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, 38 (7), 1475-82

Kinematics of the Anterior Cruciate Ligament During Gait

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Kinematics of the Anterior Cruciate Ligament During Gait

Jia-Lin Wu et al. Am J Sports Med.

Abstract

Background: The function of the anteromedial (AM) and posterolateral (PL) bundles of the anterior cruciate ligament (ACL) during gait has not been reported.

Hypothesis: The AM and PL bundles have distinct functional behavior during the stance phase of treadmill gait.

Study design: Descriptive laboratory study.

Methods: Three-dimensional models of the knee were created by magnetic resonance images from 8 healthy subjects. The contour of the 2 bundle attachments were constructed on each model. Each bundle was represented by a straight line connecting its tibial and femoral attachment centroids. Next, the knee kinematics during the stance phase of gait was determined with a dual fluoroscopic imaging system. The relative elongation, sagittal plane elevation, coronal plane elevation, and transverse plane deviation of the 2 bundles were measured directly from heel strike to toe-off.

Results: At heel strike, the AM and PL bundles had first peak elongation of 9% +/- 7% and 9% +/- 13%, respectively. At 50% progress of the stance phase, both bundles were maximally elongated, 12% +/- 7% for the AM bundle and 13% +/- 15% for the PL bundle. No significant difference was found for each bundle between 40% and 60% of the stance phase (P > .05). With increasing knee flexion, the sagittal plane and coronal plane elevations of the 2 bundles decreased, whereas the deviation angles increased.

Conclusion: Both bundles are anisometric and function in a similar manner during the stance phase of gait. They were maximally elongated throughout the midstance where they were stretched maximally to resist anterior tibial translation.

Clinical relevance: This information can be useful for further improving anatomical ACL reconstructions to better reproduce the 2 bundle functions. It may also be useful for designing postoperative rehabilitation regimens to prevent overstretch of the grafts.

Conflict of interest statement

One or more authors has declared a potential conflict of interest:

Figures

Figure 1
Figure 1
Sagittal and coronal plane magnetic resonance images of the knee were digitized and used to create the femoral and tibial attachment areas of the ACL bundles.
Figure 2
Figure 2
The 3-dimensional anatomical model of the knee including ACL attachment areas was created. The attachment areas were divided into 2 functional bundles using an established protocol.
Figure 3
Figure 3
The orientation of each bundle was described using 3 angles: sagittal plane elevation, coronal plane elevation, and transverse plane deviation. The sagittal plane elevation angle (α) was defined as the angle between each bundle projected onto the sagittal plane of the tibia and the anteroposterior axis. The coronal plane elevation angle (β) was defined as the angle between the bundles projected onto the coronal plane of the tibia and the mediolateral axis of the coordinate system. The deviation angle (θ) was defined as the angle between the projection of each bundle on the tibial plateau and the AP axis.
Figure 4
Figure 4
The relative elongation of the anteromedial and pos-terolateral bundles from heel strike to toe-off during the stance phase of gait. *, P < .05; HS, heel strike; CTO, contralateral toe-off; HR, heel rise; CHS, contralateral heel strike; TO, toe-off.
Figure 5
Figure 5
Relationship between relative elongation of the anteromedial bundle and the knee flexion angle during stance phase of gait. AMB, anteromedial bundle.
Figure 6
Figure 6
Relationship between relative elongation of the posterolateral bundle and the knee flexion angle during stance phase of gait. PLB, posterolateral bundle.
Figure 7
Figure 7
The sagittal plane elevation (A), coronal plane elevation (B), and transverse plane deviation (C) of the ante-romedial and posterolateral bundles from heel strike to toe-off during the stance phase of gait. *, P < .05.

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