An In Vivo Prediction of Anisometry and Strain in Anterior Cruciate Ligament Reconstruction – A Combined Magnetic Resonance and Dual Fluoroscopic Imaging Analysis
Open accessAbstract
Purpose: To evaluate the in vivo anisometry and strain of theoretical anterior cruciate ligament (ACL) grafts in the healthy knee using various socket locations on both the femur and tibia. Methods: Eighteen healthy knees were imaged using magnetic resonance imaging and dual fluoroscopic imaging techniques during a step‐up and sit‐to‐stand motion. The anisometry of the medial aspect of the lateral femoral condyle was mapped using 144 theoretical socket positions connected to an anteromedial, central, and posterolateral attachment site on the tibia. The 3‐dimensional wrapping paths of each theoretical graft were measured. Comparisons were made between the anatomic, over the top (OTT), and most‐isometric (isometric) femoral socket locations, as well as between tibial insertions. Results: The area of least anisometry was found in the proximal‐distal direction just posterior to the intercondylar notch. The most isometric attachment site was found midway on the Blumensaat line with approximately 2% and 6% strain during the step‐up and sit‐to‐stand motion, respectively. Posterior femoral attachments resulted in decreased graft lengths with increasing flexion angles, whereas anterodistal attachments yielded increased lengths with increasing flexion angles. The anisometry of the anatomic, OTT and isometric grafts varied between tibial insertions ( P < .001). The anatomic graft was significantly more anisometric than the OTT and isometric graft at deeper flexion angles ( P < .001). Conclusions: An area of least anisometry was found in the proximal‐distal direction just posterior to the intercondylar notch. ACL reconstruction at the isometric and OTT location resulted in nonanatomic graft behavior, which could overconstrain the knee at deeper flexion angles. Tibial location significantly affected graft strains for the anatomic, OTT, and isometric socket location. Clinical Relevance: This study improves the knowledge on ACL anisometry and strain and helps surgeons to better understand the consequences of socket positioning during intra‐articular ACL reconstruction.
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Because forces and stresses are directly related to strains, investigators have measured ligament displacements and calculated strain patterns to gain an understanding of the in vivo biomechanics of ACL grafts.
“Because forces and stresses are directly related to strains, investigators have measured ligament displacements and calculated strain patterns to gain an understanding of the in vivo biomechanics of ACL grafts recently [7].”
From Dual fluoroscopic imaging and CT-based finite element modelling to estimate forces and stresses of grafts in anatomical single-bundle ACL reconstruction with different femoral tunnels (2021) · cites this paper as [7]
The Methods (Strain measurements; page not provided) describe calculating relative graft strain from changes in predicted graft length during in-vivo knee motion. The Discussion relates graft elongation to load through stress–strain behavior. However, the study modeled theoretical grafts in healthy knees; its Limitations state that no ACL reconstructions were performed, so it did not measure displacement or strain in actual ACL grafts. (LLM, conf=0.86)
Experimental — accuracy not yet measuredIsometric placement of the graft resulted in nonanatomical graft behaviour, which can overconstrain the knee at larger flexion angles.
“Isometric placement of the graft resulted in nonanatomical graft behaviour, which can overconstrain the knee at larger flexion angles [7].”
From Dual fluoroscopic imaging and CT-based finite element modelling to estimate forces and stresses of grafts in anatomical single-bundle ACL reconstruction with different femoral tunnels (2021) · cites this paper as [7]
The Discussion (page unavailable) says an isometric socket produces a nonanatomic reconstruction and that theoretical isometric grafts have higher relative strain than anatomic grafts beyond about 20° of flexion. It links excessive graft strain to over-constraint, but does not show that isometric placement overconstrains the knee at deeper flexion angles. (LLM, conf=0.85)
Experimental — accuracy not yet measuredStrains measured in previous works were predictions from measurements of length change and no actual ACL reconstructions were performed.
“But strains were predictions from the measurements of length change and no actual ACL reconstructions were performed in their works.”
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“Because forces and stresses are directly related to strains, investigators have measured ligament displacements and calculated strain patterns to gain an understanding of the in vivo biomechanics of ACL grafts recently [7].”
Background
- Authors
- Kernkamp, W. A., Varady, N. H., Li, J., Tsai, T., Asnis, P. D., van Arkel, E. R. A., Nelissen, R. G. H. H., Gill, T. J., Van de Velde, S. K., & Li, G.
- Affiliations
- Harvard University (US)
- Focus Clinic Orthopedic Surgery Haaglanden Medical Center The Hague The Netherlands
- Leiden University Medical Center (NL)
- Boston Sports Medicine and Research Institute Dedham Massachusetts U.S.A.
- Corresponding author
- Li, Guoan
- Venue
- Arthroscopy
- Publisher
- Wiley
- Published
- 2018-02-04
- Volume
- 34
- Issue
- 4
- Pages
- 1094-1103
- ISSN
- 0749-8063 (ISSN-L)
- 1526-3231
- PMC
- PMC5889360
- OpenAlex
- W2786281551
- Cited by
- 12
- References
- 33
- Citations by year
- 2024: 2 · 2023: 1 · 2022: 1 · 2021: 3 · 2020: 3 · 2018: 2
- FWCI
- 2.08
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- Locations
- Arthroscopy The Journal of Arthroscopic and Related Surgery (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Leiden Repository (Leiden University) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Funders
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (R01AR055612)
- 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, Blumensaat line, knee flexion, intercondylar notch
- MeSH terms
- Adolescent, Adult, Biomechanical Phenomena, Epiphyses, Female, Femur, Fluoroscopy, Humans, Knee Joint, Magnetic Resonance Imaging, Male, Middle Aged, Tibia, Range of Motion, Articular, Anterior Cruciate Ligament, Young Adult, Anterior Cruciate Ligament Reconstruction, Multimodal Imaging
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