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Dynamic quantification of tibio-femoral rotation in postero-lateral bundle insufficiency of the anterior cruciate ligament: a cadaver study

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Abstract

Purpose

Anterior cruciate ligament (ACL) injury represents one of the most common diagnoses in orthopaedic sports medicine. In the past, anatomic knowledge about the different bundles within the cruciate ligaments triggered new treatment concepts, such as double-bundle ACL reconstruction. Recently, besides complete tearing, partial ACL ruptures and bundle augmentation became a focus. However, only little is known regarding rotational stability of the knee with an isolated torn postero-lateral (PL) bundle. Therefore, the aim of the present study was the torsiometric analysis of tibio-femoral restraint patterns of the PL-insufficient knee joint.

Methods

Fresh human whole body cadavers were enrolled. After diagnostic arthroscopy to ensure the structural integrity of the cruciate ligaments, knee joints underwent torsiometry at 0°, 30°, and 90° degree flexion. Then stepwise the PL bundle and the anteromedial (AM) bundle were arthroscopically resected, while torsiometry of the PL- as well as of the ACL-deficient knee joints was repeated. An area under the curve (AUC) was calculated. All statistical analyses were conducted using a p-value of 0.05 as level of significance.

Results

The comparison of charged and equilibrated curves during internal rotation revealed significant results at low flexion (30° flexion) angles between the ACL intact versus PL absent conditions (p = 0.04). In addition, charged and equilibrated curves during external rotation at 90° flexion, thus high angles, resulted in a significant difference when comparing the ACL-intact with the PL-deficient condition (p = 0.01).

Conclusions

In the present cadaver study using the Torsiometer tool we found a distinct destabilization of the rotational restraints in full knee extension only after total ACL resection. In contrast, no significant findings resulted after an isolated dissection of the PL bundle during internal deflection. Nevertheless, a significant loss of stability was found during unstressed external deflection after isolated PL bundle dissection. Therefore patients, undergoing PL augmentation might benefit regarding rotational instability patterns.

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Acknowledgements

We would like to explicitly thank Fritz Seidl, MA Interpreting and Translating, for his excellent language copyediting.

Conflict of interest

This study has been supported by a grant from the Deutsche Arthrose-Hilfe e.V. (Frankfurt am Main, Germany).

There is no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technische Universitaet Muenchen, Ismaningerstrasse 22, 81675, Munich, Germany

    Stephan Lorenz, Stefan Hinterwimmer & Andreas Obermeier

  2. Department of Trauma Surgery, Klinikum rechts der Isar, Technische Universitaet Muenchen, Ismaningerstrasse 22, 81675, Munich, Germany

    Philipp Ahrens, Marc Beirer & Chlodwig Kirchhoff

  3. Department of Orthopaedics, Klinikum Mittelbaden, Lilienmattstrasse 5, 76530, Baden-Baden, Germany

    Philipp Ahrens

  4. Institute of Clinical Radiology, Klinikum der Universitaet Muenchen – Campus Innenstadt, Ludwig-Maximilians Universitaet Muenchen, Nussbaumstrasse 20, 80336, Munich, Germany

    Sonja Kirchhoff

  5. Institute of Medical Statistics and Epidemiology, Klinikum rechts der Isar, Technische Universitaet Muenchen, Ismaninger Strasse 22, 81675, Munich, Germany

    Petra Wolf

Authors
  1. Stephan Lorenz
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  2. Philipp Ahrens
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Corresponding author

Correspondence to Chlodwig Kirchhoff.

Additional information

Stephan Lorenz and Philipp Ahrens contributed equally to this work.

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Lorenz, S., Ahrens, P., Kirchhoff, S. et al. Dynamic quantification of tibio-femoral rotation in postero-lateral bundle insufficiency of the anterior cruciate ligament: a cadaver study. International Orthopaedics (SICOT) 39, 865–870 (2015). https://doi.org/10.1007/s00264-014-2537-1

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  • DOI: https://doi.org/10.1007/s00264-014-2537-1

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