Skip to main content
SpringerLink
Log in

Effect of graft fixation sequence on knee joint biomechanics in double-bundle anterior cruciate ligament reconstruction

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To investigate the effect of graft fixation sequence in double-bundle anterior cruciate ligament (ACL) reconstruction on knee biomechanics.

Methods

Twelve mature porcine knees underwent double-bundle ACL reconstruction with a randomized fixation order of the two graft bundles. The knees were subjected to external loadings of (1) an 89 N anterior tibial load at 30°, 60° and 90° of knee flexion and (2) 4 N-m internal and external tibial torques at 30° and 60° of knee flexion for ACL intact, deficient and reconstructed states. Knee kinematics and in situ graft forces were measured under the applied loads.

Results

The anterior tibial translation of the two reconstructions was not different from each other but was significantly different from the intact ACL. There was no difference in internal and external rotations between the intact knees and the reconstructions. At lower flexion angles, the graft that was fixed last (whether anteromedial or posterolateral) tended to carry significantly higher in situ load under anterior tibial loading and tibial torques.

Conclusion

While a difference in knee kinematics may not be observable with different graft fixation sequences, fixation sequence can alter the in situ forces that the grafts bear under knee loading.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Belisle AL, Bicos J, Geaney L, Andersen MH, Obopilwe E, Rincon L, Nyland J, Morgan C, Caborn DN, Arciero RA (2007) Strain pattern comparison of double- and single-bundle anterior cruciate ligament reconstruction techniques with the native anterior cruciate ligament. Arthroscopy 23:1210–1217

    Article  PubMed  Google Scholar 

  2. Branch T, Siebold R, Freedberg H, Jacobs C (2011) Double-bundle ACL reconstruction demonstrated superior clinical stability to single-bundle ACL reconstruction: a matched-pairs analysis of instrumented tests of tibial anterior translation and internal rotation laxity. Knee Surg Sports Traumatol Arthrosc 19:432–440

    Article  CAS  PubMed  Google Scholar 

  3. Chen C-H, Gadikota R, Gill T, Li G (2011) The effect of graft fixation sequence on force distribution in double-bundle anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 19(5):712–718

    Article  PubMed Central  PubMed  Google Scholar 

  4. Cohen SB, Fu FH (2007) Three-portal technique for anterior cruciate ligament reconstruction: use of a central medial portal. Arthroscopy 23(325):e321–e325

    Google Scholar 

  5. Cuomo P, Rama KR, Bull AM, Amis AA (2007) The effects of different tensioning strategies on knee laxity and graft tension after double-bundle anterior cruciate ligament reconstruction. Am J Sports Med 35(12):2083–2090

    Article  PubMed  Google Scholar 

  6. Ejerhed L, Kartus J, Sernert N, Kohler K, Karlsson J (2003) Patellar tendon or semitendinosus tendon autografts for anterior cruciate ligament reconstruction? A prospective randomized study with a two-year follow-up. Am J Sports Med 31:19–25

    PubMed  Google Scholar 

  7. Fu FH, Shen W, Starman JS, Okeke N, Irrgang JJ (2008) Primary anatomic double-bundle anterior cruciate ligament reconstruction: a preliminary 2-year prospective study. Am J Sports Med 36:1263–1274

    Article  PubMed  Google Scholar 

  8. Fujie H, Livesay GA, Woo SL, Kashiwaguchi S, Blomstrom G (1995) The use of a universal force-moment sensor to determine in situ forces in ligaments: a new methodology. J Biomech Eng 117:1–7

    Article  CAS  PubMed  Google Scholar 

  9. Fujie H, Livesay GA, Fujita M, Woo SL (1996) Forces and moments in six-DOF at the human knee joint: mathematical description for control. J Biomech 29:1577–1585

    Article  CAS  PubMed  Google Scholar 

  10. Gabriel MT, Wong EK, Woo SL, Yagi M, Debski RE (2004) Distribution of in situ forces in the anterior cruciate ligament in response to rotatory loads. J Orthop Res 22:85–89

    Article  PubMed  Google Scholar 

  11. Giron F, Cuomo P, Edwards A, Bull AM, Amis AA, Aglietti P (2007) Double-bundle “anatomic” anterior cruciate ligament reconstruction: a cadaveric study of tunnel positioning with a transtibial technique. Arthroscopy 23:7–13

    Article  PubMed  Google Scholar 

  12. Harner CD, Honkamp NJ, Ranawat AS (2008) Anteromedial portal technique for creating the anterior cruciate ligament femoral tunnel. Arthroscopy 24:113–115

    Article  PubMed  Google Scholar 

  13. Herbort M, Lenchow S, Fu FH, Petersen W, Zantop T (2010) ACL mismatch reconstructions: influence of different tunnel placement strategies in single-bundle ACL reconstructions on the knee kinematics. Knee Surg Sports Traumatol Arthrosc 18:1551–1558

    Article  PubMed  Google Scholar 

  14. Hemmerich A, van der Merwe W, Batterham M, Vaughan C (2011) Double-bundle ACL surgery demonstrates superior rotational kinematics to single-bundle technique during dynamic task. Clin Biomech 26(10):998–1004

    Article  CAS  Google Scholar 

  15. Kato Y, Maeyama A, Lertwanich P, Wang JH, Ingham S, Kramer S, Martins C, Smolinski P, Fu FH (2013) Biomechanical comparison of different graft positions for single-bundle anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 21:816–823

    Article  PubMed Central  PubMed  Google Scholar 

  16. Lam MH, Fong DT, Yung PS, Ho EP, Fung KY, Chan KM (2011) Knee rotational stability during pivoting movement is restored after anatomic double-bundle anterior cruciate ligament reconstruction. Am J Sports Med 39:1032–1038

    Article  PubMed  Google Scholar 

  17. Markolf KL, Park S, Jackson SR, McAllister DR (2008) Contributions of the posterolateral bundle of the anterior cruciate ligament to anterior–posterior knee laxity and ligament forces. Arthroscopy 24:805–809

    Article  PubMed  Google Scholar 

  18. Miura K, Woo SL, Brinkley R, Fu YC, Noorani S (2006) Effects of knee flexion angles for graft fixation on force distribution in double-bundle anterior cruciate ligament grafts. Am J Sports Med 34:577–585

    Article  PubMed  Google Scholar 

  19. Miyasaka KC, Daniel DM, Shore ML, Hirsham P (1991) The incidence of knee ligament injuries in the general population. Am J Knee Surg 4:3–8

    Google Scholar 

  20. Oster DM, Grood ES, Feder SM, Butler DL, Levy MS (1992) Primary and coupled motions in the intact and the ACL-deficient knee: an in vitro study in the goat model. J Orthop Res 10:476–484

    Article  CAS  PubMed  Google Scholar 

  21. Petersen W, Zantop T (2007) Anatomy of the anterior cruciate ligament with regard to its two bundles. Clin Orthop Relat Res 454:35–47

    Article  PubMed  Google Scholar 

  22. Sakane M, Fox RJ, Woo SL, Livesay GA, Li G, Fu FH (1997) In situ forces in the anterior cruciate ligament and its bundles in response to anterior tibial loads. J Orthop Res 15:285–293

    Article  CAS  PubMed  Google Scholar 

  23. Seon JK, Gadikota HR, Wu JL, Sutton K, Gill TJ, Li G (2010) Comparison of single- and double-bundle anterior cruciate ligament reconstructions in restoration of knee kinematics and anterior cruciate ligament forces. Am J Sports Med 38(7):1359–1367

    Article  PubMed  Google Scholar 

  24. Suomalainen P, Moisala A, Paakkala A, Kannus P, Järvelä T (2013) Comparison of tunnel placements and clinical results of single-bundle anterior cruciate ligament reconstruction before and after starting the use of double-bundle technique. Knee Surg Sports Traumatol Arthrosc 21:646–653

    Article  PubMed  Google Scholar 

  25. van Eck CF, Lesniak BP, Schreiber VM, Fu FH (2010) Anatomic single- and double-bundle anterior cruciate ligament reconstruction flowchart. Arthroscopy 26:258–268

    Article  PubMed  Google Scholar 

  26. Vercillo F, Woo SL, Noorani SY, Dede O (2007) Determination of a safe range of knee flexion angles for fixation of the grafts in double-bundle anterior cruciate ligament reconstruction: a human cadaveric study. Am J Sports Med 35:1513–1520

    Article  PubMed  Google Scholar 

  27. Woo SL, Fox RJ, Sakane M (1997) Force and force distribution in the anterior cruciate ligament and its clinical implications: first place winner of the inaugural GOTS-Beiersdorf research award competition for sports medicine. Sportorthopadie Sporttraumatologie 13:37–48

    Google Scholar 

  28. Wu C, Noorani S, Vercillo F, Woo SL (2009) Tension patterns of the anteromedial and posterolateral grafts in a double-bundle anterior cruciate ligament reconstruction. J Orthop Res 27:879–884

    Article  PubMed Central  PubMed  Google Scholar 

  29. Wu JL, Seon JK, Gadikota HR, Hosseini A, Sutton KM, Gill TJ, Li G (2010) In situ forces in the anteromedial and posterolateral bundles of the anterior cruciate ligament under simulated functional loading conditions. Am J Sports Med 38:558–563

    Article  PubMed Central  PubMed  Google Scholar 

  30. Xu Y, Liu J, Kramer S, Martins C, Kato Y, Linde-Rosen M, Smolinski P, Fu FH (2011) Comparison of in situ forces and knee kinematics in the anteromedial and high anteromedial bundle augmentation for partially ruptured anterior cruciate ligament. Am J Sports Med 39:272–278

    Article  PubMed  Google Scholar 

  31. Yasuda K, Kondo E, Ichiyama H, Kitamura N, Tanabe Y, Tohyama H, Minami A (2004) Anatomic reconstruction of the anteromedial and posterolateral bundles of the anterior cruciate ligament using hamstring tendon grafts. Arthroscopy 20:1015–1025

    Article  PubMed  Google Scholar 

  32. Yasuda K, Ichiyama H, Kondo E, Miyatake S, Inoue M, Tanabe Y (2008) An in vivo biomechanical study on the tension-versus knee flexion angle curves of 2 grafts in anatomic double-bundle anterior cruciate ligament reconstruction: effects of initial tension and internal tibial rotation. Arthroscopy 24:276–284

    Article  PubMed  Google Scholar 

  33. Zantop T, Petersen W, Sekiya JK, Musahl V, Fu FH (2006) Anterior cruciate ligament anatomy and function relating to anatomical reconstruction. Knee Surg Sports Traumatol Arthrosc 14:982–992

    Article  PubMed  Google Scholar 

  34. Zantop T, Herbort M, Raschke MJ, Fu FH, Petersen W (2007) The role of the anteromedial and posterolateral bundles of the anterior cruciate ligament in anterior tibial translation and internal rotation. Am J Sports Med 35:223–227

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, 1010 Kaufmann Building, Pittsburgh, PA, 15213, USA

    Dongliang Shi, Jingbin Zhou, Can Yapici, Monica Linde-Rosen, Patrick Smolinski & Freddie H. Fu

  2. Department of Pediatric Orthopaedic Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People’s Republic of China

    Dongliang Shi

  3. Department of Mechanical Engineering and Material Science, University of Pittsburgh, Pittsburgh, PA, USA

    Patrick Smolinski & Freddie H. Fu

Authors
  1. Dongliang Shi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jingbin Zhou
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Can Yapici
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Monica Linde-Rosen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Patrick Smolinski
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Freddie H. Fu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Freddie H. Fu.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shi, D., Zhou, J., Yapici, C. et al. Effect of graft fixation sequence on knee joint biomechanics in double-bundle anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 23, 655–660 (2015). https://doi.org/10.1007/s00167-014-3158-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-014-3158-3

Keywords

Search

Navigation