Coordination of the anterior and posterior cruciate ligaments in constraining the varus–valgus and internal–external rotatory instability of the knee

Abstract.

 Tension along both cruciate ligaments was measured simultaneously under various loading conditions, and the interaction of these ligaments as constraints on knee instability was analyzed. Six fresh cadaveric knees were used. The attachments for both cruciate ligaments were detached from the femur and reattached to their original positions using metal plates equipped with 12 strain gauges. Each knee was moved under various loading conditions, and changes in tension along the cruciate ligaments were recorded simultaneously using the output of the strain gauges. Under varus torque, tension along the anterior cruciate ligament increased near full extension whereas that along the posterior cruciate ligament increased near 90° of flexion. Similar results were obtained under valgus torque. Under internal rotatory torque, a pattern similar to that under varus torque was also observed. Under external rotatory torque, no remarkable changes in tension were observed along either cruciate ligament. Thus, we conclude that both the anterior cruciate ligament and the posterior cruciate ligament cooperate to control varus–valgus and internal rotatory instabilities of the knee, and that the constraining function is transferred from the anterior cruciate ligament to the posterior cruciate ligament as the knee joint is flexed.