Abstract
A real improvement in anterior cruciate ligament (ACL) surgery would be achieved if a global kinematic evaluation of graft performance could be made during surgery. A quantitative evaluation of all residual instabilities would be helpful in the evaluation of graft performances. This paper describes a new protocol for an accurate and extensive computer-assisted in vivo evaluation of joint laxities during ACL reconstruction. Fifteen in vivo kinematic evaluations during ACL reconstruction were performed using an optical localizer and custom software. The capability of the protocol was studied by analyzing the accuracy and repeatability of the results, the ergonomics of the setup, time taken, interactions with the surgical steps, and efficacy of the acquisitions. Repeatability of the tests, at maximum force, remained under 1 mm/2°. Repeatability in tibia position and orientation was lower than 1 mm/4°. Secondary laxities during stress tests remained under 2 mm/3°. Added time to surgery was about 11 min. ACL graft increased joint stability up to 52% with respect to the preoperative level. The simplicity and morbidity of the test procedure and system was minimally invasive and allowed a quantitative evaluation of knee laxities at time zero. The repeatability of the tests opens the way for future research on in vivo evaluation of different ACL reconstruction techniques, which may lead to a better understanding of associated lesions and their role to the global knee stability.
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References
Allard P, Stokes I, Blanchi JP (1995) Three-dimensional analysis of human movement human kinetics PO Box 5076, Champaign, Illinois 61825
Amis AA, Dawkins GP (1991) Functional anatomy of the anterior cruciate ligament. Fibre bundle actions related to ligament replacements and injuries. J Bone Joint Surg Br 73(2):260–267
Balasch H, Schiller M, Friebel H, Hoffmann F (1999) Evaluation of anterior knee joint instability with the Rolimeter. A test in comparison with manual assessment and measuring with the KT-1000 arthrometer. Knee Surg Sports Traumatol Arthrosc 7(4):204–208
Boyer P, Djian P, Christel P, Paoletti X, Degeorges R (2004) Reliability of the KT-1000 arthrometer (Medmetric) for measuring anterior knee laxity: comparison with Telos in 147 knees. Rev Chir Orthop Reparatrice Appar Mot Dec 90(8):757–764
Cannon W, Dilworth MD (2002) Use of arthrometers to assess knee laxity and outcomes. Sports Med Arthrosc Rev 10(3):191–200
Daniel D, Akeson W, O'Connor J (1990) Knee Ligaments: Structure, Function, Injury, and Repair. Raven Press, New York, pp 153–161
Daniel D, Malcolm L, Losse G (1985) Instrumented measurement of anterior laxity of the knee. J Bone Joint Surg Am 67:720–726
Edixhoven P, Huiskes R, de Graaf R, van Rens TJ, Slooff TJ (1987) Accuracy and reproducibility of instrulented knee-drawer tests. J Orthop Res 5(3):378–387
Forster I, Warren-Smith C, Tew M (1989) Is the KT-1000 knee ligament arthrometer reliable? J Bone Joint Surg Br 71:843–847
Ganko L, Engebretsen L, Ozer H (2000) The rolimeter: a new arthrometer compared with the KT-1000. Knee Surg Sports Traumatol Arthrosc 8(1):36–39
Grood, ES, Suntay, WJ A joint coordination system for the clinical description of threedimensional motions: application to the knee. J Biomed Eng 105:136–144
Hrubesch R, Rangger C, Reichkendler R, Sailer RF, Gloetzer W, Eibl G (2000) Comparison of score evaluations and instrumented measurement after anterior cruciate ligament reconstruction. Am J Sports Med 28:850–856
Irrgang JJ, Anderson AF, Boland AL (2001) Development and validation of the international knee documentation committee subjective knee form. Am J Sports Med 29:600–613
Katabi M, Djian P, Christel P (2002) Anterior cruciate ligament reconstruction: patellar tendon autograft versus four-strand hamstring tendon autografts. A comparative study at one year follow-up. Rev Chir Orthop Reparatrice Appar Mot 88(2):139–148
Langrana NA, Bronfeld J (1985) Computer-assisted analysis of ligament constraints in the knee. Clin Orthop Rel Res 186:42–50
Loh JC, Fukuda Y, Tsuda E, Steadman R, Fu FH, Woo SL (2000) Knee stability and graft function following ACL reconstruction: comparison between 11 o’clock and 10 o’clock femoral tunnel placement. J Arthroscopy Relat Res 19(3):297–304
Marcacci M, Molgora AP, Zaffagnini S, Vascellari A, Iacono F, Presti ML (2003) Anatomic double-bundle anterior cruciate ligament reconstruction with hamstrings. Arthroscopy 19(5):540–546
Markolf LK, Kochan A, Amstutz HC (1984) Measurement of knee stiffness and laxity in patients with documented absence of the ACL. J Bone Joint Surg Am 66(2):242–252
Martelli S, Zaffagnini S, Falcioni B, Motta M (2001) Determination of an optimal kinematic protocol for computer-assisted evaluation of anterior cruciate ligament deficiency. Ann Biomed Eng 29(12):1112–1121
Martelli S (2003) New method for simultaneous anatomical and functional studies of articular joints and its application to the human knee. Comput Methods Programs Biomed 70:223–240
Pedowitz RA, Popejoy DJ (2004) Initial laxity does not correlate with subsequent laxity after ACL reconstruction in humans: a prospective evaluation. Am J Orthop Nov 33(11):560–564
Pollet V, Barrat D, Meirhaeghe E, Vaes P, Handelberg F. (2005) The role of the rolimeter in quantifying knee instability compared to the functional outcome of ACL-reconstructed versus conservatively-treated knees Epub 2004 Jun 19. Knee Surg Sports Traumatol Arthrosc 13(1):12–8
Saeki K, Mihalko WM, Patel V, Conway J, Naito M, Thrum H, Vandenneuker H, Whiteside LA (2001) Stability after medial collateral ligament release in total knee arthroscopy. Clin Orthop Relat Res 392:184–189
Shaw JA, Murray DG (1974) The longitudinal axis of the knee and the role of the cruciate ligaments in controlling transverse rotation. J Bone J Surg 56-A:161–170
Shino K (1987) Measurement of anterior instability of the knee. J Bone Joint Surg Br 69(4):608–613
Shoemaker SC (1982) In vivo rotatory knee stability. J Bone Joint Surg Am 64(2):208–216
Schuster AJ, McNicholas MJ, Wachtl SW, McGurty DW, Jakob RP (2004) A new mechanical testing device for measuring anteroposterior knee laxity. Am J Sports Med 32:1731–1735
Yamamoto Y, Hsu WH, Woo SL, Van Scyoc AH, Takakura Y, Debski RE (2004) Knee stability and graft function after anterior cruciate ligament reconstruction: a comparison of a lateral and an anatomical femoral tunnel placement. Am J Sports Med 32(8):1825–1832
Yoshioka Y, Siu DW, Scudamore RA, Cooke TD (1989) Tibial anatomy and functional axes. J Orthop Res 7:132–137
Zaffagnini S, Martelli S, Acquaroli F (2004) Computer investigation of ACL orientation during passive range of motion. Comput Biol Med 34(2):153–163
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Zaffagnini, S., Bignozzi, S., Martelli, S. et al. New intraoperative protocol for kinematic evaluation of ACL reconstruction: preliminary results. Knee Surg Sports Traumatol Arthr 14, 811–816 (2006). https://doi.org/10.1007/s00167-006-0057-2
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DOI: https://doi.org/10.1007/s00167-006-0057-2