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Cited by 41Knee injuries and reconstruction techniquesFoot and Ankle SurgeryTendon Structure and Treatment

The effects of graft size and insertion site location during anterior cruciate ligament reconstruction on intercondylar notch impingement

Orsi, Alexander D., Canavan, Paul K., Vaziri, Askhan, Goebel, Ruben, Kapasi, Onaly A., Nayeb-Hashemi, Hamid·2017·The Knee
DOI 10.1016/j.knee.2017.02.010
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Abstract

Background Intercondylar notch impingement is detrimental to the anterior cruciate ligament (ACL). Notchplasty is a preventative remodeling procedure performed on the intercondylar notch during ACL reconstruction (ACLR). This study investigates how ACL graft geometry and both tibial and femoral insertion site location may affect ACL-intercondylar notch interactions post ACLR. A range of ACL graft sizes are reported during ACLR, from six millimeters to 11mm in diameter. Variability of three millimeters in ACL insertion site location is reported during ACLR. This study aims to determine the post-operative effects of minor variations in graft size and insertion location on intercondylar notch impingement.Methods Several 3D finite element knee joint models were constructed using three ACL graft sizes and polar arrays of tibial and femoral insertion locations. Each model was subjected to flexion, tibial external rotation, and valgus motion. Impingement force and contact area between the ACL and intercondylar notch compared well with experimental cadaver data from literature.Results A three millimeter anterior-lateral tibial insertion site shift of the maximum size ACL increased impingement force by 242.9%. A three millimeter anterior-proximal femoral insertion site shift of the maximum size ACL increased impingement by 346.2%. Simulated notchplasty of five millimeters eliminated all impingement for the simulation with the greatest impingement. For the kinematics applied, small differences in graft size and insertion site location led to large increases in impingement force and contact area.Conclusions Minor surgical variations may increase ACL impingement. The results indicate that notchplasty reduces impingement during ACLR. Notchplasty may help to improve ACLR success rates.

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Authors
Orsi, A. D., Canavan, P. K., Vaziri, A., Goebel, R., Kapasi, O. A., & Nayeb-Hashemi, H.
Affiliations
  • Northeastern University (US)
  • UMass Memorial Medical Center (US)
  • Qatar University (QA)
  • Brigham and Women's Faulkner Hospital (US)
ORCID
Venue
The Knee
Publisher
Elsevier BV
Published
2017-06
Volume
24
Issue
3
Pages
525-535
ISSN
0968-0160 (ISSN-L)
DOI
10.1016/j.knee.2017.02.010
OpenAlex
W2601807811
Cited by
41
References
50
Citations by year
2025: 10 · 2024: 3 · 2023: 3 · 2022: 7 · 2021: 10 · 2020: 2 · 2019: 3 · 2018: 3
FWCI
2.25
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • The Knee (publishedVersion)
  • PubMed (publishedVersion)
  • Qatar University QSpace (Qatar University) (submittedVersion)
Funders
Qatar National Research Fund (5-086-2-031)
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, notchplasty, contact area, knee kinematics, finite element knee model
MeSH terms
Biomechanical Phenomena, Computer Simulation, Femur, Humans, Stress, Mechanical, Tibia, Finite Element Analysis, Imaging, Three-Dimensional, Anterior Cruciate Ligament Reconstruction

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