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Cited by 110Knee injuries and reconstruction techniquesFoot and Ankle SurgeryTendon Structure and Treatment

The effect of femoral attachment location on anterior cruciate ligament reconstruction: graft tension patterns and restoration of normal anterior–posterior laxity patterns

Zavras, T. Dionyssios, Race, Amos, Amis, Andrew A.·2005·Knee Surgery, Sports Traumatology, Arthroscopy
DOI 10.1007/s00167-004-0541-5
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Abstract

The issue of the best place to attach an anterior cruciate ligament graft to the femur is controversial, and different anatomic or isometric points have been recommended. It was hypothesised that one attachment site could be identified that would be best for restoring normal anterior–posterior laxity throughout the range of knee flexion. It was also hypothesised that these different attachment sites would cause different graft tension patterns during knee flexion. Using six cadaver knees, an isometric point was found 3 mm distal to the posterior edge of Blumensaat's line, at the 10:30–11:00 o'clock position in right knees, at the antero‐proximal edge of the anatomic ACL attachment. Anterior–posterior laxity was measured at ±150 N draw force at 20–120° flexion with the knee intact and after anterior cruciate ligament transection. The graft was placed at the isometric point, and AP laxity was restored to normal at 20° flexion, then measured at other angles. Graft tension was measured throughout, and also during passive flexion–extension. This was repeated for four other graft positions around the isometric point in every knee. Laxity was restored best by grafts tensioned to a mean of 9±14 N, positioned isometrically and 3 mm posterior to the isometric point. Their tension remained low until terminal extension. Grafts 3 mm anterior to the isometric point caused significant overconstraint, and had higher tension beyond 80° knee flexion. Small changes in attachment site had large effects on laxity and tension patterns. These results support an isometric/posterior anatomic femoral graft attachment, which restored knee laxity to normal from 20 to 120° flexion and did not induce high graft tension as the knee flexed. Grafts attached to the roof of the intercondylar notch caused overconstraint and higher tension in the flexed knee.

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Authors
Zavras, T. D., Race, A., & Amis, A. A.
Affiliations
Imperial College London (GB)
Corresponding author
Amis, Andrew A.
ORCID
Amis, Andrew A.
Venue
Knee Surgery, Sports Traumatology, Arthroscopy
Publisher
Wiley
Published
2004-12-10
Volume
13
Issue
2
Pages
92-100
ISSN
  • 0942-2056 (ISSN-L)
  • 1433-7347
DOI
10.1007/s00167-004-0541-5
OpenAlex
W1971259732
Cited by
110
References
41
Citations by year
2026: 1 · 2025: 2 · 2024: 2 · 2023: 5 · 2022: 6 · 2021: 4 · 2020: 6 · 2019: 3 · 2018: 8 · 2017: 10 · 2016: 4 · 2015: 5 · 2014: 5 · 2013: 5 · 2012: 11
FWCI
3.47
Type
journal article
Language
en
Open access
closed
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Knee Surgery Sports Traumatology Arthroscopy (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Surgery › Knee injuries and reconstruction techniques
  • Health Sciences › Medicine › Orthopedics and Sports Medicine › Foot and Ankle Surgery
  • Health Sciences › Medicine › Orthopedics and Sports Medicine › Tendon Structure and Treatment
Keywords
anterior cruciate ligament reconstruction, graft tension, anterior-posterior laxity, Blumensaat's line, knee flexion, intercondylar notch, cadaveric knee
MeSH terms
Anterior Cruciate Ligament Injuries, Biomechanical Phenomena, Cadaver, Femur, Humans, Joint Instability, Knee Injuries, Range of Motion, Articular, Anterior Cruciate Ligament, Tissue Transplantation, Orthopedic Procedures

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