased stability in the knee joint. Therefore, in the clinical setting, the bundle attachment point needs to be considered prior to the bundle diameter, and the current selection method of graft diameters for both bundles appears justified.

[1]  Dragan Savic,et al.  Anatomic reconstruction of the anteromedial and posterolateral bundles of the anterior cruciate ligament using hamstring tendon grafts. , 2005, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[2]  S. Woo,et al.  Determination of the In Situ Forces in the Human Posterior Cruciate Ligament Using Robotic Technology , 1998, The American journal of sports medicine.

[3]  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.

[4]  T. Guess,et al.  A subject specific multibody model of the knee with menisci. , 2010, Medical engineering & physics.

[5]  Kevin A. Dodd,et al.  Computational Knee Ligament Modeling Using Experimentally Determined Zero-Load Lengths , 2012, The open biomedical engineering journal.

[6]  T. Zantop,et al.  Double-bundle reconstruction cannot restore intact knee kinematics in the ACL/LCL-deficient knee , 2010, Archives of Orthopaedic and Trauma Surgery.

[7]  H. Yoshikawa,et al.  Single- versus two-femoral socket anterior cruciate ligament reconstruction technique: Biomechanical analysis using a robotic simulator. , 2001, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[8]  Harry E Rubash,et al.  The cartilage thickness distribution in the tibiofemoral joint and its correlation with cartilage-to-cartilage contact. , 2005, Clinical biomechanics.

[9]  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.

[10]  Yoon-Hyuk Kim,et al.  Contribution of posterolateral corner structures to knee joint translational and rotational stabilities: A computational study , 2013, Proceedings of the Institution of Mechanical Engineers. Part H, Journal of engineering in medicine.

[11]  H. Grootenboer,et al.  Articular contact in a three-dimensional model of the knee. , 1991, Journal of Biomechanics.

[12]  S L Woo,et al.  A validated three-dimensional computational model of a human knee joint. , 1999, Journal of biomechanical engineering.

[13]  Trent M. Guess,et al.  Forward dynamics simulation using a natural knee with menisci in the multibody framework , 2012 .

[14]  Kenji Hara,et al.  A prospective randomized study of 4-strand semitendinosus tendon anterior cruciate ligament reconstruction comparing single-bundle and double-bundle techniques. , 2007, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[15]  Kenji Hara,et al.  Anatomy of Normal Human Anterior Cruciate Ligament Attachments Evaluated by Divided Small Bundles , 2009, The American journal of sports medicine.

[16]  Thore Zantop,et al.  Rotational instability of the knee: internal tibial rotation under a simulated pivot shift test , 2009, Archives of Orthopaedic and Trauma Surgery.

[17]  M. Mullaney,et al.  A Prospectively Randomized Double-Blind Study on the Effect of Initial Graft Tension on Knee Stability after Anterior Cruciate Ligament Reconstruction , 2004, The American journal of sports medicine.

[18]  M. Strobel,et al.  Joint kinematics and in situ forces after single bundle PCL reconstruction: a graft placed at the center of the femoral attachment does not restore normal posterior laxity , 2006, Archives of Orthopaedic and Trauma Surgery.

[19]  R. LaPrade,et al.  Mechanical Properties of the Posterolateral Structures of the Knee , 2005, The American journal of sports medicine.

[20]  L Blankevoort,et al.  Recruitment of knee joint ligaments. , 1991, Journal of biomechanical engineering.

[21]  Freddie H. Fu,et al.  Anatomy of the anterior cruciate ligament double bundle structure: a macroscopic evaluation , 2006, Scandinavian journal of medicine & science in sports.

[22]  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.

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

[24]  F. Noyes,et al.  Human Meniscus Allografts’ in Vivo Size and Motion Characteristics , 2006, The American journal of sports medicine.

[25]  Yuji Yamamoto,et al.  Knee Stability and Graft Function after Anterior Cruciate Ligament Reconstruction , 2004, The American journal of sports medicine.

[26]  Thomas P Andriacchi,et al.  The influence of deceleration forces on ACL strain during single-leg landing: a simulation study. , 2007, Journal of biomechanics.

[27]  E. Abdel-Rahman,et al.  Three-dimensional dynamic behaviour of the human knee joint under impact loading. , 1998, Medical engineering & physics.

[28]  A. K. Aune,et al.  Four-Strand Hamstring Tendon Autograft Compared with Patellar Tendon-Bone Autograft for Anterior Cruciate Ligament Reconstruction , 2001, The American journal of sports medicine.

[29]  L. Engebretsen,et al.  The Posterolateral Attachments of the Knee , 2003, The American journal of sports medicine.