Journal article
No Difference in Knee Kinematics Between Anterior Cruciate Ligament-First and Posterior Cruciate Ligament-First Fixation During Single-Stage Multiligament Knee Reconstruction: A Biomechanical Study
Orthopaedic journal of sports medicine, Vol.10(9), p.23259671221118587
09/01/2022
DOI: 10.1177/23259671221118587
PMCID: PMC9523854
PMID: 36186708
Abstract
Background: For combined reconstruction of both the anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL), there is no consensus regarding which graft should be tensioned and fixed first. Purpose: The purpose of this study was to determine which sequence of graft tensioning and fixation better restores normal knee kinematics. The hypothesis was that ACL-first fixation would more closely restore normal knee kinematics, graft force, and the tibiofemoral orientation in the neutral (resting) position compared with PCL-first fixation. Study Design: Controlled laboratory study. Methods: A total of 15 unpaired human cadaveric knees were examined using a robotic testing system under the following 4 conditions: (1) 89.0-N anterior tibial load at different knee angles; (2) 89.0-N posterior tibial load at different knee angles; (3) combined rotational 7.0-N center dot m valgus and 5.0-N center dot m internal rotation load (simulated pivot shift) at 0 degrees, 15 degrees, and 30 degrees of flexion; and (4) 5.0-N center dot m external rotation load at 0 degrees, 15 degrees, and 30 degrees of flexion. The 4 evaluated knee states were (1) intact ACL and PCL (intact), (2) ACL and PCL deficient (deficient), (3) combined anatomic ACL-PCL reconstruction fixing the ACL first (ACL-first), and (4) combined anatomic ACL-PCL reconstruction fixing the PCL first (PCL-first). A 9.0 mm-diameter quadriceps tendon autograft was used for the ACL graft, tensioned with 40.0 N at 30 degrees of flexion. A 9.5 mm-diameter hamstring tendon autograft (gracilis and semitendinosus, quadrupled loop, and augmented with an additional allograft strand if needed), tensioned with 40.0 N at 90 degrees of flexion, was used for the PCL graft. Results: There were no statistically significant differences between ACL-first and PCL-first fixation regarding knee kinematics. ACL-first fixation restored anterior tibial translation to the intact state at all tested knee angles, while PCL-first fixation showed higher anterior tibial translation than the intact state at 90 degrees of flexion (9.05 +/- 3.05 and 5.87 +/- 2.40 mm, respectively; P = .018). Neither sequence restored posterior tibial translation to the intact state at 30 degrees, 60 degrees, and 90 degrees of flexion. At 15 degrees of flexion, PCL-first fixation restored posterior tibial translation to the intact state, whereas ACL-first fixation did not. Conclusion: There were no differences in knee laxity between ACL-first and PCL-first fixation with the ACL graft fixed at 30 degrees and the PCL graft fixed at 90 degrees.
Details
- Title: Subtitle
- No Difference in Knee Kinematics Between Anterior Cruciate Ligament-First and Posterior Cruciate Ligament-First Fixation During Single-Stage Multiligament Knee Reconstruction: A Biomechanical Study
- Creators
- Aly M. Fayed - University of PittsburghRyo Kanto - University of PittsburghTaylor M. Price - University of PittsburghMichael DiNenna - University of PittsburghMonica A. Linde - University of PittsburghPatrick Smolinski - University of PittsburghCarola van Eck - University of Pittsburgh
- Resource Type
- Journal article
- Publication Details
- Orthopaedic journal of sports medicine, Vol.10(9), p.23259671221118587
- DOI
- 10.1177/23259671221118587
- PMID
- 36186708
- PMCID
- PMC9523854
- NLM abbreviation
- Orthop J Sports Med
- ISSN
- 2325-9671
- eISSN
- 2325-9671
- Publisher
- Sage
- Number of pages
- 9
- Grant note
- Zimmer Biomet DJO Albert B. Ferguson Jr MD Orthopaedic Fund of the Pittsburgh Foundation
- Language
- English
- Date published
- 09/01/2022
- Academic Unit
- Orthopedics and Rehabilitation
- Record Identifier
- 9984949462602771
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