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In vivo static and dynamic lengthening measurements of the posterior cruciate ligament at high knee flexion angles

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International Journal of Computer Assisted Radiology and Surgery Aims and scope Submit manuscript

Abstract

Purpose

Rehabilitation is an important aspect of both non-operative and operative treatments of knee ligament tear. Posterior cruciate ligament (PCL) non-operative treatment consists of a step-by-step rehabilitation protocol and is well described. It goes from rest (phase I) to strengthening exercises (phase IV). More specific and high-intensity exercises such as cutting, sidestepping or jumps are, however, not described in detail, as no in vivo data exist to tell how these exercises constrain the ligaments and whether they have the same effect on all of them, in particular regarding lengthening. The goal of this study was to measure the ligament lengthening in static knee flexion based on 3D reconstructions from magnetic resonance imaging (MRI) and from motion capture and ligament simulation during dynamic exercises.

Methods

The knee of nine volunteers was first imaged in a closed-bore MRI scanner at various static knee flexion angles (up to 110°), and the corresponding lengthening of the PCL and the other major knee ligaments was measured. Then, the volunteers underwent motion capture of the knee where dynamic exercises (sitting, jumping, sidestepping, etc.) were recorded. For each exercise, knee ligament elongation was simulated and evaluated.

Results

According to the MRI scans, maximal lengthening occurred at 110° of flexion in the anterior cruciate ligament and 90° of flexion in the PCL. Daily living movements such as sitting were predicted to elongate the cruciate ligaments, whereas they shortened the collateral ligaments. More active movements such as jumping put the most constrain to cruciate ligaments.

Conclusion

This study provides interesting insights into a tailored postoperative regimen. In particular, knowing the knee ligament lengthening during dynamic exercises can help better define the last stages of the rehabilitation protocol, and hence provide a safe return to play.

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Author information

Authors and Affiliations

  1. Medical Research Department, Artanim Foundation, 40, chemin du Grand-Puits, 1217, Meyrin, Geneva, Switzerland

    Caecilia Charbonnier & Sylvain Chagué

  2. Faculty of Medicine, University of Geneva, Geneva, Switzerland

    Caecilia Charbonnier

  3. Centre de médecine du sport et de l’exercice, Hirslanden Clinique La Colline, Geneva, Switzerland

    Victoria B. Duthon & Jacques Ménétrey

  4. Rive Droite Radiology Center, Geneva, Switzerland

    Frank C. Kolo

Authors
  1. Caecilia Charbonnier
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  2. Victoria B. Duthon
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  3. Sylvain Chagué
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  4. Frank C. Kolo
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  5. Jacques Ménétrey
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Correspondence to Caecilia Charbonnier.

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Ethical standard

Institutional ethical approval (CCER n°15-043) was obtained prior to data collection. All procedures performed in the study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from the individual participant included in the study.

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Charbonnier, C., Duthon, V.B., Chagué, S. et al. In vivo static and dynamic lengthening measurements of the posterior cruciate ligament at high knee flexion angles. Int J CARS 15, 555–564 (2020). https://doi.org/10.1007/s11548-019-02107-9

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  • DOI: https://doi.org/10.1007/s11548-019-02107-9

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