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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Age, Time From Injury To Surgery And Quadriceps Strength Affect The Risk Of Revision Surgery After Primary Acl Reconstruction Abstract Presentation 6 minutes Riccardo Cristiani, MD, PhD, SWEDEN Magnus Forssblad, SWEDEN Gunnar Edman, MD, PhD, Prof., SWEDEN Karl Eriksson, MD, PhD, Prof., SWEDEN Anders Stalman, MD, PhD, Associate Professor, SWEDEN
Skeletally Immature Patients with Classic Anterior Cruciate Ligament Bone Bruise Patterns Have a Higher Chance of Having an Intact Anterior Cruciate Ligament than Skeletally Mature Patients Abstract Presentation 6 minutes Aaron Baessler, MD, UNITED STATES Jessica M Buchman, MD, UNITED STATES Dexter Witte, MD, UNITED STATES Tyler Brolin, MD, UNITED STATES Thomas Ward Throckmorton, MD Frederick M. Azar, MD, UNITED STATES David Lee Bernholt, MD, UNITED STATES
Ligamentous Laxity, Male Sex, Chronicity, Meniscus Injury And Posterior Tibial Slope Are Associated With A High-Grade Pre-Operative Pivot Shift: A Post Hoc Analysis Of The Stability Study Abstract Presentation 6 minutes Lachlan Batty, FRACS, AUSTRALIA Andrew Firth, PhD, CANADA Gilbert Moatshe, MD, PhD, NORWAY Dianne M. Bryant, PhD, CANADA S. Mark A. Heard, MD, FRCS, CANADA Robert G. McCormack, MD, CANADA Alex Rezansoff, MD, FRCSC, CANADA Devin Clarke Peterson, MD, FRCSC, Dip Sport Med, CANADA Davide Bardana, MD, CANADA Peter B. MacDonald, MD, FRCS, Dip Sport Med, CANADA Tim Spalding, FRCS(Orth), UNITED KINGDOM Alan Getgood, MD, FRCS(Tr&Orth), DipSEM, QATAR
Comparative Study Of “Concomitant Patellar Tendon Rupture With Anterior cruciate ligament tear and Patellar Tendon Rupture With Multi- Ligamentous Knee Injury –MLKI” Abstract Presentation 6 minutes Silvampatti Ramasamy Sundararajan, MS(Orth), INDIA Rajagopalakrishnan Ramakanth, D.ortho, DNB(ortho), D.SICOT, INDIA S Rajasekaran, MS(Orth),DOrth,DNB,FRCS(Ed),FRCS(Lon),MCh(Liv),PhD, INDIA
Early ROM exercise after ACLR with hamstring autograft does not cause joint laxity : A Prospective Randomized Controlled Trial, 2 years follow up ePoster Presentation Jeong-Ku Ha, MD, phD, Prof, KOREA, REPUBLIC OF Kyu Sung Chung, MD, PhD, Prof., KOREA, REPUBLIC OF
A Comparison of Lower Limb Strength and Plyometric Ability in Athletes who underwent ACLR with Lateral Extra-Articular Ilio-Tibial Band Tenodesis when compared with Isolated ACLR Surgery. A Biomechanical Study. Abstract Presentation 7 minutes Bláithín Brady, BSc MSc , IRELAND Sarah Crosbie, BSc, IRELAND Neil Welch, BSc MSc PhD, IRELAND Mihai Vioreanu, MD, MCh, FFSEM, FRCSI(Tr&Orth), IRELAND
Return To Elite Sport After ACL Reconstruction In 376 'Professional' Athletes Abstract Presentation 5 minutes Kyle Borque, MD, UNITED STATES Mary Jones, MSc, Grad. Dip. Phys., UNITED KINGDOM Ganesh Balendra, MBBS, AUSTRALIA Lukas Willinger, MD, GERMANY Vitor Hugo Pinheiro, MD, UNITED KINGDOM Andy Williams, MBBS, FRCS(Orth), FFSEM(UK), UNITED KINGDOM
Sex Related Outcomes Following Anterior Cruciate Ligament Reconstruction (Aclr): A Systematic Review and Meta-Analysis Abstract Presentation 5 minutes Anthony Charles Mok, BS, UNITED STATES Andrew J Fancher, BS, UNITED STATES Matthew L Vopat, MD, UNITED STATES Jordan Charles Baker, BS, UNITED STATES Armin Tarakemeh, BS, UNITED STATES Mary K. Mulcahey, MD, UNITED STATES Scott Mullen, MD, UNITED STATES Paul Schroeppel, MD, UNITED STATES Kimberly J. Templeton, MD, UNITED STATES Bryan Vopat, UNITED STATES
Quadriceps Tendon Autograft Has Lower MRI Signal Than Hamstring Tendon Autograft In Anterior Cruciate Ligament Reconstructions Of Adolescent Athletes Abstract Presentation 5 minutes David Alcoloumbre, MD, UNITED STATES Alexandra Hunter Aitchison, UNITED STATES Douglas Mintz, MD, UNITED STATES Frank A. Cordasco, MD, MS, UNITED STATES Daniel W. Green, MD, MS, UNITED STATES

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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

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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