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Peak stresses shift from femoral tunnel aperture to tibial tunnel aperture in lateral tibial tunnel ACL reconstructions: a 3D graft-bending angle measurement and finite-element analysis

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

A Correction to this article was published on 08 December 2017

This article has been updated

Abstract

Purpose

To investigate the effect of tibial tunnel orientation on graft-bending angle and stress distribution in the ACL graft.

Methods

Eight cadaveric knees were scanned in extension, 45°, 90°, and full flexion. 3D reconstructions with anatomically placed anterior cruciate ligament (ACL) grafts were constructed with Mimics 14.12®. 3D graft-bending angles were measured for classic medial tibial tunnels (MTT) and lateral tibial tunnels (LTT) with different drill-guide angles (DGA) (45°, 55°, 65°, and 75°). A pivot shift was performed on 1 knee in a finite-element analysis. The peak stresses in the graft were calculated for eight different tibial tunnel orientations.

Results

In a classic anatomical ACL repair, the largest graft-bending angle and peak stresses are seen at the femoral tunnel aperture. The use of a different DGA at the tibial side does not change the graft-bending angle at the femoral side or magnitude of peak stresses significantly. When using LTT, the largest graft-bending angles and peak stresses are seen at the tibial tunnel aperture.

Conclusion

In a classic anatomical ACL repair, peak stresses in the ACL graft are found at the femoral tunnel aperture. When an LTT is used, peak stresses are similar compared to classic ACL repairs, but the location of the peak stress will shift from the femoral tunnel aperture towards the tibial tunnel aperture. Clinical relevance: the risk of graft rupture is similar for both MTTs and LTTs, but the location of graft rupture changes from the femoral tunnel aperture towards the tibial tunnel aperture, respectively.

Level of evidence

I.

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Fig. 1

(reprinted with permission from Arthroscopy, 2012 Jun; 28(6):818–826)

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Change history

  • 08 December 2017

    Unfortunately, one of the co-author’s name was missed in the original online publication of this article. The name should be included as sixth author in the author group.

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Acknowledgements

The computational resources (Stevin Supercomputer Infrastructure) and services used for the finite-element study were provided by Ghent University, the Hercules Foundation and the Flemish Government—department EWI.

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Author notes

  1. Hans Van Der Bracht and Thomas Tampere contributed equally to this paper.

Authors and Affiliations

  1. Department of Orthopaedic Surgery and Traumatology, AZ Sint-Lucas Gent, Groenebriel 1, 9000, Ghent, Belgium

    Hans Van Der Bracht & Alexander Schepens

  2. Department of Orthopaedics and Traumatology, University Hospital Ghent, De pintelaan 185, 9000, Ghent, Belgium

    Thomas Tampere, Pieter Beekman & Jan Victor

  3. Department of Biofluid, Tissue and Solid Mechanics for Medical Applications, bioMMeda, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium

    Wouter Devriendt

  4. Department of Orthopaedics and Traumatology, AZ Monica, Harmoniestraat 68, 2018, Antwerp, Belgium

    Peter Verdonk

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  1. Hans Van Der Bracht
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  2. Thomas Tampere
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  3. Pieter Beekman
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  4. Alexander Schepens
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Corresponding author

Correspondence to Pieter Beekman.

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Conflict of interest

The authors declare that they have no conflict of interests.

Funding

The authors received no financial support for the research, authorship, and/or this article.

Ethical approval

In these testaments is stated that the human body can be implemented in educational or research programs with no further specification. The body donation program guarantees high ethical standards during implementation of the human body in the different projects.

Informed consent

In the Ghent Anatomical Facility informed consent for anatomical study is given as people voluntary sign up for the body donation program.

Additional information

A correction to this article is available online at https://doi.org/10.1007/s00167-017-4821-2.

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Van Der Bracht, H., Tampere, T., Beekman, P. et al. Peak stresses shift from femoral tunnel aperture to tibial tunnel aperture in lateral tibial tunnel ACL reconstructions: a 3D graft-bending angle measurement and finite-element analysis. Knee Surg Sports Traumatol Arthrosc 26, 508–517 (2018). https://doi.org/10.1007/s00167-017-4739-8

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