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Restoring tibiofemoral alignment during ACL reconstruction results in better knee biomechanics

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

Abstract

Purpose

Anterior cruciate ligament (ACL) reconstruction (ACLR) aims to restore normal knee joint function, stability and biomechanics and in the long term avoid joint degeneration. The purpose of this study is to present the anatomic single bundle (SB) ACLR that emphasizes intraoperative correction of tibiofemoral subluxation that occurs after ACL injury. It was hypothesized that this technique leads to optimal outcomes and better restoration of pathological tibiofemoral joint movement that results from ACL deficiency (ACLD).

Methods

Thirteen men with unilateral ACLD were prospectively evaluated before and at a mean follow-up of 14.9 (SD = 1.8) months after anatomic SB ACLR with bone patellar tendon bone autograft. The anatomic ACLR replicated the native ACL attachment site anatomy and graft orientation. Emphasis was placed on intraoperative correction of tibiofemoral subluxation by reducing anterior tibial translation (ATT) and internal tibial rotation. Function was measured with IKDC, Lysholm and the Tegner activity scale, ATT was measured with the KT-1000 arthrometer and tibial rotation (TR) kinematics were measured with 3Dmotion analysis during a high-demand pivoting task.

Results

The results showed significantly higher TR of the ACL-deficient knee when compared to the intact knee prior to surgery (12.2° ± 3.7° and 10.7° ± 2.6° respectively, P = 0.014). Postoperatively, the ACLR knee showed significantly lower TR as compared to the ACL-deficient knee (9.6°±3.1°, P = 0.001) but no difference as compared to the control knee (n.s.). All functional scores were significantly improved and ATT was restored within normal values (P < 0.001).

Conclusions

Intraoperative correction of tibiofemoral subluxation that results after ACL injury is an important step during anatomic SB ACLR. The intraoperative correction of tibiofemoral subluxation along with the replication of native ACL anatomy results in restoration of rotational kinematics of ACLD patients to normal levels that are comparable to the control knee. These results indicate that the reestablishment of tibiofemoral alignment during ACLR may be an important step that facilitates normal knee kinematics postoperatively.

Level of evidence

Level II, prospective cohort study.

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Aknowledgements

The authors gratefully acknowledge the funding support from the Hellenic Association of Orthopaedic Surgery and Traumatology (HAOST-EEXOT).

Author information

Authors and Affiliations

  1. 1st Department of Orthopaedics, ATTIKON University General Hospital, Haidari, Greece

    Frantzeska Zampeli

  2. Orthopaedic Sports Medicine Center, Department of Orthopaedic Surgery, University of Ioannina, Ioannina, Greece

    Frantzeska Zampeli, Jim-Dimitris Georgoulis, Evangelos Pappas & Anastasios D. Georgoulis

  3. The-MIS, Center of Orthopaedic Surgery, Sports Medicine and Rehabilitation, St Luke’s Hospital, Thessaloniki, Greece

    Ioannis Terzidis

  4. Orthopaedics Department of Minho University, Minho, Portugal

    João Espregueira-Mendes

  5. Clínica do Dragão, Espregueira-Mendes Sports Centre - FIFA Medical Centre of Excellence, Porto, Portugal

    João Espregueira-Mendes

  6. Departement of Orthopaedic Surgery, Klinik Sanssouci, Helene-Lange, Potsdam, Germany

    Manfred Bernard

  7. Discipline of Physiotherapy-Faculty of Health Sciences, The University of Sydney, Sydney, Australia

    Evangelos Pappas

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  1. Frantzeska Zampeli
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Correspondence to Frantzeska Zampeli.

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The authors declare that they have no conflict of interest.

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

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The study was approved by the Ethical committee of the institution that the study was conducted.

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Patients were informed, and they consented to conduct the study.

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Zampeli, F., Terzidis, I., Espregueira-Mendes, J. et al. Restoring tibiofemoral alignment during ACL reconstruction results in better knee biomechanics. Knee Surg Sports Traumatol Arthrosc 26, 1367–1374 (2018). https://doi.org/10.1007/s00167-017-4742-0

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  • DOI: https://doi.org/10.1007/s00167-017-4742-0

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