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, 8 (11), 509-517
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The Anterolateral Ligament Is a Secondary Stabilizer in the Knee Joint: A Validated Computational Model of the Biomechanical Effects of a Deficient Anterior Cruciate Ligament and Anterolateral Ligament on Knee Joint Kinematics

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The Anterolateral Ligament Is a Secondary Stabilizer in the Knee Joint: A Validated Computational Model of the Biomechanical Effects of a Deficient Anterior Cruciate Ligament and Anterolateral Ligament on Knee Joint Kinematics

Kyoung-Tak Kang et al. Bone Joint Res.

Abstract

Objectives: The aim of this study was to investigate the biomechanical effect of the anterolateral ligament (ALL), anterior cruciate ligament (ACL), or both ALL and ACL on kinematics under dynamic loading conditions using dynamic simulation subject-specific knee models.

Methods: Five subject-specific musculoskeletal models were validated with computationally predicted muscle activation, electromyography data, and previous experimental data to analyze effects of the ALL and ACL on knee kinematics under gait and squat loading conditions.

Results: Anterior translation (AT) significantly increased with deficiency of the ACL, ALL, or both structures under gait cycle loading. Internal rotation (IR) significantly increased with deficiency of both the ACL and ALL under gait and squat loading conditions. However, the deficiency of ALL was not significant in the increase of AT, but it was significant in the increase of IR under the squat loading condition.

Conclusion: The results of this study confirm that the ALL is an important lateral knee structure for knee joint stability. The ALL is a secondary stabilizer relative to the ACL under simulated gait and squat loading conditions.Cite this article: Bone Joint Res 2019;8:509-517.

Keywords: Anterior cruciate ligament; Anterolateral ligament; Computational analysis.

Figures

Fig. 1
Fig. 1
Schematic of subject-specific musculoskeletal models during a) gait and b) squat loading conditions.
Fig. 2
Fig. 2
Schematic of subject-specific musculoskeletal model during gait and squat conditions with contact conditions and 21 ligament bundles: anteromedial bundle (aACL) and posterolateral bundle (pACL) of the anterior cruciate ligament; anterolateral bundle (aPCL) and posteromedial bundle of the posterior cruciate ligament (pPCL); anterolateral ligament (ALL); lateral collateral ligament (LCL); popliteofibular ligament (PFL); anterior portion (aMCL), central portion (cMCL), and posterior portion (pMCL) of the medial collateral ligament; anterior portion (aCM) and posterior portion (pCM) of the deep medial collateral ligament; medial (mCAP) and lateral (lCAP) posterior capsules; oblique popliteal ligament (OPL); superior (sMPFL), middle (mMPFL), and inferior (iMPFL) medial patellofemoral ligament; and superior (sLPFL), middle (mLPFL), and inferior (iLPFL) lateral patellofemoral ligament.
Fig. 3
Fig. 3
Comparison of the anterior tibial translations in the anterior drawer test between the intact and the anterolateral ligament (ALL) and anterior cruciate ligament (ACL) deficient conditions.
Fig. 4
Fig. 4
Mean (sd) anteroposterior translation (AP) and internal–external (IE) rotation under gait cycle condition for deficiency of anterolateral ligament (ALL), anterior cruciate ligament (ACL), and both ALL and ACL. *Statistically significant.
Fig. 5
Fig. 5
Mean (sd) anteroposterior translation and internal–external rotation under squat cycle condition for deficiency of anterior cruciate ligament (ALL), anterior cruciate ligament (ACL), and both ALL and ACL. *Statistically significant.

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