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Dastgerdi AK, Esrafilian A, Carty CP, Nasseri A, Barzan M, Korhonen RK, Astori I, Hall W, Saxby DJ. Sensitivity analysis of paediatric knee kinematics to the graft surgical parameters during anterior cruciate ligament reconstruction: A sequentially linked neuromusculoskeletal-finite element analysis. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 248:108132. [PMID: 38503071 DOI: 10.1016/j.cmpb.2024.108132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 02/26/2024] [Accepted: 03/08/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND AND OBJECTIVE Incidence of paediatric anterior cruciate ligament (ACL) rupture has increased substantially over recent decades. Following ACL rupture, ACL reconstruction (ACLR) surgery is typically performed to restore passive knee stability. This surgery involves replacing the failed ACL with a graft, however, surgeons must select from range of surgical parameters (e.g., type, size, insertion, and pre-tension) with no robust evidence guiding these decisions. This study presents a systemmatic computational approach to study effects of surgical parameter variation on kinematics of paediatric knees. METHODS This study used sequentially-linked neuromusculoskeletal (NMSK) finite element (FE) models of three paediatric knees to estimate the: (i) sensitivity of post-operative knee kinematics to four surgical parameters (type, size, insertion, and pre-tension) through multi-input multi-output sensitivity analysis; (ii) influence of motion and loading conditions throughout stance phase of walking gait on sensitivity indices; and (iii) influence of subject-specific anatomy (i.e., knee size) on sensitivivty indices. A previously validated FE model of the intact knee for each subject served as a reference against which ACLR knee kinematics were compared. RESULTS Sensitivity analyses revealed significant influences of surgical parameters on ACLR knee kinematics, albeit without discernible trend favouring any one parameter. Graft size and pre-tension were primary drivers of variation in knee translations and rotations, however, their effects fluctuated across stance indicating motion and loading conditions affect system sensitivity to surgical parameters. Importantly, the sensitivity of knee kinematics to surgical parameter varied across subjects, indicating geometry (i.e., knee size) influenced system sensitivity. Notably, alterations in graft parameters yielded substantial effects on kinematics (normalized root-mean-square-error > 10 %) compared to intact knee models, indicating surgical parameters vary post-operative knee kinematics. CONCLUSIONS Overall, this initial study highlights the importance of surgical parameter selection on post-operative kinematics in the paediatric ACLR knee, and provides evidence of the need for personalized surgical planning to ultimately enhance patient outcomes.
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Affiliation(s)
- Ayda Karimi Dastgerdi
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland and the Advanced Design and Prototyping Technologies Institute (ADAPT), Griffith University, Gold Coast, QLD, Australia.
| | - Amir Esrafilian
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
| | - Christopher P Carty
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland and the Advanced Design and Prototyping Technologies Institute (ADAPT), Griffith University, Gold Coast, QLD, Australia; Department of Orthopedics, Children's Health Queensland Hospital and Health Service, QLD, Australia
| | - Azadeh Nasseri
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland and the Advanced Design and Prototyping Technologies Institute (ADAPT), Griffith University, Gold Coast, QLD, Australia
| | - Martina Barzan
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland and the Advanced Design and Prototyping Technologies Institute (ADAPT), Griffith University, Gold Coast, QLD, Australia
| | - Rami K Korhonen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
| | - Ivan Astori
- Department of Orthopedics, Children's Health Queensland Hospital and Health Service, QLD, Australia
| | - Wayne Hall
- School of Engineering and Built Environment, Mechanical Engineering and Industrial Design, Griffith University, Gold Coast, QLD, Australia
| | - David John Saxby
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland and the Advanced Design and Prototyping Technologies Institute (ADAPT), Griffith University, Gold Coast, QLD, Australia
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Zhu J, Zhu W, Zhao Q. Computational modelling of the graft-tunnel interaction in single-bundle ACL reconstructed knee. BIOMED ENG-BIOMED TE 2023; 68:573-582. [PMID: 37462669 DOI: 10.1515/bmt-2022-0136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 07/06/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVES Tunnel enlargement and graft failure are common complications associated with ACL reconstruction. The mechanical interaction between the graft and the tunnel aperture may play a more important role. This study aims to evaluate graft position within femoral tunnel and the graft force under external loads. METHODS An FE model of the femur-graft-tibia complex was constructed from CT images of an anatomically reconstructed knee specimen. The model was subjected to kinematics of passive flexion extension, anterior/posterior translation, internal/external rotation and valgus kinematics, which were collected from experimental testing. Graft shift and rotation of graft-tunnel contact region during flexion/extension and external loadings were recorded and compared to experimental measurements. RESULTS Model showed that the graft shifted in the femoral tunnel during flexion and under external loads. The graft-tunnel contact area rotated by up to 55° during flexion from full extension to 90° of extension implying that the so-called "wiper effect" occurs during most of flexion angles. CONCLUSIONS Different regions of the femoral tunnel aperture, particularly the anterior region, were under significantly more contact force from the graft than other areas of the aperture during the anterior translation test, potentially leading to femoral tunnel enlargement to the anterior side of the aperture.
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Affiliation(s)
- Junjun Zhu
- Shanghai Key Laboratory of Intelligent Manufacturing and Robotics, School of Mechatronic Engineering and Automation, Shanghai University, Shanghai, China
| | - Weimin Zhu
- Shenzhen 2nd People's Hospital (The First Affiliated Hospital of Shenzhen University), Shenzhen, Guangdong, China
| | - Qijie Zhao
- School of Mechatronic Engineering and Automation, Shanghai University, Shanghai, China
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Spierings J, Van den Hengel M, Janssen RPA, Van Rietbergen B, Ito K, Foolen J. Knee instability caused by altered graft mechanical properties after anterior cruciate ligament reconstruction: the early onset of osteoarthritis? Front Bioeng Biotechnol 2023; 11:1244954. [PMID: 37691908 PMCID: PMC10484411 DOI: 10.3389/fbioe.2023.1244954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 08/15/2023] [Indexed: 09/12/2023] Open
Abstract
Anterior cruciate ligament (ACL) rupture is a very common knee joint injury. Torn ACLs are currently reconstructed using tendon autografts. However, half of the patients develop osteoarthritis (OA) within 10 to 14 years postoperatively. Proposedly, this is caused by altered knee kine(ma)tics originating from changes in graft mechanical properties during the in vivo remodeling response. Therefore, the main aim was to use subject-specific finite element knee models and investigate the influence of decreasing graft stiffness and/or increasing graft laxity on knee kine(ma)tics and cartilage loading. In this research, 4 subject-specific knee geometries were used, and the material properties of the ACL were altered to either match currently used grafts or mimic in vivo graft remodeling, i.e., decreasing graft stiffness and/or increasing graft laxity. The results confirm that the in vivo graft remodeling process increases the knee range of motion, up to >300 percent, and relocates the cartilage contact pressures, up to 4.3 mm. The effect of remodeling-induced graft mechanical properties on knee stability exceeded that of graft mechanical properties at the time of surgery. This indicates that altered mechanical properties of ACL grafts, caused by in vivo remodeling, can initiate the early onset of osteoarthritis, as observed in many patients clinically.
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Affiliation(s)
- Janne Spierings
- Department of Biomedical Engineering, Orthopaedic Biomechanics, Eindhoven University of Technology, Eindhoven, Netherlands
- Institute of Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Marloes Van den Hengel
- Department of Biomedical Engineering, Orthopaedic Biomechanics, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Rob P. A. Janssen
- Department of Biomedical Engineering, Orthopaedic Biomechanics, Eindhoven University of Technology, Eindhoven, Netherlands
- Department of Orthopaedic Surgery and Trauma, Máxima Medical Centre Eindhoven/Veldhoven, Eindhoven, Netherlands
- Department of Paramedical Sciences, Health Innovations and Technology, Fontys University of Applied Sciences, Eindhoven, Netherlands
| | - Bert Van Rietbergen
- Department of Biomedical Engineering, Orthopaedic Biomechanics, Eindhoven University of Technology, Eindhoven, Netherlands
- Institute of Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Keita Ito
- Department of Biomedical Engineering, Orthopaedic Biomechanics, Eindhoven University of Technology, Eindhoven, Netherlands
- Institute of Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Jasper Foolen
- Department of Biomedical Engineering, Orthopaedic Biomechanics, Eindhoven University of Technology, Eindhoven, Netherlands
- Institute of Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, Netherlands
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Zhang X, Qian Y, Gao F, He C, Guo S, Gao Q, Zhou J. High anteromedial insertion reduced anteroposterior and rotational knee laxity on mid-term follow-up after anatomic anterior cruciate ligament reconstruction. PeerJ 2023; 11:e15898. [PMID: 37609439 PMCID: PMC10441525 DOI: 10.7717/peerj.15898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 07/24/2023] [Indexed: 08/24/2023] Open
Abstract
Background The position of the femoral insertion has a great influence on the laxity of the knee joint after ACLR, especially for rotational laxity. Purpose To compare the effects of different femoral tunnel positions on knee stability after arthroscopic anterior cruciate ligament reconstruction (ACLR). Methods The clinical outcomes of 165 patients after autograft ACLR were analyzed retrospectively. The patients were separated into three groups according to the position of the femoral tunnel, as follows: low center (LC) group, 53 patients; high center (HC) group, 45 patients; and high anteromedial (HAM) group, 67 patients. The side-to-side differences (SSDs) in anteroposterior knee laxity measured using a KT-2000 arthrometer and the pivot shift test (PST) pre- and postoperatively were compared among the three groups and analyzed. Results After 5 years postoperatively, the SSD in the anteroposterior knee laxity in the three groups was significantly decreased postoperatively compared with preoperatively in knees; meanwhile, the negative PST rate was significantly increased in the three groups. The postoperative SSD in anteroposterior knee laxity was significantly increased in the HC group compared with the LC and HAM groups (1.5 ± 1.3 VS 1.0 ± 1.1 VS 1.0 ± 1.0, P<0.05). The negative postoperative PST rate was higher in both the LC and HAM groups than in the HC group (84.9% VS 91.0% VS 71.1%, P<0.05), and there was no significant difference in the negative PST rate between the LC and HAM groups (84.9% VS 91.0%, P>0.05). The negative postoperative PST rate was significantly higher in the HAM group than in the LC and HC groups for patients with a high degree of laxity preoperatively (31.3% VS 3.3% VS 14.4%, P>0.05). Conclusion Patients in HAM group showed better control over anteroposterior laxity, rotational laxity, and subjective knee function compared to other groups post operation. Therefore, the HAM point is the closest to the I.D.E.A.L point concept, and is recommended as the preferred location for the femoral tunnel in ACLR.
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Affiliation(s)
- Xiaohan Zhang
- School of Sport Medicine and Rehabilitation, Beijing Sport University, Beijing, China
| | - Yi Qian
- National Institute of Sports Medicine, Beijing, China
| | - Feng Gao
- National Institute of Sports Medicine, Beijing, China
| | - Chen He
- National Institute of Sports Medicine, Beijing, China
| | - Sen Guo
- National Institute of Sports Medicine, Beijing, China
| | - Qi Gao
- School of Sport Medicine and Rehabilitation, Beijing Sport University, Beijing, China
| | - Jingbin Zhou
- National Institute of Sports Medicine, Beijing, China
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Moustridi E, Risvas K, Moustakas K. Predictive simulation of single-leg landing scenarios for ACL injury risk factors evaluation. PLoS One 2023; 18:e0282186. [PMID: 36893124 PMCID: PMC9997920 DOI: 10.1371/journal.pone.0282186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 02/08/2023] [Indexed: 03/10/2023] Open
Abstract
The Anterior Cruciate Ligament (ACL) rupture is a very common knee injury during sport activities. Landing after jump is one of the most prominent human body movements that can lead to such an injury. The landing-related ACL injury risk factors have been in the spotlight of research interest. Over the years, researchers and clinicians acquire knowledge about human movement during daily-life activities by organizing complex in vivo studies that feature high complexity, costs and technical and most importantly physical challenges. In an attempt to overcome these limitations, this paper introduces a computational modeling and simulation pipeline that aims to predict and identify key parameters of interest that are related to ACL injury during single-leg landings. We examined the following conditions: a) landing height, b) hip internal and external rotation, c) lumbar forward and backward leaning, d) lumbar medial and lateral bending, e) muscle forces permutations and f) effort goal weight. Identified on related research studies, we evaluated the following risk factors: vertical Ground Reaction Force (vGRF), knee joint Anterior force (AF), Medial force (MF), Compressive force (CF), Abduction moment (AbdM), Internal rotation moment (IRM), quadricep and hamstring muscle forces and Quadriceps/Hamstrings force ratio (Q/H force ratio). Our study clearly demonstrated that ACL injury is a rather complicated mechanism with many associated risk factors which are evidently correlated. Nevertheless, the results were mostly in agreement with other research studies regarding the ACL risk factors. The presented pipeline showcased promising potential of predictive simulations to evaluate different aspects of complicated phenomena, such as the ACL injury.
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Affiliation(s)
- Evgenia Moustridi
- Department of Electrical and Computer Engineering, University of Patras, Patras, Achaia, Greece
| | - Konstantinos Risvas
- Department of Electrical and Computer Engineering, University of Patras, Patras, Achaia, Greece
| | - Konstantinos Moustakas
- Department of Electrical and Computer Engineering, University of Patras, Patras, Achaia, Greece
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6
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Halloran JP, Abdollahi Nohouji N, Hafez MA, Besier TF, Chokhandre SK, Elmasry S, Hume DR, Imhauser CW, Rooks NB, Schneider MTY, Schwartz A, Shelburne KB, Zaylor W, Erdemir A. Assessment of reporting practices and reproducibility potential of a cohort of published studies in computational knee biomechanics. J Orthop Res 2023; 41:325-334. [PMID: 35502762 PMCID: PMC9630164 DOI: 10.1002/jor.25358] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/22/2022] [Accepted: 04/20/2022] [Indexed: 02/04/2023]
Abstract
Reproducible research serves as a pillar of the scientific method and is a foundation for scientific advancement. However, estimates for irreproducibility of preclinical science range from 75% to 90%. The importance of reproducible science has not been assessed in the context of mechanics-based modeling of human joints such as the knee, despite this being an area that has seen dramatic growth. Framed in the context of five experienced teams currently documenting knee modeling procedures, the aim of this study was to evaluate reporting and the perceived potential for reproducibility across studies the teams viewed as important contributions to the literature. A cohort of studies was selected by polling, which resulted in an assessment of nine studies as opposed to a broader analysis across the literature. Using a published checklist for reporting of modeling features, the cohort was evaluated for both "reporting" and their potential to be "reproduced," which was delineated into six major modeling categories and three subcategories. Logistic regression analysis revealed that for individual modeling categories, the proportion of "reported" occurrences ranged from 0.31, 95% confidence interval (CI) [0.23, 0.41] to 0.77, 95% CI: [0.68, 0.86]. The proportion of whether a category was perceived as "reproducible" ranged from 0.22, 95% CI: [0.15, 0.31] to 0.44, 95% CI: [0.35, 0.55]. The relatively low ratios highlight an opportunity to improve reporting and reproducibility of knee modeling studies. Ongoing efforts, including our findings, contribute to a dialogue that facilitates adoption of practices that provide both credibility and translation possibilities.
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Affiliation(s)
- Jason P Halloran
- Applied Sciences Laboratory, Institute for Shock Physics, Washington State University, Spokane, WA, USA,Corresponding author: Applied Sciences Laboratory, Institute for Shock Physics, 412 E Spokane Falls Blvd, Spokane, WA 99202, Phone: 509-358-7713,
| | - Neda Abdollahi Nohouji
- Center for Human Machine Systems, Cleveland State University, Cleveland, OH, USA,Department of Mechanical Engineering, Cleveland State University, Cleveland, OH, USA,Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OHIO, USA
| | - Mhd Ammar Hafez
- Center for Human Machine Systems, Cleveland State University, Cleveland, OH, USA,Department of Civil Engineering, Cleveland State University, Cleveland, OH, USA
| | - Thor F Besier
- Auckland Bioengineering Institute, University of Auckland, Auckland, NZ,Department of Engineering Science, Faculty of Engineering, University of Auckland, Auckland, NZ
| | - Snehal K Chokhandre
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OHIO, USA,Computational Biomodeling (CoBi) Core, Lerner Research Institute, Cleveland Clinic, USA
| | - Shady Elmasry
- Department of Biomechanics, Hospital for Special Surgery, New York, NY, USA
| | - Donald R Hume
- Department of Mechanical and Materials Engineering, University of Denver, Denver, CO, USA,Center for Orthopaedic Biomechanics, University of Denver, Denver, CO, USA
| | - Carl W Imhauser
- Department of Biomechanics, Hospital for Special Surgery, New York, NY, USA
| | - Nynke B Rooks
- Auckland Bioengineering Institute, University of Auckland, Auckland, NZ
| | | | - Ariel Schwartz
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OHIO, USA,Computational Biomodeling (CoBi) Core, Lerner Research Institute, Cleveland Clinic, USA
| | - Kevin B Shelburne
- Department of Mechanical and Materials Engineering, University of Denver, Denver, CO, USA,Center for Orthopaedic Biomechanics, University of Denver, Denver, CO, USA
| | - William Zaylor
- Center for Human Machine Systems, Cleveland State University, Cleveland, OH, USA,Department of Mechanical Engineering, Cleveland State University, Cleveland, OH, USA
| | - Ahmet Erdemir
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OHIO, USA,Computational Biomodeling (CoBi) Core, Lerner Research Institute, Cleveland Clinic, USA
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Chen WM, Yu Y, Geng X, Wang C, Chen L, Ma X. Modulation of internal tissue stresses of the knee via control of variable-stiffness properties in a 3D-printed footwear: A combined experimental and finite element analysis. Med Eng Phys 2022; 104:103800. [DOI: 10.1016/j.medengphy.2022.103800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 03/19/2022] [Accepted: 04/12/2022] [Indexed: 11/25/2022]
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Evaluation of anterior cruciate ligament surgical reconstruction through finite element analysis. Sci Rep 2022; 12:8044. [PMID: 35577879 PMCID: PMC9110399 DOI: 10.1038/s41598-022-11601-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 04/21/2022] [Indexed: 11/08/2022] Open
Abstract
Anterior cruciate ligament (ACL) tear is one of the most common knee injuries. The ACL reconstruction surgery aims to restore healthy knee function by replacing the injured ligament with a graft. Proper selection of the optimal surgery parameters is a complex task. To this end, we developed an automated modeling framework that accepts subject-specific geometries and produces finite element knee models incorporating different surgical techniques. Initially, we developed a reference model of the intact knee, validated with data provided by the Open Knee(s) project. This helped us evaluate the effectiveness of estimating ligament stiffness directly from MRI. Next, we performed a plethora of “what-if” simulations, comparing responses with the reference model. We found that (a) increasing graft pretension and radius reduces relative knee displacement, (b) the correlation of graft radius and tension should not be neglected, (c) graft fixation angle of 20\documentclass[12pt]{minimal}
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\begin{document}$$^{\circ }$$\end{document}∘ can reduce knee laxity, and (d) single-versus double-bundle techniques demonstrate comparable performance in restraining knee translation. In most cases, these findings confirm reported values from comparative clinical studies. The numerical models are made publicly available, allowing for experimental reuse and lowering the barriers for meta-studies. The modeling approach proposed here can complement orthopedic surgeons in their decision-making.
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Cohen D, Slawaska-Eng D, Almasri M, Sheean A, de Sa D. Quadricep ACL Reconstruction Techniques and Outcomes: an Updated Scoping Review of the Quadricep Tendon. Curr Rev Musculoskelet Med 2021; 14:462-474. [PMID: 34755275 DOI: 10.1007/s12178-021-09726-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/06/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to provide an up-to-date summary on the most recent literature examining techniques and outcomes in anterior cruciate ligament (ACL) reconstruction using quadriceps tendon (QT) which will enable surgeons to make well informed evidence-based decisions when choosing a particular graft option and technique in ACL reconstruction. RECENT FINDINGS Several RCTs and systematic reviews have been published recently on this topic, and overall, there were no differences found between the QT, HT, and BPTB groups in patient-reported outcomes, stability testing, or graft re-rupture rates. In terms of strength testing, the QT group did have inferior knee extensor strength on isokinetic testing when compared to the HT group, whereas the HT group had inferior knee flexor strength compared to the QT group. No differences were found on strength testing between the QT and BPTB groups. Currently, two large RCTs, the Stability2 and SQuASH trials, are ongoing examining the effectiveness of the QT vs BPTB with or without LET and QT vs HT in the pediatric population which will help shed further light on the effectiveness of the QT as a graft choice in ACL reconstruction. The findings of this scoping review demonstrate that the QT is an excellent graft option in ACL reconstruction both in the primary and revision settings, among adult and pediatric populations. This review provides surgeons with further assurance when selecting QT autograft in ACL reconstruction.
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Affiliation(s)
- Dan Cohen
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - David Slawaska-Eng
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Mahmoud Almasri
- Mercy Health - Cincinnati Sports Medicine and Orthopaedic Center, Cincinnati, OH, USA
| | - Andrew Sheean
- Department of Orthopaedic Surgery, San Antonio Military Medical Center, San Antonio, TX, USA
| | - Darren de Sa
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada. .,McMaster University Medical Centre, 1200 Main St West, 4E, Hamilton, Ontario, L8N 3Z5, Canada.
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Numerical Analysis of the ACL, with Sprains of Different Degrees after Trauma. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2021; 2021:2109348. [PMID: 34349834 PMCID: PMC8328720 DOI: 10.1155/2021/2109348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 06/28/2021] [Indexed: 11/26/2022]
Abstract
Nowadays, cruciate ligament injuries have increased in incidence, since practicing a sport or physical activity has become a trend in current societies. Although this lifestyle generates multiple benefits, as a consequence, injury has also increased. Due to its nature and complexity, the ligaments of the knee are those that are most frequently affected, mainly the ACL (anterior cruciate ligament). This tissue reacts to overexertion or movements out of range, either caused by the exercise itself or caused by trauma caused by the practice of physical activity, causing various degrees of sprain. Whatever the etiology of these injuries, they will require a therapy indicated for each degree of injury. This therapy initially entails immobilization of the affected area and later; physical therapy will be required to a lesser or greater degree. Commonly, in the physiotherapy of these injuries, rehabilitation exercises are prescribed, where the physiotherapist asks a patient to use equipment with an estimated weight. However, the effectiveness of a generalized therapy in this way does not always give the expected results. This is related to the fact that these therapies are standardized and do not consider some factors such as the remaining muscle fibres that are not directly affected by the sprain, which does not mean that they should not be considered. Therefore, in the present work, a biomodel of a human knee has been developed and used to evaluate numerically how the ACL acts under an external load, when there are different degrees of injuries, caused by trauma. Four case studies were considered: Case 1 (control case) where the ACL is healthy, Case 2 where the ACL presents a 1st-degree sprain, Case 3 where the ACL presents a 2nd-degree sprain, and finally Case 4 where the ACL presents a 3rd-sprain grade. After performing the analyses, in the control case, it was found that it presents a balance between tensile and compressive stresses. While in the 4th case, the most critical tensile stress decreases while compression stresses increase. This shows that the ligament, having considerable damage, no longer works as it should and can eventually damage the collateral structures. It was found that, when there was a sprain, where the continuity of the ligament is compromised, a second torsional moment occurs in the ACL which causes the tissue fibres not to act according to their normal physiology or in a healthy state. The results obtained from the present study provide the possibility of predicting where the following injuries will occur by considering the von Mises failure criterion. Likewise, they will allow to improve the therapeutic procedures considering not only the injured structure but also the system as a whole.
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Kim SJ, Song SY, Kim TS, Kim YS, Jang SW, Seo YJ. Creating a Femoral Tunnel Aperture at the Anteromedial Footprint Versus the Central Footprint in ACL Reconstruction: Comparison of Contact Stress Patterns. Orthop J Sports Med 2021; 9:23259671211001802. [PMID: 33997070 PMCID: PMC8111278 DOI: 10.1177/23259671211001802] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 12/15/2020] [Indexed: 11/16/2022] Open
Abstract
Background: It remains unclear whether an anteromedial (AM) footprint or a central footprint anterior cruciate ligament (ACL) graft exhibits less contact stress with the femoral tunnel aperture. This contact stress can generate graft attrition forces, which can lead to potential graft failure. Purpose/Hypothesis: The purpose of this study was to compare the difference in contact stress patterns of the graft around a femoral tunnel that is created at the anatomic AM footprint versus the central footprint. It was hypothesized that the difference in femoral tunnel positions would influence the contact stress at the interface between the reconstructed graft and the femoral tunnel orifice. Study Design: Controlled laboratory study. Methods: A total of 24 patients who underwent anatomic single-bundle ACL reconstruction were included in this study. In 12 patients, the femoral tunnels were created at the center of the native AM footprint (AM group), and in the remaining 12 patients the center of the femoral tunnel was placed in the anatomic central footprint (central group). Three-dimensional knee models were created and manipulated using several modeling programs, and the graft-tunnel angle (GTA) was determined using a special software program. The peak contact stresses generated on the virtual ACL graft around the femoral tunnel orifice were calculated using a finite element method. Results: The mean GTA was significantly more obtuse in the AM group than in the central group (124.2° ± 5.9° vs 112.6° ± 7.9°; P = .001). In general, both groups showed high stress distribution on the anterior surface of the graft, which came in contact with the anterior aspect of the femoral tunnel aperture. The degree of stress in the central group (5.3 ± 2.6 MPa) was significantly higher than that in the AM group (1.2 ± 1.1 MPa) (P < .001). Conclusion: Compared with the AM footprint ACL graft, the central footprint ACL graft developed significantly higher contact stress in the extended position, especially around the anterior aspect of the femoral tunnel orifice. Clinical Relevance: The contact stress of the ACL graft at the extended position of the knee may be minimized by creating the femoral tunnel at the AM-oriented footprint.
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Affiliation(s)
- Sung-Jae Kim
- Department of Orthopaedic Surgery, Hallym University, Dongtan Sacred Heart Hospital, Hwaseong, Gyeonggi-do, Republic of Korea
| | - Si Young Song
- Department of Orthopaedic Surgery, Hallym University, Dongtan Sacred Heart Hospital, Hwaseong, Gyeonggi-do, Republic of Korea
| | - Tae Soung Kim
- Department of Orthopaedic Surgery, Hallym University, Dongtan Sacred Heart Hospital, Hwaseong, Gyeonggi-do, Republic of Korea
| | - Yoon Sang Kim
- BioComputing Lab, School of Computer Science and Engineering, Korea University of Technology and Education (KOREATECH), Cheonan, Republic of Korea
| | - Seong-Wook Jang
- BioComputing Lab, School of Computer Science and Engineering, Korea University of Technology and Education (KOREATECH), Cheonan, Republic of Korea
| | - Young-Jin Seo
- Department of Orthopaedic Surgery, Hallym University, Dongtan Sacred Heart Hospital, Hwaseong, Gyeonggi-do, Republic of Korea
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Chen LX, Wang HH. Comparison between single- and double-bundle anterior cruciate ligament reconstructions for knee with grade 2 medial collateral ligament injury. Medicine (Baltimore) 2021; 100:e24846. [PMID: 33725956 PMCID: PMC7982167 DOI: 10.1097/md.0000000000024846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 01/28/2021] [Indexed: 01/05/2023] Open
Abstract
This research discussed clinical outcomes of anterior cruciate ligament reconstruction accompanied by conservative treatment for grade 2 medial collateral ligament injury, and comparison was performed between double-bundle and single-bundle anterior cruciate ligament reconstruction.Clinical information was retrospectively collected for 41 cases suffering anterior cruciate ligament injuries accompanied by grade 2 medial collateral ligament injuries. Within 14 days after their injuries 22 cases received single-bundle anterior cruciate ligament reconstruction (SB group), while 19 were treated with double-bundle medial collateral ligament reconstruction (DB group). Physical statuses were estimated based on International Knee Documentation Committee (IKDC) and Lysholm scores, Lachman, pivot shift and manual valgus test, and range of motion (ROM), while side-to-side difference was estimated through KT 2000 arthometer.Anterior cruciate ligament reconstruction accompanied by conservative treatment showed significantly improved anteroposterior, rotational and valgus stability, and IKDC and Lysholm scores (in comparison to pre-operative status, P < .05). Incidence of pivot shift was dramatically lower in DB group (2/19) than in SB group (7/22 and 2/22; P = .028). No substantial dissimilarity existed between DB and SB groups either in Lachman and valgus tests, KT 2000, ROM, IKDC, or Lysholm scores.Anterior cruciate ligament reconstruction accompanied by conservative treatment could achieve outstanding stability and functional manifestations for cases facing anterior cruciate ligament injury accompanied by grade 2 medial collateral ligament injury. Moreover, double-bundle anterior cruciate ligament reconstruction is superior to single-bundle operation in treating rotational instability of the knee.Level of evidence: Retrospective comparative study, Level III.
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Affiliation(s)
- Lian-Xu Chen
- Department of Orthopaedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University
| | - Hong-Hong Wang
- Department of Emergency, Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, China
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13
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Blanke F, Boljen M, Lutter C, Oehler N, Tischer T, Vogt S. Does the anterolateral ligament protect the anterior cruciate ligament in the most common injury mechanisms? A human knee model study. Knee 2021; 29:381-389. [PMID: 33711673 DOI: 10.1016/j.knee.2021.02.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 12/01/2020] [Accepted: 02/18/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) reconstruction still has a risk of re-rupture and persisting rotational instability. Thus, extra-articular structures such as the anterolateral ligament (ALL) are increasingly treated. The ALL however prevents the internal rotation of the tibia and it must be doubted that the ALL protects the ACL in other common injury mechanisms which primarily include tibial external rotation. In this study we aimed to evaluate which extra-articular structures support the ACL in excessive tibial internal and external rotation using a knee finite element (FE) model. METHODS Internal and external rotations of the tibia were applied to an FE model with anatomical ACL, posterior cruciate ligament (PCL), lateral collateral ligament (LCL), medial collateral ligament (MCL) and intact medial and lateral meniscus. Three additional anatomic structures (anterolateral ligament, popliteal tendon and posterior oblique ligament) were added to the FE model separately and then all together. The force histories within all structures were measured and determined for each case. RESULTS The ACL was the most loaded ligament both in tibial internal and external rotation. The ALL was the main stabilizer of the tibial internal rotation (46%) and prevented the tibial external rotation by only 3%. High forces were only observed in the LCL with tibial external rotation. The ALL reduced the load on the ACL in tibial internal rotation by 21%, in tibial external rotation only by 2%. The POL reduced the load on the ACL by 8%, the PLT by 6% in tibial internal rotation. In tibial external rotation the POL and PLT did not reduce the load on the ACL by more than 1%. CONCLUSION The ALL protects the ACL in injury mechanisms with tibial internal rotation but not in mechanisms with tibial external rotation. In injury mechanisms with tibial external rotation other structures that support the ACL need to be considered.
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Affiliation(s)
- F Blanke
- Department of Orthopedic Sports Medicine and Arthroscopic Surgery, Hessing Stiftung Augsburg, Augsburg, Germany; Department of Orthopedic Surgery, University Hospital Rostock, Rostock, Germany.
| | - M Boljen
- Fraunhofer Institute for High-Speed Dynamics, Ernst-Mach-Institut, EMI, Freiburg i. Breisgau, Germany
| | - C Lutter
- Department of Orthopedic Surgery, University Hospital Rostock, Rostock, Germany
| | - N Oehler
- Department of Orthopedic Sports Medicine and Arthroscopic Surgery, Hessing Stiftung Augsburg, Augsburg, Germany
| | - T Tischer
- Department of Orthopedic Surgery, University Hospital Rostock, Rostock, Germany
| | - S Vogt
- Department of Orthopedic Sports Medicine and Arthroscopic Surgery, Hessing Stiftung Augsburg, Augsburg, Germany
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Tanaka Y, Nakamura S, Kuriyama S, Nishitani K, Watanabe M, Song YD, Ikebe S, Higaki H, Matsuda S. Length of anterior cruciate ligament affects knee kinematics and kinetics using a musculoskeletal computer simulation model. J Orthop 2020; 21:370-374. [PMID: 32904327 DOI: 10.1016/j.jor.2020.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 08/02/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction The tension of anterior cruciate ligament (ACL) graft has an important role in antero-posterior (AP) and rotational stability of the knee. The purposes of this study were to analyze the kinematics and kinetics of normal knee models with loose and tight ACL tension, and to evaluate the effect of the tension of ACL on knee kinematics and kinetics. Materials and methods Slack and tight ACL models were constructed in a musculoskeletal computer simulation. The effect of ACL tension on kinematics, and femorotibial contact force during various activities was analyzed. Results During stair descent activity in the slack ACL models, the lateral femoral condyles were positioned posterior, and more external rotation of the femur was observed in comparison with the normal model. The contact forces at the lateral compartment in the tight models increased during all activities, and the tension of the medial collateral ligament (MCL) in the slack models increased during the stair descent activity, compared with the normal knee model. Conclusion AP and rotational instability and excessive MCL tension were observed in the ACL slack knees especially during stair descent movement, whereas the tibiofemoral contact force of the lateral compartment increased in the tight ACL knees.
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Affiliation(s)
- Yoshihisa Tanaka
- Department of Orthopaedic Surgery, Kyoto University, Graduate School of Medicine, 54 Shogoin-kawaharacho, Sakyo-ku, Kyoto, 6068507, Japan
| | - Shinichiro Nakamura
- Department of Orthopaedic Surgery, Kyoto University, Graduate School of Medicine, 54 Shogoin-kawaharacho, Sakyo-ku, Kyoto, 6068507, Japan
| | - Shinichi Kuriyama
- Department of Orthopaedic Surgery, Kyoto University, Graduate School of Medicine, 54 Shogoin-kawaharacho, Sakyo-ku, Kyoto, 6068507, Japan
| | - Kohei Nishitani
- Department of Orthopaedic Surgery, Kyoto University, Graduate School of Medicine, 54 Shogoin-kawaharacho, Sakyo-ku, Kyoto, 6068507, Japan
| | - Mutsumi Watanabe
- Department of Orthopaedic Surgery, Kyoto University, Graduate School of Medicine, 54 Shogoin-kawaharacho, Sakyo-ku, Kyoto, 6068507, Japan
| | - Young Dong Song
- Department of Orthopaedic Surgery, Kyoto University, Graduate School of Medicine, 54 Shogoin-kawaharacho, Sakyo-ku, Kyoto, 6068507, Japan
| | - Satoru Ikebe
- National Institute of Technology, Kitakyushu College, 5-20-1 Shii, Kokuraminami-ku, Kitakyushu, Fukuoka, 8020985, Japan
| | - Hidehiko Higaki
- Department of Life Science, Faculty of Life Science, Kyushu Sangyo University, 2-3-1 Matsukadai, Higasi-ku, Fukuoka, 8138503, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Kyoto University, Graduate School of Medicine, 54 Shogoin-kawaharacho, Sakyo-ku, Kyoto, 6068507, Japan
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Benos L, Stanev D, Spyrou L, Moustakas K, Tsaopoulos DE. A Review on Finite Element Modeling and Simulation of the Anterior Cruciate Ligament Reconstruction. Front Bioeng Biotechnol 2020; 8:967. [PMID: 32974307 PMCID: PMC7468435 DOI: 10.3389/fbioe.2020.00967] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/27/2020] [Indexed: 01/22/2023] Open
Abstract
The anterior cruciate ligament (ACL) constitutes one of the most important stabilizing tissues of the knee joint whose rapture is very prevalent. ACL reconstruction (ACLR) from a graft is a surgery which yields the best outcome. Taking into account the complicated nature of this operation and the high cost of experiments, finite element (FE) simulations can become a valuable tool for evaluating the surgery in a pre-clinical setting. The present study summarizes, for the first time, the current advancement in ACLR in both clinical and computational level. It also emphasizes on the material modeling and properties of the most popular grafts as well as modeling of different surgery techniques. It can be concluded that more effort is needed to be put toward more realistic simulation of the surgery, including also the use of two bundles for graft representation, graft pretension and artificial grafts. Furthermore, muscles and synovial fluid need to be included, while patellofemoral joint is an important bone that is rarely used. More realistic models are also required for soft tissues, as most articles used isotropic linear elastic models and springs. In summary, accurate and realistic FE analysis in conjunction with multidisciplinary collaboration could contribute to ACLR improvement provided that several important aspects are carefully considered.
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Affiliation(s)
- Lefteris Benos
- Institute for Bio-Economy and Agri-Technology, Centre for Research and Technology-Hellas, Thessaloniki, Greece
| | - Dimitar Stanev
- Department of Electrical and Computer Engineering, University of Patras, Patras, Greece.,School of Engineering, Institute of Bioengineering, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Leonidas Spyrou
- Institute for Bio-Economy and Agri-Technology, Centre for Research and Technology-Hellas, Thessaloniki, Greece
| | | | - Dimitrios E Tsaopoulos
- Institute for Bio-Economy and Agri-Technology, Centre for Research and Technology-Hellas, Thessaloniki, Greece
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