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Review
, 27 (2), 69-75

Kinematic Analysis of Five Different Anterior Cruciate Ligament Reconstruction Techniques

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Review

Kinematic Analysis of Five Different Anterior Cruciate Ligament Reconstruction Techniques

Hemanth R Gadikota et al. Knee Surg Relat Res.

Abstract

Several anatomical anterior cruciate ligament (ACL) reconstruction techniques have been proposed to restore normal joint kinematics. However, the relative superiorities of these techniques with one another and traditional single-bundle reconstructions are unclear. Kinematic responses of five previously reported reconstruction techniques (single-bundle reconstruction using a bone-patellar tendon-bone graft [SBR-BPTB], single-bundle reconstruction using a hamstring tendon graft [SBR-HST], single-tunnel double-bundle reconstruction using a hamstring tendon graft [STDBR-HST], anatomical single-tunnel reconstruction using a hamstring tendon graft [ASTR-HST], and a double-tunnel double-bundle reconstruction using a hamstring tendon graft [DBR-HST]) were systematically analyzed. The knee kinematics were determined under anterior tibial load (134 N) and simulated quadriceps load (400 N) at 0°, 15°, 30°, 60°, and 90° of flexion using a robotic testing system. Anterior joint stability under anterior tibial load was qualified as normal for ASTR-HST and DBR-HST and nearly normal for SBR-BPTB, SBR-HST, and STDBR-HST as per the International Knee Documentation Committee knee examination form categorization. The analysis of this study also demonstrated that SBR-BPTB, STDBR-HST, ASTR-HST, and DBR-HST restored the anterior joint stability to normal condition while the SBR-HST resulted in a nearly normal anterior joint stability under the action of simulated quadriceps load. The medial-lateral translations were restored to normal level by all the reconstructions. The internal tibial rotations under the simulated muscle load were over-constrained by all the reconstruction techniques, and more so by the DBR-HST. All five ACL reconstruction techniques could provide either normal or nearly normal anterior joint stability; however, the techniques over-constrained internal tibial rotation under the simulated quadriceps load.

Keywords: Anatomical reconstruction; Anterior cruciate ligament; Knee kinematics; Robotic testing system; Single-bundle.

Conflict of interest statement

Conflict of Interest: No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1. The difference in anterior-posterior tibial translation between the intact knee and five anterior cruciate ligament (ACL) reconstructions under an anterior tibial load (134 N). Error bars represent standard deviations. SBR-BPTB: single-bundle reconstruction using a bone-patellar tendon-bone graft, SBR-HST: single-bundle reconstruction using a hamstring tendon graft, STDBR-HST: single-tunnel double-bundle reconstruction using a hamstring tendon graft, ASTR-HST: anatomical single-tunnel reconstruction using a hamstring tendon graft, DBR-HST: double-tunnel double-bundle reconstruction using a hamstring tendon graft.
*p<0.05; significantly different compared to ACL intact knee.
Fig. 2
Fig. 2. The difference in anterior-posterior tibial translation between the intact knee and five anterior cruciate ligament (ACL) reconstructions under simulated quadriceps load (400 N). Error bars represent standard deviations. SBR-BPTB: single-bundle reconstruction using a bone-patellar tendon-bone graft, SBR-HST: single-bundle reconstruction using a hamstring tendon graft, STDBR-HST: single-tunnel double-bundle reconstruction using a hamstring tendon graft, ASTR-HST: anatomical single-tunnel reconstruction using a hamstring tendon graft, DBR-HST: double-tunnel double-bundle reconstruction using a hamstring tendon graft.
*p<0.05; significantly different compared to ACL intact knee.
Fig. 3
Fig. 3. The difference in medial-lateral tibial translation between the intact knee and five anterior cruciate ligament (ACL) reconstructions under simulated quadriceps load (400 N). Error bars represent standard deviations. SBR-BPTB: single-bundle reconstruction using a bone-patellar tendon-bone graft, SBR-HST: single-bundle reconstruction using a hamstring tendon graft, STDBR-HST: single-tunnel double-bundle reconstruction using a hamstring tendon graft, ASTR-HST: anatomical single-tunnel reconstruction using a hamstring tendon graft, DBR-HST: double-tunnel double-bundle reconstruction using a hamstring tendon graft.
*p<0.05; significantly different compared to ACL intact knee.
Fig. 4
Fig. 4. The difference in internal-external tibial rotations between the intact knee and five anterior cruciate ligament (ACL) reconstructions under simulated quadriceps load (400 N). Error bars represent standard deviations. SBR-BPTB: single-bundle reconstruction using a bone-patellar tendon-bone graft, SBR-HST: single-bundle reconstruction using a hamstring tendon graft, STDBR-HST: single-tunnel double-bundle reconstruction using a hamstring tendon graft, ASTR-HST: anatomical single-tunnel reconstruction using a hamstring tendon graft, DBR-HST: double-tunnel double-bundle reconstruction using a hamstring tendon graft.
*p<0.05; significantly different compared to ACL intact knee.

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