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ACL graft can replicate the normal ligament’s tension curve

Knee Surgery, Sports Traumatology, Arthroscopy volume 13, pages 625–631 (2005)Cite this article

Abstract

The anatomical femoral insertion of the normal anterior cruciate ligament (ACL) lies on the deep portion of the lateral wall of the intercondylar fossa. Following the deep bone–cartilage border, it stretches from 11 o’clock high in the notch all the way down to its lowest border at 8 o’clock. The tension curve of the normal ACL during passive flexion–extension shows a characteristic pattern with two tension peaks, one in full extension and the other in deep flexion. Low tension in mid-flexion is measured between those two peaks. Standard ACL reconstructions use a femoral insertion at 11 o’clock, which results in non-physiological tension curves with one peak in full extension only. The hypothesis was that it is possible to reproduce the typical tension curve of the normal ACL by placing the femoral tunnel into the low part of the normal ACL footprint. In a controlled laboratory study, three different femoral tunnel positions at 9, 10 and 11 o’clock were tested in four cadaver knees while using the identical standard tibial tunnel each time. The tension curve was measured during passive flexion–extension with a custom-made tension measurement device, using an artificial Dacron graft. The tension curve of grafts in the 9 o’clock tunnels showed the characteristic pattern of the normal ACL’s tension curve with tension peaks in extension as well as in deep flexion. The tunnels in the 10 and 11 o’clock positions failed to reproduce the normal ACL’s tension curve with high-tension values in extension only. Clinical relevance: If an ACL graft is placed low within the normal femoral footprint, the physiological tension curve of the normal ACL can be reproduced.

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Acknowledgements

Willem van de Wijdeven, from the Biomechanical Research Laboratory (BRL) of the Orthopaedic Department of St. Radboud University Medical Center in Nijmegen, The Netherlands, solved all the technical problems during the project. René van der Venne developed the software for the measurement of the relative tunnel positions, and Gerjon Hannink, also from the same facility, assisted in the statistical evaluation of the data. Jan Kooloos, from the Department of Anatomy of the University of Nijmegen, provided the specimens. Ruth Rose (Washington, DC) was the authors’ editor for the manuscript. The experiments comply with the current laws in the Netherlands.

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Affiliations

  1. Department of Orthopaedic Surgery, University Medical Centre, Hanzeplein 1, 9700, RB Groningen, The Netherlands

    Markus P. Arnold

  2. Orthopaedic Department, St. Radboud University Medical Centre, Nijmegen, The Netherlands

    Nico Verdonschot & Albert van Kampen

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  1. Markus P. Arnold
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  2. Nico Verdonschot
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  3. Albert van Kampen
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Correspondence to Markus P. Arnold.

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Arnold, M.P., Verdonschot, N. & van Kampen, A. ACL graft can replicate the normal ligament’s tension curve. Knee Surg Sports Traumatol Arthrosc 13, 625–631 (2005). https://doi.org/10.1007/s00167-004-0601-x

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  • DOI: https://doi.org/10.1007/s00167-004-0601-x

Keywords

  • Anterior cruciate ligament
  • Position
  • Anatomy
  • Tension
  • Surgery