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, Professor, SWEDEN
The Effect of Lateral Extra-Articular Tenodesis on Medial and Lateral Menisci Loading in Response To Simulated Tests of the Pivot Shift and Anterior Laxity Abstract Presentation 6 minutes Niv Marom, MD, ISRAEL Hamid Jahandar, BS, UNITED STATES Zaid Zayyad, MD, MS, UNITED STATES thomas fraychineaud, MD, UNITED STATES Herve Ouanezar, MD, UNITED ARAB EMIRATES Ronak M. Patel, MD, UNITED STATES Carl W Imhauser, PhD, UNITED STATES Thomas L. Wickiewicz, MD, UNITED STATES Andrew D. Pearle, MD, UNITED STATES Danyal H. Nawabi, MD, FRCS(Orth), UNITED STATES
Acl Deficiency Influences Medio-Lateral Tibial Alignment And Knee Varus–Valgus During In Vivo Activities Abstract Presentation 3 minutes Piero Agostinone, MD, ITALY Stefano Di Paolo, Eng, PhD, ITALY Alberto Grassi, PhD, ITALY Marco Bontempi, PhD, ITALY Erika Pinelli, MsC, ITALY Laura Bragonzoni, Prof., ITALY Stefano Zaffagnini, MD, Prof., ITALY
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
Higher Return To Pre-Injury Activity Levels Following ACL Reconstruction With Bone-Patellar Tendon-Bone Versus Hamstring Tendon Autograft In High Activity Patients: Results From The New Zealand ACL Registry Abstract Presentation 6 minutes Simon W. Young, MD, FRACS, NEW ZEALAND Richard Rahardja, MBChB, BMedSc(Hons), NEW ZEALAND Mark G. Clatworthy, FRACS, NEW ZEALAND Paul Monk, DPhil (Oxon), FRCS, NEW ZEALAND Hamish Love, FRACS, NEW ZEALAND
Local Anaesthetic Infiltration (Lia) Is Equally Effective As Adductor Nerve Blocks For Pain Relief In Anterior Cruciate Ligament (Acl) Reconstructions. Abstract Presentation 8 minutes Mohammad Abou Salhab, MBChB, MSc, UNITED KINGDOM Sonal Sonwalkar , FRCA, UNITED KINGDOM Sanjeev Anand, MD, UNITED KINGDOM Martin Stone, MD, UNITED KINGDOM
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
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, QATAR
High Rate of Initially Overlooked Kaplan Fiber Complex Injuries in Patients With Isolated Anterior Cruciate Ligament Injury Abstract Presentation 5 minutes Ryan M Bell, BS, UNITED STATES Daniel P. Berthold, Association.-Prof., GERMANY Lukas Willinger, MD, GERMANY Matthew R. Levasseur, MD, UNITED STATES Daniel Marrero, MD, UNITED STATES Lukas Nawid Muench, MD, GERMANY Andreas B. Imhoff, MD, Prof. Emeritus, GERMANY Elmar Herbst, MD, PhD, GERMANY Mark P. Cote, PT, DPT, MSCTR, UNITED STATES Robert A. Arciero, MD, UNITED STATES Cory M. Edgar, MD, PhD, 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