The effect of anterior cruciate ligament graft rotation on knee biomechanics

Knee Surg Sports Traumatol Arthrosc. 2017 Apr;25(4):1093-1100. doi: 10.1007/s00167-016-4381-x. Epub 2016 Nov 17.


Purpose: The purpose of this study was to evaluate the effects on knee biomechanics of rotating the distal end of the bone-patellar tendon graft 90° in anatomic single-bundle (SB) anterior cruciate ligament (ACL) reconstruction with a porcine model.

Methods: Twenty (n = 20) porcine knees were evaluated using a robotic testing system. Two groups and three knee states were compared: (1) intact ACL, (2) deficient ACL and (3) anatomic SB ACL reconstruction with (a) non-rotated graft or (b) rotated graft (anatomic external fibre rotation). Anterior tibial translation (ATT), internal (IR) and external rotation (ER) and the in situ tissue force were measured under an 89-N anterior tibial (AT) load and 4-N m internal and external tibial torques.

Results: A significant difference from the intact ACL was found in ATT at 60° and 90° of knee flexion for rotated and non-rotated graft reconstructions (p < 0.05). There was a significant difference in the in situ force from the intact ACL with AT loading for rotated and non-rotated graft reconstructions at 60° and 90° of knee flexion (p < 0.05). Under IR loading, the in situ force was significantly different from the intact ACL at 30° and 60° of knee flexion for rotated and non-rotated graft reconstructions (p < 0.05). There were no significant differences in ATT, IR, ER and the in situ force between rotated and non-rotated reconstructions.

Conclusion: Graft rotation can be used with anatomic SB ACL reconstruction and not have a deleterious effect on knee anterior and rotational biomechanics. This study has clinical relevance in regard to the use of graft rotation to better reproduce the native ACL fibre orientation in ACL reconstruction.

Keywords: ACL reconstruction; Graft rotation; Porcine.

MeSH terms

  • Animals
  • Anterior Cruciate Ligament Reconstruction / methods*
  • Arthroscopy
  • Biomechanical Phenomena / physiology
  • Bone-Patellar Tendon-Bone Grafting / methods*
  • Rotation
  • Stifle / physiology*
  • Swine