Restoring tibiofemoral alignment during ACL reconstruction results in better knee biomechanics

Knee Surg Sports Traumatol Arthrosc. 2018 May;26(5):1367-1374. doi: 10.1007/s00167-017-4742-0. Epub 2017 Oct 24.


Purpose: Anterior cruciate ligament (ACL) reconstruction (ACLR) aims to restore normal knee joint function, stability and biomechanics and in the long term avoid joint degeneration. The purpose of this study is to present the anatomic single bundle (SB) ACLR that emphasizes intraoperative correction of tibiofemoral subluxation that occurs after ACL injury. It was hypothesized that this technique leads to optimal outcomes and better restoration of pathological tibiofemoral joint movement that results from ACL deficiency (ACLD).

Methods: Thirteen men with unilateral ACLD were prospectively evaluated before and at a mean follow-up of 14.9 (SD = 1.8) months after anatomic SB ACLR with bone patellar tendon bone autograft. The anatomic ACLR replicated the native ACL attachment site anatomy and graft orientation. Emphasis was placed on intraoperative correction of tibiofemoral subluxation by reducing anterior tibial translation (ATT) and internal tibial rotation. Function was measured with IKDC, Lysholm and the Tegner activity scale, ATT was measured with the KT-1000 arthrometer and tibial rotation (TR) kinematics were measured with 3Dmotion analysis during a high-demand pivoting task.

Results: The results showed significantly higher TR of the ACL-deficient knee when compared to the intact knee prior to surgery (12.2° ± 3.7° and 10.7° ± 2.6° respectively, P = 0.014). Postoperatively, the ACLR knee showed significantly lower TR as compared to the ACL-deficient knee (9.6°±3.1°, P = 0.001) but no difference as compared to the control knee (n.s.). All functional scores were significantly improved and ATT was restored within normal values (P < 0.001).

Conclusions: Intraoperative correction of tibiofemoral subluxation that results after ACL injury is an important step during anatomic SB ACLR. The intraoperative correction of tibiofemoral subluxation along with the replication of native ACL anatomy results in restoration of rotational kinematics of ACLD patients to normal levels that are comparable to the control knee. These results indicate that the reestablishment of tibiofemoral alignment during ACLR may be an important step that facilitates normal knee kinematics postoperatively.

Level of evidence: Level II, prospective cohort study.

Keywords: ACL reconstruction; Anatomic ACL reconstruction; Anterior cruciate ligament; Biomechanics; Rotational kinematics; Single bundle; Tibiofemoral subluxation.

MeSH terms

  • Adolescent
  • Adult
  • Anterior Cruciate Ligament / physiopathology*
  • Anterior Cruciate Ligament / surgery
  • Anterior Cruciate Ligament Injuries / physiopathology
  • Anterior Cruciate Ligament Injuries / surgery*
  • Anterior Cruciate Ligament Reconstruction / methods*
  • Arthroscopy
  • Biomechanical Phenomena
  • Female
  • Follow-Up Studies
  • Humans
  • Imaging, Three-Dimensional
  • Intraoperative Period
  • Knee Joint / physiopathology*
  • Knee Joint / surgery
  • Lysholm Knee Score
  • Male
  • Prospective Studies
  • Range of Motion, Articular / physiology*
  • Time Factors
  • Young Adult