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Soft-tissue graft fixation in posterior cruciate ligament reconstruction: evaluation of the effect of tibial insertion site on joint kinematics and in situ forces using a robotic/UFS testing system

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Abstract

Introduction

Surgical reconstruction of the posterior cruciate ligament (PCL) is recommended in acute injuries that result in severe tibial subluxation and instability. The surgical outcome level may be affected by the tibial fixation site. In response to a 110-N posterior tibial load, kinematics and in situ forces of anatomical soft-tissue graft fixation in single-bundle PCL reconstruction using an interference screw fixation are significantly closer to those in the intact knee than with extracortical fixation with two staples.

Materials and methods

Using a robotic/universal force moment sensor (UFS) testing system, we examined joint kinematics and in situ forces of porcine knees following single-bundle PCL reconstruction fixed at two different tibial fixation sites: anatomical interference screw and extracortical fixation.

Results

The site of the tibial graft fixation had significant effect on the resulting posterior displacement and in situ forces of the graft. Both PCL reconstruction techniques reduced the posterior tibial translation significantly. Proximal fixation techniques provided significantly less posterior tibial translation than extracortical fixation. Single-bundle PCL reconstruction with an interference screw showed higher in situ forces of the graft than the extracortical fixation.

Conclusions

The kinematics and in situ forces of a single-bundle PCL reconstruction using an interference screw fixation technique are superior to the primary stability of an extracortical fixation with staples.

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Acknowledgements

The authors thank the Deutschsprachige Arbeitsgemeinschaft für Arthroskopie (AGA) for funding of the robot. T.Z. is currently AGA Research Fellow at the Department of Orthopaedic Surgery, University of Pittsburgh. This fellowship is supported by Aircast. The authors thank Prof. Dr. Savio L.-Y. Woo since without his education and technical support an establishment of the robotic/UFS testing system would not have been possible. We also thank Mr. N. Settele from Kuka Robotics (Wolfsburg, Germany) for his technical advice. The UFS was provided by Amatech (Augsburg, Germany). We thank Prof. Schütt from the Department of Robotic Technology of the University Westkueste in Heide, Germany, for his technical support. The precise technical work of Mr. J. Studt and Mr. S. Zander is also deeply appreciated. The implants and instruments used in the present study were donated by Smith&Nephew (Hamburg, Germany). None of the authors received financial support of any commercial parties.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pa., USA

    Thore Zantop

  2. Department of Orthopaedic Surgery, Christian Albrecht University, Kiel, Germany

    Simon Lenschow

  3. KUKA Robotics, Augsburg, Germany

    Thomas Lemburg

  4. Department of Trauma, Hand, and Reconstructive Surgery, Westfälische Wilhelms Universität Münster, Waldeyerstrasse 1, 49148, Münster, Germany

    Andre Weimann & Wolf Petersen

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  1. Thore Zantop
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  5. Wolf Petersen
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Correspondence to Wolf Petersen.

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Zantop, T., Lenschow, S., Lemburg, T. et al. Soft-tissue graft fixation in posterior cruciate ligament reconstruction: evaluation of the effect of tibial insertion site on joint kinematics and in situ forces using a robotic/UFS testing system. Arch Orthop Trauma Surg 124, 614–620 (2004). https://doi.org/10.1007/s00402-004-0741-y

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