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Mishra S, Mylarappa A, Satapathy D, Samal S. Morphometric Analysis of Anatomy of Anterior Cruciate Ligament of Knee and its Attachments - a Cadaveric Study in Indian Population. Malays Orthop J 2021; 15:8-14. [PMID: 34966489 PMCID: PMC8667243 DOI: 10.5704/moj.2111.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 06/24/2021] [Indexed: 11/10/2022] Open
Abstract
Introduction: The Anterior Cruciate Ligament tends to stabilise the knee in various range of extension and flexion. Precise study of anatomy, attachments and position of bundles is important for successful ACL reconstruction. In our study, we attempt to assess general anatomy of ACL, determine and compare its morphometric data pertaining to length and width and its tibio-femoral foot prints in different gender and secondarily determine changes in the same during ACL dynamics witnessed during knee flexion changes. Materials and methods: A total of 19 knees from 10 cadavers were used in the research with mean age of 61±7 years. After dissecting the skin, muscles, patellar and articular capsule were removed and bundle attachments were studied. Thereafter the relative length, width and stiffness of ACL bundles at 0, 90, 140 (maximum) angles of knee flexion were measured along with maximum horizontal and vertical bundle footprints at tibio-femoral attachments were recorded. Results: Mean length and width of insertion of anteromedial (AM) bundle on the tibial surface was 8.8mm and 9.0mm in males and 8.1mm and 8.8mm in females. Furthermore, that of PL bundle was 9.1mm and 7.8mm in males and 8.9mm and 7.1mm in females. Conclusion: The anteromedial (AM) bundle and posterolateral (PL) bundle of ACL were found to be most relaxed at full extension and were most taut at maximum flexion of 140°. AM bundle underwent greater stretching and change of length in comparison to the PL bundle, indicating that it is comparatively a more dominant bundle.
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Affiliation(s)
- S Mishra
- Department of Orthopaedics, Siksha O Anusandhan University Institute of Medical Sciences and SUM Hospital, Bhubaneswar, India
| | - A Mylarappa
- Department of Orthopaedics, Siksha O Anusandhan University Institute of Medical Sciences and SUM Hospital, Bhubaneswar, India
| | - D Satapathy
- Department of Orthopaedics, Siksha O Anusandhan University Institute of Medical Sciences and SUM Hospital, Bhubaneswar, India
| | - S Samal
- Department of Orthopaedics, Siksha O Anusandhan University Institute of Medical Sciences and SUM Hospital, Bhubaneswar, India
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Oh JY, Kim KT, Park YJ, Won HC, Yoo JI, Moon DK, Cho SH, Hwang SC. Biomechanical comparison of single-bundle versus double-bundle anterior cruciate ligament reconstruction: a meta-analysis. Knee Surg Relat Res 2020; 32:14. [PMID: 32660562 PMCID: PMC7219200 DOI: 10.1186/s43019-020-00033-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 02/18/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Of the many issues regarding surgical techniques related to anterior cruciate ligament reconstruction (ACLR), single-bundle (SB) or double-bundle (DB) ACLR is one of the most debated topics. However, it is unclear which of the techniques yields better outcomes after ACLR for ACL injury. The purpose of this meta-analysis was to compare the benefits of SB versus DB ACLR in terms of biomechanical outcomes. METHODS The electronic databases MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, Web of Science, and Scopus were searched for relevant articles comparing the outcomes of SB-ACLR versus DB-ACLR that were published until November 2019. RESULTS Seventeen biomechanical studies were included. The anterior laxity measured using the anterior drawer test showed significantly better results in DB-ACLR when compared with SB-ACLR. In addition, outcomes of the anterior tibial translation test under a simulated pivot shift presented with better results at low flexion and 30° in DB-ACLR, compared with SB-ACLR. However, there were no significant biomechanical differences between the groups in internal rotation. CONCLUSIONS The present study demonstrated that both techniques for ACLR are associated with restoration of normal knee kinematics. DB-ACLR is superior to SB-ACLR in terms of restoration of anteroposterior stability. However, which technique yields better improvement in internal rotation laxity, and internal rotation laxity under a simulated pivot shift at a specific angle, remains unclear. LEVEL OF EVIDENCE This is a level II meta-analysis.
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Affiliation(s)
- Jin-Young Oh
- Department of Orthopaedic Surgery, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 15, Jinju-daero 816 beon-gil, Jinju-si, Gyeongsangnam-do, Republic of Korea, 660-751
| | - Kun-Tae Kim
- Department of Orthopaedic Surgery, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 15, Jinju-daero 816 beon-gil, Jinju-si, Gyeongsangnam-do, Republic of Korea, 660-751
| | - Young-Jin Park
- Department of Orthopaedic Surgery, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 15, Jinju-daero 816 beon-gil, Jinju-si, Gyeongsangnam-do, Republic of Korea, 660-751
| | - Hee-Chan Won
- Department of Orthopaedic Surgery, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 15, Jinju-daero 816 beon-gil, Jinju-si, Gyeongsangnam-do, Republic of Korea, 660-751
| | - Jun-Il Yoo
- Department of Orthopaedic Surgery, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 15, Jinju-daero 816 beon-gil, Jinju-si, Gyeongsangnam-do, Republic of Korea, 660-751
| | - Dong-Kyu Moon
- Department of Orthopaedic Surgery, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 15, Jinju-daero 816 beon-gil, Jinju-si, Gyeongsangnam-do, Republic of Korea, 660-751
| | - Sung-Hee Cho
- Department of Orthopaedic Surgery, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 15, Jinju-daero 816 beon-gil, Jinju-si, Gyeongsangnam-do, Republic of Korea, 660-751
| | - Sun-Chul Hwang
- Department of Orthopaedic Surgery, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, 15, Jinju-daero 816 beon-gil, Jinju-si, Gyeongsangnam-do, Republic of Korea, 660-751.
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Anderson MJ, Browning WM, Urband CE, Kluczynski MA, Bisson LJ. A Systematic Summary of Systematic Reviews on the Topic of the Anterior Cruciate Ligament. Orthop J Sports Med 2016; 4:2325967116634074. [PMID: 27047983 PMCID: PMC4794976 DOI: 10.1177/2325967116634074] [Citation(s) in RCA: 121] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND There has been a substantial increase in the amount of systematic reviews and meta-analyses published on the anterior cruciate ligament (ACL). PURPOSE To quantify the number of systematic reviews and meta-analyses published on the ACL in the past decade and to provide an overall summary of this literature. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS A systematic review of all ACL-related systematic reviews and meta-analyses published between January 2004 and September 2014 was performed using PubMed, MEDLINE, and the Cochrane Database. Narrative reviews and non-English articles were excluded. RESULTS A total of 1031 articles were found, of which 240 met the inclusion criteria. Included articles were summarized and divided into 17 topics: anatomy, epidemiology, prevention, associated injuries, diagnosis, operative versus nonoperative management, graft choice, surgical technique, fixation methods, computer-assisted surgery, platelet-rich plasma, rehabilitation, return to play, outcomes assessment, arthritis, complications, and miscellaneous. CONCLUSION A summary of systematic reviews on the ACL can supply the surgeon with a single source for the most up-to-date synthesis of the literature.
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Affiliation(s)
| | | | | | | | - Leslie J. Bisson
- The State University of New York at Buffalo, Buffalo, New York, USA
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Zhao L, Thambyah A, Broom N. Crimp morphology in the ovine anterior cruciate ligament. J Anat 2015; 226:278-88. [PMID: 25677165 DOI: 10.1111/joa.12276] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2014] [Indexed: 11/30/2022] Open
Abstract
While the crimp morphology in ligaments and tendons has been described in detail in the literature, its relative distribution within the tissue has not been studied, especially in relation to the complex multi-bundle arrangement as is found in the anterior cruciate ligament (ACL). In this study, the crimp morphology of the ovine ACL was examined topologically and with respect to its double-bundle structure. The crimp morphologies were compared with the knee in three knee positions, namely stance, maximum extension and maximum flexion. As a control, the crimp morphology of the ACL free from its bony attachments was determined. In the control samples, the anterior-medial (AM) bundle contained a combination of coarse and fine crimp, whereas the posterior-lateral (PL) bundle manifested only a coarse crimp. Using the extent of crimp loss observed when subjecting the knee to the respective positions, and comparing with the controls, the crimp morphologies show that the AM bundle of the ACL is most active in the stance position, whereas for the maximum extension and flexion positions the PL bundle is most active. We propose that these differences in crimp morphologies have relevance to ACL design and function.
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Affiliation(s)
- Lei Zhao
- Experimental Tissue Mechanics Laboratory, Department of Chemical and Materials Engineering, University of Auckland, Auckland, New Zealand
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Lee SH, Choi JY, Kim DH, Kang BJ, Nam DC, Yoon HK, Hwang SC. Correlation between femoral guidewire position and tunnel communication in double bundle anterior cruciate ligament reconstruction. Yonsei Med J 2014; 55:1592-9. [PMID: 25323896 PMCID: PMC4205699 DOI: 10.3349/ymj.2014.55.6.1592] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The object of this study was to determine the shortest possible distances of antero-medial (AM) and postero-lateral (PL) guide wire tunnel positions required to prevent femoral bone tunnel communication in double-bundle anterior cruciate ligament (ACL) reconstruction using human cadaver knees. MATERIALS AND METHODS The centers of femoral AM and PL bundles of 16 cadaveric knees were drilled with guide wires and the distances of guide wires, were measured upon entrance into the bone. Femoral tunnel drilling was performed using transportal technique. The diameters of AM and PL graft were 8 mm and 6 mm, respectively. CT scans were taken on each knee, and 3-dimensional models were constructed to identify the femoral tunnel position and to create AM and PL tunnel virtual cylinders. Thickness of the bone bridge between the two tunnels was measured. RESULTS In four out of six specimens, in which the guide wires were placed at less than or equal to 9 mm, communication was noted. In specimens with guide wires placed at distances greater than or equal to 10 mm, communication was not noted. The two groups showed a statistically significant difference (p=0.008). In cases where the distance between the AM and PL femoral tunnel guide wires was 12 mm, the bone bridge thickness was greater than 2 mm along the tunnel. CONCLUSION The technique for double bundle-anterior cruciate ligament (DB-ACL) reconstruction that we show here can avoid bone tunnel communication when AM and PL femoral guide wires are placed at least 10 mm apart, and 12 mm should be kept to preserve 2 mm bone bridge thickness.
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Affiliation(s)
- Sang Hyuk Lee
- Department of Orthopaedic Surgery and Institute of Health Sciences, School of Medicine, Gyeongsang National University, Gyeongsang National University Hospital, Jinju, Korea
| | - Jun Young Choi
- Department of Thoracic and Cardiovascular Surgery and Institute of Health Sciences, School of Medicine, Gyeongsang National University, Gyeongsang National University Hospital, Jinju, Korea
| | - Dong Hee Kim
- Department of Orthopaedic Surgery and Institute of Health Sciences, School of Medicine, Gyeongsang National University, Gyeongsang National University Hospital, Jinju, Korea
| | - Bun Jung Kang
- Department of Orthopaedic Surgery and Institute of Health Sciences, School of Medicine, Gyeongsang National University, Gyeongsang National University Hospital, Jinju, Korea
| | - Dae Cheol Nam
- Department of Orthopaedic Surgery and Institute of Health Sciences, School of Medicine, Gyeongsang National University, Gyeongsang National University Hospital, Jinju, Korea
| | - Hong Kwon Yoon
- Department of Orthopaedic Surgery and Institute of Health Sciences, School of Medicine, Gyeongsang National University, Gyeongsang National University Hospital, Jinju, Korea
| | - Sun Chul Hwang
- Department of Orthopaedic Surgery and Institute of Health Sciences, School of Medicine, Gyeongsang National University, Gyeongsang National University Hospital, Jinju, Korea.
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Otani M, Nozaki M, Kobayashi M, Goto H, Tawada K, Waguri-Nagaya Y, Okamoto H, Iguchi H, Watanabe N, Otsuka T. Comparative risk of common peroneal nerve injury in far anteromedial portal drilling and transtibial drilling in anatomical double-bundle ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 2012; 20:838-43. [PMID: 21830114 DOI: 10.1007/s00167-011-1632-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2010] [Accepted: 07/18/2011] [Indexed: 12/12/2022]
Abstract
PURPOSE The purpose of this study was to investigate the risk of common peroneal nerve injury in FM drilling as compared to transtibial drilling in anatomical double-bundle ACL reconstruction. METHODS Ten cadaveric knees without ligament injury or significant arthritis were used for this study. Knees were secured at 90° and 120° of flexion. In transtibial drilling groups, a guide pin was drilled through either the anteromedial bundle (AMB) or posterolateral bundle (PLB) tibial insertion site to either the AMB or PLB femoral insertion site (tibial insertion site-femoral insertion site: AM-AM, PL-PL, PL-AM and AM-PL). In FM drilling groups (FM-AM and FM-PL),the pin was drilled at the AMB or PLB femoral insertion site through the FM. We measured the shortest distance between the point at which the pin ran through the lateral cortex of the femur and the ipsilateral common peroneal nerve at a knee flexion of 90° and 120°. RESULTS At a knee flexion of 90°, the shortest mean distance to the common peroneal nerve was 15.3 mm in the FM-PL group, 13.4 mm in the FM-AM group, 27.9 mm in the PL-PL group, 30.8 mm in the AM-AM group, 37.8 mm in the PL-AM group and 29.5 mm in the AM-PL group. At a knee of flexion 120°, the mean distance was 17.3 mm in the FM-PL group, 18.1 mm in the FM-AM group, 32.2 mm in the PL-PL group, 36.6 mm in the AM-AM group, 38.0 mm in the PL-AM group and 35.2 mm in the AM-PL group. Significant differences were observed between 90° and 120° of knee flexion in the FM-AM, PL-PL, AM-AM and AM-PL groups (P < 0.05). Significant differences were observed at flex 90° between the FM-AM group and AM-AM group, and between the FM-AM group and PL-AM group. Significant differences were observed at flex 120° between the FM-AM group and AM-AM group, between the FM-AM group and PL-AM group and between the FM-PL group and AM-PL group. CONCLUSION The distance to the peroneal nerve in FM drilling was significantly longer at 120° than at 90° of knee flexion. Therefore, the risk of peroneal injury using FM drilling should decrease at a higher angle of knee flexion.
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Affiliation(s)
- M Otani
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, 1-Kawasumi, Mizuho-Cho, Mizuho-Ku, Nagoya, 467-8601, Japan
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Gadikota HR, Seon JK, Chen CH, Wu JL, Gill TJ, Li G. In vitro and intraoperative laxities after single-bundle and double-bundle anterior cruciate ligament reconstructions. Arthroscopy 2011; 27:849-60. [PMID: 21624681 PMCID: PMC3105362 DOI: 10.1016/j.arthro.2010.12.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2010] [Revised: 09/14/2010] [Accepted: 12/02/2010] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to objectively evaluate whether double-bundle anterior cruciate ligament (ACL) reconstruction can better restore the normal translational and rotational laxities than the conventional single-bundle ACL reconstruction among the reported biomechanical studies. METHODS A systematic literature search was conducted to identify in vitro and in vivo (intraoperative) biomechanical studies that compared the laxities (anterior or anteroposterior or rotational) between single- and double-bundle ACL reconstructions. Because of large variability among the loading conditions and testing methods used to determine the rotational laxities among the studies, a meta-analysis of rotational laxities was not feasible. RESULTS Seven in vitro and three in vivo studies were included in this analysis based on the predefined inclusion criteria. The overall mean differences calculated by the random effects model in anteroposterior laxity between the single-bundle and double-bundle ACL reconstruction techniques at 0°, 30°, 60°, and 90° of flexion were 0.99 mm, 0.38 mm, 0.34 mm, and 0.07 mm, respectively. No statistically significant difference was noted between the 2 treatments at all flexion angles. Among the 9 studies that compared the rotational laxity of single-bundle and double-bundle ACL reconstructions, 4 reported that double-bundle reconstruction can provide better rotational control than single-bundle reconstruction. The other 5 studies could not identify any significant difference between the 2 reconstructions in terms of rotational laxity. CONCLUSIONS Both single- and double-bundle treatment options for ACL injury result in similar anteroposterior knee joint laxity at time 0. No conclusive evidence on the superiority of 1 reconstruction technique over the other in terms of rotation laxity can be obtained because of several variations in the experimental protocol and the kinematics used to measure the rotational laxity among the studies. LEVEL OF EVIDENCE Level III, meta-analysis.
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Affiliation(s)
- Hemanth R Gadikota
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Jong Keun Seon
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA,Department of Orthopaedic, Chonnam National University Hwasun Hospital, Jeonnam, South Korea
| | - Chih-Hui Chen
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA,Department of Orthopaedic Surgery, Taichung Veterans General Hospital, Taichung City, Taiwan
| | - Jia-Lin Wu
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA,Department of Orthopaedic Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Thomas J Gill
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Guoan Li
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA
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