Skip to main content
SpringerLink
Log in

Roles of ACL remnants in knee stability

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

Abstract

Purpose

This study evaluated knee laxity in anterior tibial translation and rotation following removal of anterior cruciate ligament (ACL) remnants using a computer navigation system.

Methods

This prospective study included 50 knees undergoing primary ACL reconstruction using a navigation system. ACL remnants were classified into four morphologic types: Type 1, bridging between the roof of the intercondylar notch and tibia; Type 2, bridging between the posterior cruciate ligament and tibia; Type 3, bridging between the anatomical insertions of the ACL on the lateral wall of the femoral condyle and the tibia; and Type 4, no bridging of ACL remnants. Anterior tibial translation and rotatory laxity were measured before and after remnant resection using a navigation system at 30°, 60°, and 90° of knee flexion. The amount of change in anterior tibial translation and rotatory laxity of each type was compared among the types.

Results

The different morphologic types of ACL remnants were as follows: Type 1, 15 knees; Type 2, 9 knees; Type 3, 6 knees; and Type 4, 20 knees. The amount of change in anterior tibial translation and rotatory laxity at 30° knee flexion in Type 3 was significantly larger than in the other types. There were no significant differences in either tibial translation or rotatory laxity at 60° and 90° knee flexion among the types.

Conclusions

In Type 3, ACL remnants contributed to anteroposterior and rotatory knee laxity evaluated at 30° knee flexion. The bridging point of the remnants is important to knee laxity. The Type 3 remnant should be preserved as much as possible when ACL reconstruction surgery is performed.

Level of evidence

Prognostic study, Level II.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Adachi N, Ochi M, Uchio Y, Sumen Y (2000) Anterior cruciate ligament augmentation under arthroscopy. A minimum 2-year follow-up in 40 patients. Arch Orthop Trauma Surg 120:128–133

    Article  PubMed  CAS  Google Scholar 

  2. Adachi N, Ochi M, Uchino Y, Iwasa J, Ryoke K, Kuriwaka M (2002) Contribution of mechanoreceptors in the anterior cruciate ligament to the joint position sense knee. Acta Orthop Scand 73:330–334

    Article  PubMed  Google Scholar 

  3. Borbon CA, Mouzopoulos G, Siebold R (2012) Why perform an ACL augmentation? Knee Surg Sports Traumatol Arthrosc 20:245–251

    Article  PubMed  Google Scholar 

  4. Bray R, Leonard C, Salo P (2002) Vascular physiology and longterm healing of partial ligament tears. J Orthop Res 20:984–989

    Article  PubMed  Google Scholar 

  5. Buoncristiani AM, Tjoumakaris FP, Starman JS, Ferretti M, Fu FH (2006) Anatomic double-bundle anterior cruciate ligament reconstruction. Arthroscopy 22:1000–1006

    Article  PubMed  Google Scholar 

  6. Colombet P, Robinson J, Christel P, Franceschi JP, Djian P (2007) Using navigation to measure rotation kinematics during ACL reconstruction. Clin Orthop Relat Res 454:59–65

    Article  PubMed  Google Scholar 

  7. Crain EH, Fithian DC, Paxton EW, Luetzow WF (2005) Variation in anterior cruciate ligament scar pattern: does the scar pattern affect anterior laxity in anterior cruciate ligament-deficient knees? Arthroscopy 21:19–24

    Article  PubMed  Google Scholar 

  8. Georgoulis A, Pappa L, Moebius U et al (2001) The presence of proprioceptive mechanoreceptors in the remnants of the ruptured ACL as a possible source of re-innervation of the ACL autograft. Knee Surg Sports Traumatol Arthrosc 9:364–368

    Article  PubMed  CAS  Google Scholar 

  9. Gohil S, Annear PO, Breidahl W (2007) Anterior cruciate ligament reconstruction using autologous double hamstrings: a comparison of standard versus minimal debridement techniques using MRI to assess revascurisation. J Bone Joint Surg Br 89:1165–1171

    PubMed  CAS  Google Scholar 

  10. Hart R, Krejzla J, Svab P, Kocis J, Stipcak V (2008) Outcomes after conventional versus computer-navigated anterior cruciate ligament reconstruction. Arthroscopy 24:569–578

    Article  PubMed  Google Scholar 

  11. Hofbauer M, Valentin P, Kdolsky R, Ostermann RC, Graf A, Figl M, Aldrian S (2010) Rotational and translational laxity after computer-navigated single- and double\bundle anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 18:1201–1207

    Article  PubMed  CAS  Google Scholar 

  12. Ishibashi Y, Tsuda E, Tazawa K, Sato H, Toh S (2005) Intraoperative evaluation of the anatomical double-bundle anterior cruciate ligament reconstruction with the orthopilot navigation system. Orthopedics 28:s1277–s1282

    PubMed  Google Scholar 

  13. Lee S, Kim H, Jang J, Seong SC, Lee MC (2012) Comparison of anterior and rotatory laxity using navigation between single- and double-bundle ACL reconstruction: prospective randomized trial. Knee Surg Sports Traumatol Arthrosc 20:752–761

    Article  PubMed  Google Scholar 

  14. Lopomo N, Zaffagnini S, Bignozzi S, Visani A, Marcacci M (2010) Pivot-shift test: analysis and quantification of knee laxity parameters using a navigation system. J Orthop Res 28:164–169

    PubMed  Google Scholar 

  15. Maeda S, Ishibashi Y, Tsuda E, Yamamoto Y, Toh S (2011) Intraoperative navigation evaluation of tibial translation after resection of anterior cruciate ligament remnants. Arthroscopy 27:1203–1210

    Article  PubMed  Google Scholar 

  16. Monaco E, Labianca L, Conteduca F, De Carli A, Ferretti A (2007) Double bundle or single bundle plus extraarticular tenodesis in ACL reconstruction? A CAOS study. Knee Surg Sports Traumatol Arthros 15:1168–1174

    Article  CAS  Google Scholar 

  17. Nakamae A, Ochi M, Deie M, Adachi N, Kanaya A, Nishimori M, Nakasa T (2010) Biomechanical function of anterior cruciate ligament remnants: how long do they contribute to knee stability after injury in patients with complete tears? Arthroscopy 26:1577–1585

    Article  PubMed  Google Scholar 

  18. Muneta T, Koga H, Ju YJ, Horie M, Nakamura T, Sekiya I (2012) Remnant volume of anterior cruciate ligament correlates preoperative patient’s status and postoperative outcome. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-012-2023-5

    Google Scholar 

  19. Noyes FR, Bassett RW, Grood ES (1980) Arthroscopy in acute traumatic hemarthrosis of the knee. Incidence of anterior cruciate tears and other injuries. J Bone Joint Surg Am 62(687–695):757

    Google Scholar 

  20. Ochi M, Iwasa J, Uchino Y, Adachi N, Kawasaki K (2002) Induction of somatosensory evoked potentials by mechanical stimulation in reconstructed human anterior cruciate ligaments. J Bone Joint Surg Br 84:761–766

    Article  PubMed  CAS  Google Scholar 

  21. Robinson J, Carrat L, Granchi C, Colombet P (2007) Influence of anterior cruciate ligament bundles on knee kinematics: clinical assessment using computer-assisted navigation. Am J Sports Med 35:2006–2013

    Article  PubMed  Google Scholar 

  22. Siebold R, Fu F (2008) Assessment and augmentation of symptomatic anteromedial or posterolateral bundle tears of the anterior cruciate ligament. Arthroscopy 24:1289–1298

    Article  PubMed  Google Scholar 

  23. Tsuda E, Ishibashi Y, Fukuda A, Tsukada H, Toh S (2007) Validation of computer-assisted double-bundle anterior cruciate ligament reconstruction. Orthopedics 30:S136–S140

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, School of Medicine, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-0934, Japan

    Junsuke Nakase, Tatsuhiro Toratani, Masahiro Kosaka, Yoshinori Ohashi & Hiroyuki Tsuchiya

Authors
  1. Junsuke Nakase
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tatsuhiro Toratani
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Masahiro Kosaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yoshinori Ohashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hiroyuki Tsuchiya
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Junsuke Nakase.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Nakase, J., Toratani, T., Kosaka, M. et al. Roles of ACL remnants in knee stability. Knee Surg Sports Traumatol Arthrosc 21, 2101–2106 (2013). https://doi.org/10.1007/s00167-012-2260-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-012-2260-7

Keywords

Search

Navigation