The Importance of the ACL for the Function of the Knee: Relevance to Future Developments in Total Knee Arthroplasty

  • A. M. Chaudhari
  • C. O. Dyrby
  • T. P. Andriacchi


This chapter discusses the importance of the anterior cruciate ligament (ACL) for the function of the knee by examining the functional role of the cruciate ligaments in healthy knee joints and the functional results of different total knee designs. The cruciate ligaments influence the motion of the knee in multiple planes, restraining AP translations as well as axial rotations to varying degrees, based on the angle of flexion. Functional analyses of knee arthroplasty designs that retain no cruciate ligaments, the PCL only, and both ligaments show differences, with unicompartmental knee arthroplasties retaining function that is the closest to normal function. After total knee arthroplasties, even asymptomatic patients showed gait abnormalities such as quadriceps avoidance that could lead to reduced functional ability to perform activities of daily living over time. These results and continuing positive short- and long-term follow-up of patients who have received ACL-retaining prostheses should increase enthusiasm for these procedures in the future.


Anterior Cruciate Ligament Total Knee Arthroplasties Cruciate Ligament Posterior Cruciate Ligament Unicompartmental Knee Arthroplasties 
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  1. 1.
    Andriacchi TP et al (2004) Interactions between kinematics and loading during walking for the normal and ACL-deficient knee. J Biomech (in press)Google Scholar
  2. 2.
    Andriacchi TP, Strickland AB (1985) Biomechanics of normal and pathological human articulating joints. Proceedings of the NATO Advanced Study Institute. 93/83, Martinus Nijhoff, DordrechtGoogle Scholar
  3. 3.
    Andriacchi TP, et al (1982) The influence of total knee-replacement design on walking and stair-climbing. J Bone Joint Surg [Am] 64:1328–1335PubMedGoogle Scholar
  4. 4.
    Berchuck M, et al (1990) Gait adaptations by patients who have a deficient anterior cruciate ligament. J Bone Joint Surg [Am] 72:871–877PubMedGoogle Scholar
  5. 5.
    Berger RA, et al (1990) Functional differences following unicompartmental and total knee replacements. Trans 36th Annu Meeting Orthopedic Research Society 15/1:282, American Association of Orthopedic Surgeons, Rosemont, ILGoogle Scholar
  6. 6.
    Berger RA, et al (1989) Advantages of rising from a chair to quantitate human performance, Trans 35th Annu Meeting Orthopedic Research Society 14/91, American Association of Orthopedic Surgeons, Rosemont, ILGoogle Scholar
  7. 7.
    Berger RA, et al (1999) Unicompartmental knee arthroplasty. Clinical experience at 6-to 10-year follow-up. Clin Orthop Rel Res 367:50–60Google Scholar
  8. 8.
    Chassin EP et al (1996) Functional analysis of cemented medial unicompartmental knee arthroplasty. J Arthroplasty 11:553–559CrossRefPubMedGoogle Scholar
  9. 9.
    Cloutier JM, et al (1999) Total knee arthroplasty with retention of both cruciate ligaments. A nine to eleven-year follow-up study. J Bone Joint Surg [Am] 81:697–702PubMedGoogle Scholar
  10. 10.
    Feng EL, et al (1994) Progressive subluxation and polyethylene wear in total knee replacements with flat articular surfaces. Clin Orthop Rel Res 299:60–71Google Scholar
  11. 11.
    Hopp JF (1993) Effects of age and resistance training on skeletal muscle — a review, Phys Ther 73:361–373PubMedGoogle Scholar
  12. 12.
    Hughes MA et al (1996) The role of strength in rising from a chair in the functionally impaired elderly. J Biomech 29:1509–1513CrossRefPubMedGoogle Scholar
  13. 13.
    Lewis P et al (1994) Posteromedial tibial polyethylene failure in total knee replacements. Clin Orthop Rel Res 299:11–17Google Scholar
  14. 14.
    Schenkman M et al (1990) Whole-body movements during rising to standing from sitting. Phys Ther 70:638–651PubMedGoogle Scholar
  15. 15.
    Wasielewski RC et al (1994) Wear patterns on retrieved polyethylene tibial inserts and their relationship to technical considerations during total knee arthroplasty. Clin Orthop Rel Res 299:31–43Google Scholar

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© Springer Medizin Verlag Heidelberg 2005

Authors and Affiliations

  • A. M. Chaudhari
  • C. O. Dyrby
  • T. P. Andriacchi

There are no affiliations available

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