Summary: In this biomechanical study on combined ACL-PCL multiligament knee reconstruction, no statistically significant difference was found between both sequences in terms of anterior or posterior tibial translation

Introduction

There is no consensus regarding which graft should be tensioned and fixed first in combined anterior (ACL) and posterior (PCL) multiligament reconstruction. Most clinical studies tend to tension and fix the PCL first, however there is no biomechanical evidence to support this. The purpose of this study was to determine which sequence of tensioning and fixation better restores normal knee laxity. The hypothesis was that tensioning and fixing ACL first, better restores knee kinematics.

Methods

Fifteen unpaired fresh frozen human cadaveric knees were tested after being prepared by dissecting the soft tissue around the femur and tibia approximately 10 cm from the knee joint line and then mounted into metal cylinders. A 6 degree of freedom robotic testing system was used to test each knee under 89 Newton anterior and posterior tibial loads at full extension (FE), 15°, 30°, 60° and 90° of knee flexion, as well as 7 Nm valgus with 5 Nm internal rotation (simulated pivot shift), (d) 5 Nm external rotation at FE, 15º and 30. The knee states that were evaluated were: (1) intact, (2) ACL and PCL deficient (3) ACL-PCL reconstruction with ACL fixation first, and (4) ACL-PCL reconstruction with PCL fixation first. The 3rd and 4th states were randomized. The ACL graft tensioning and fixation first on tibial side (at 30º of knee flexion) followed by PCL fixation (at 90º of knee flexion) then the order of tensioning was reversed for each knee. Anatomic ACL and PCL reconstruction was performed using a single bundle (9 mm) quadriceps tendon autograft for the anterior cruciate ligament (ACL) graft and a single bundle (9.5 mm) hamstrings autograft for the PCL. Both grafts were tensioned equally at 40 Newton. One-way repeated measures analysis of variance (ANOVA) with Bonferroni correction was used to compare knee kinematics between intact, deficient, ACL fixation first, and PCL fixation first. The p value prior to Bonferroni correction was set at 0.05.

Results

There were no statistically significant differences between both sequences regarding knee kinematics. Both sequences failed to fully restore the intact knee kinematics. ACL first showed no statistically differences for anterior tibial translation (ATT) as compared to the intact state at all tested knee flexion angles, while PCL first showed higher than intact ATT at 90º knee flexion (9.05 ± 3.05 mm vs. 5.87 ± 2.40 mm respectively, p = 0.018). Both sequences failed to restore posterior tibial translation (PTT) back to the intact state at 30º (p = 0.001), 60º (p < 0.001) and 90º (p < 0.001).

Conclusion

The most important finding of this study is that no statistically significant difference was found between both sequences in terms of ATT and PTT. ACL first tensioning and fixation restored intact ATT at all tested knee flexion angles. Neither sequence fully restored PTT to the intact state. This is consistent with clinical studies indicating residual posterior laxity after PCL reconstruction whether in isolation or after multi-ligament knee reconstruction.

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Can Pre-operative MRI Accurately Predict Hamstring Autograft Diameter in Anterior-cruciate Ligament Reconstruction? Abstract Presentation 6 minutes Michael Tan Arnold, BS, UNITED STATES Ignacio Garcia-Mansilla, MD, ARGENTINA Myra Trivellas, MD, UNITED STATES Thomas J. Kremen, MD, UNITED STATES
In Vivo Measurement of Anterior Cruciate Ligament Elongation and Strain Rate during Increasingly Demanding Activities ePoster Presentation Kyohei Nishida , MD, PhD, JAPAN Caiqi Xu, MD, CHINA Tom Gale, MS, UNITED STATES William Anderst, PhD, UNITED STATES Freddie H. Fu, MD, UNITED STATES
Combined Reconstruction Of The Medial Collateral Ligament And Anterior Cruciate Ligament Using Ipsilateral Semitendinosus Tendon And Opposite Semitendinosus With Ipsilateral Gracilis Tendon: A Minimum One-Year Follow-Up Study In NITOR.Dhaka,Bnagladesh Abstract Presentation 4 minutes Dibakar Sarkar, MS(Orthopaedic surgery),FACS(USA),AO fellow(Bangko, BANGLADESH
Does In Vivo Kinematics Following Acl Reconstruction With Or Without Lateral Extraarticular Tenodesis Correlate With Preoperative Quantitative Pivot Shift? Abstract Presentation 5 minutes Christopher M. Gibbs, MD, UNITED STATES Philipp Wilhelm Winkler, MD, AUSTRIA Jonathan D Hughes, MD, UNITED STATES Adam Popchak, DPT, PhD, UNITED STATES Daisuke Chiba, MD, PhD, JAPAN Bryson P. Lesniak, MD, UNITED STATES William Anderst, PhD, UNITED STATES Volker Musahl, MD, Prof., UNITED STATES
Value, Limitations And Recommendations For Use Of Metal-Reduction Knee MRI Sequences Following Anterior Cruciate Ligament Reconstruction Abstract Presentation 6 minutes Brandon Zhao, MD, CANADA Nabil Khan, MBChB, MMED, FCS Orth, CANADA Mark F. Sommerfeldt, MD, CANADA Anukul Panu, MD, CANADA Jacob L Jaremko, MD, PhD, CANADA Catherine May Ting Hui, MD, FRCSC, CANADA
Second-Look Arthroscopic Evaluation And Clinical Outcomes After Anatomical Double-Bundle Anterior Cruciate Ligament Reconstruction With Generalized Joint Laxity Or Hyperextended Knee Abstract Presentation 6 minutes Yasunari Oniki, MD, PhD, JAPAN Taiki Murakami, JAPAN Eiichi Nakamura, MD, PhD, JAPAN
Predicting Patient Lost to Follow-up in the STABILITY 1 Study: A Multi-centre, International, Randomized Controlled Trial of Young, Active Patients Undergoing Anterior Cruciate Ligament Reconstruction Abstract Presentation 6 minutes Andrew Firth, PhD, CANADA Dianne M. Bryant, PhD, CANADA Andrew Johnson, PhD, CANADA Stability Study Group, CANADA Alan Getgood, MD, FRCS(Tr&Orth), DipSEM, CANADA
Increased Osteoarthritis And Knee Instability Following Postoperative Septic Knee Arthritis After Anterior Cruciate Ligament Reconstruction with a Minimum 8 Year Follow-Up ePoster Presentation Thomas R. Pfeiffer, Prof., GERMANY Julius Stüber, cand. med., GERMANY Jan-Hendrik Naendrup, BS, MD, GERMANY Daniel Guenther, MD, PD, GERMANY Robin Otchwemah, MD, GERMANY Sven T. Shafizadeh, Prof., GERMANY Paola Kappel, MD, GERMANY Arasch Wafaisade, PD, GERMANY Sebastian Imach, MD, MBA, GERMANY
Factors associated with anterior cruciate ligament (ACL) reconstruction among ACL injuries in Alberta, Canada ePoster Presentation Yuba Raj Paudel, MPH, CANADA Mark F. Sommerfeldt, MD, CANADA Donald C. Voaklander, PhD, CANADA

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Acl - Pcl Fixation Sequence During Multi-Ligament Knee Reconstruction Does Not Affect Knee Laxity

Acl - Pcl Fixation Sequence During Multi-Ligament Knee Reconstruction Does Not Affect Knee Laxity

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Conclusion

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Acl - Pcl Fixation Sequence During Multi-Ligament Knee Reconstruction Does Not Affect Knee Laxity

Acl - Pcl Fixation Sequence During Multi-Ligament Knee Reconstruction Does Not Affect Knee Laxity

Introduction

Methods

Results

Conclusion

More ISAKOS 2021: Global Content