Top

Knee Surgery, Sports Traumatology, Arthroscopy

Published in:

01-10-2015 | Knee

Biomechanical effect of posterolateral corner sectioning after ACL injury and reconstruction

Authors: Tommaso Bonanzinga, Cecilia Signorelli, Nicola Lopomo, Alberto Grassi, Maria Pia Neri, Giuseppe Filardo, Stefano Zaffagnini, Maurilio Marcacci

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 10/2015

Abstract

Purpose

Posterolateral corner structures functionally interact with the ACL. The aim of this study was to investigate the capability of an isolated ACL reconstruction control laxity parameters in a knee with combined ACL and PLC and the increase in terms of laxity produced by the resection of the PC in an ACL-deficient knee.

Method

An in vitro cadaveric study was performed on seven knees. The joints were analysed in the following conditions: intact, after ACL resection, after popliteus complex resection, after ACL reconstruction and after LCL. Testing laxity parameters were recorded with an intra-operative navigation system and defined as: AP displacement at 30° and 90° of flexion (AP30 and AP90) applying a 130 N load and IE at 30° and 90° of knee flexion with a 5 N load.

Results

Sectioning the ACL significantly increased the AP30 at 30° and 90° of knee flexion (p < 0.05). At 90° of knee flexion, the resection of the LCL determined a significant increase in terms of AP laxity (p < 0.05). At 90° has been found a significant difference for the IE laxity (p < 0.05) after PC resection. Sectioning the LCL produced a significant increase in IE laxity at 30° and 90° of knee flexion (p < 0.05).

Conclusion

Isolated ACL reconstruction is able to control the AP laxity with a combined complete lesion of the PLC at 30° of knee flexion, but not at higher angle of knee flexion. Considering the IE rotations, the reconstruction was not sufficient not even to control a partial lesion of the PLC. These findings suggest that additional surgical procedures should be considerate even when facing combined PLC lesion.

Bonanzinga T, Zaffagnini S, Grassi A, Marcheggiani Muccioli GM, Neri MP, Marcacci M (2014) Management of combined anterior cruciate ligament-posterolateral corner tears: a systematic review. Am J Sports Med 42(6):1496–1503CrossRefPubMed

Corten K, Bellemans J (2008) Cartilage damage determines intermediate outcome in the late multiple ligament and posterolateral corner-reconstructed knee: a 5- to 10-year follow-up study. Am J Sports Med 36(2):267–275CrossRefPubMed

Covey DC (2001) Current concepts review: injuries of the posterolateral corner of the knee. J Bone Joint Surg 83:106–118CrossRefPubMed

Driscoll MD, Isabell GP Jr, Conditt MA, Ismaily SK, Jupiter DC, Noble PC, Lowe WR (2012) Comparison of 2 femoral tunnel locations in anatomic single-bundle anterior cruciate ligament reconstruction: a biomechanical study. Arthroscopy 28(10):1481–1489CrossRefPubMed

Ferretti A, Monaco E, Giannetti S, Caperna L, Luzon D, Conteduca F (2011) A medium to long-term follow-up of ACL reconstruction using double gracilis and semitendinosus grafts. Knee Surg Sports Traumatol Arthrosc 19(3):473–478CrossRefPubMed

Gadikota HR, Seon JK, Kozanek M, Oh LS, Gill TJ, Montgomery KD, Li G (2009) Biomechanical comparison of single-tunnel-double-bundle and single-bundle anterior cruciate ligament reconstructions. Am J Sports Med 37(5):962–969CrossRefPubMedCentralPubMed

http://www.ndigital.com/medical/polarisfamily-techspecs.php. Date of display: July 1st, 2015

Gollehon DL, Torzilli PA, Warren RF (1987) The role of the posterolateral and cruciate ligaments in the stability of the human knee. A biomechanical study. J Bone Joint Surg Am 69:233–242PubMed

Kanamori A, Sakane M, Zeminski J, Rudy TW, Woo SL (2000) In-situ force in the medial and lateral structures of intact and ACL-deficient knees. J Orthop Sci 5:567–571CrossRefPubMed

10.

Kannus P (1989) Nonoperative treatment of Grade II and III sprains of the lateral ligament compartment of the knee. Am J Sports Med 17:83–88CrossRefPubMed

11.

Kim YC, Chung IH, Yoo WK, Shu JS, Kim SJ, Park CI (1997) Anatomic and magnetic resonance imaging of the posterolateral structures of the knee. Clin Anat 10:397–404CrossRefPubMed

12.

LaPrade RF, Hamilton CD, Engebretsen L (1997) Treatment of acute and chronic combined anterior cruciate ligament and posterolateral knee ligament injuries. Sports Med Arthrosc Rev 5:91–99CrossRef

13.

LaPrade RF, Johansen S, Wentorf FA, Engebretsen L, Esterberg JL, Tso A (2004) An analysis of an anatomical posterolateral knee reconstruction: an in vitro biomechanical study and development of a surgical technique. Am J Sports Med 32(6):1405–1414CrossRefPubMed

14.

LaPrade RF, Resig S, Wentorf F, Lewis JL (1999) The effects of grade III posterolateral knee complex injuries on anterior cruciate ligament graft force. A biomechanical analysis. Am J Sports Med 27:469–475PubMed

15.

LaPrade RF, Wentorf FA, Fritts H, Gundry C, Hightower CD (2007) A prospective magnetic resonance imaging study of the incidence of posterolateral and multiple ligament injuries in acute knee injuries presenting with a hemarthrosis. Arthroscopy 23(12):1341–1347CrossRefPubMed

16.

Lenschow S, Zantop T, Weimann A, Lemburg T, Raschke M, Strobel M, Petersen W (2006) Joint kinematics and in situ forces after single bundle PCL reconstruction: a graft placed at the center of the femoral attachment does not restore normal posterior laxity. Arch Orthop Trauma Surg 126:253–259CrossRefPubMed

17.

Marcacci M, Molgora AP, Zaffagnini S, Vascellari A, Iacono F, Presti ML (2003) Anatomic double-bundle anterior cruciate ligament reconstruction with hamstrings. Arthroscopy 19(5):540–546CrossRefPubMed

18.

Martelli S, Lopomo N, Bignozzi S, Zaffagnini S, Visani A (2007) Validation of a new protocol for navigated intraoperative assessment of knee kinematics. Comput Biol Med 37:872–878CrossRefPubMed

19.

Markolf KL, Graves BR, Sigward SM, Jackson SR, McAllister DR (2007) How well do anatomical reconstructions of the posterolateral corner restore varus stability to the posterior cruciate ligament-reconstructed knee? Am J Sports Med 35(7):1117–1122CrossRefPubMed

20.

Ménétrey J, Duthon VB, Laumonier T, Fritschy D. “Biological failure” of the anterior cruciate ligament graft (2008) Knee Surg Sports Traumatol Arthrosc 16(3):224–231

21.

Nielsen S, Helmig P (1986) Posterior instability of the knee joint. An experimental study. Arch Orthop Trauma Surg 105:121–125CrossRefPubMed

22.

Nielsen S, Helmig P (1986) The static stabilizing function of the popliteal tendon in the knee. An experimental study. Arch Orthop Trauma Surg 104:357–362CrossRefPubMed

23.

Nielsen S, Ovesen J, Rasmussen O (1985) The posterior cruciate ligament and rotatory knee instability. An experimental study. Arch Orthop Trauma Surg 104:53–56CrossRefPubMed

24.

Nielsen S, Rasmussen O, Ovesen J, Andersen K (1984) Rotatory instability of cadaver knees after transection of collateral ligaments and capsule. Arch Orthop Trauma Surg 103:165–169CrossRefPubMed

25.

O’Brien SJ, Warren RF, Pavlov H et al (1991) Reconstruction of the chronically insufficient anterior cruciate ligament with the central third of the patellar ligament. J Bone Joint Surg 73A:278–286

26.

Petersen W, Lenschow S, Weimann A, Strobel MJ, Raschke MJ, Zantop T (2006) Importance of femoral tunnel placement in double-bundle posterior cruciate ligament reconstruction: biomechanical analysis using a robotic/universal force-moment sensor testing system. Am J Sports Med 34:456–463CrossRefPubMed

27.

Seering WP, Piziali RL, Nagel DA, Schurman DJ (1980) The function of the primary ligaments of the knee in varus–valgus and axial rotation. J Biomech 13:785–794CrossRefPubMed

28.

Siston RA, Delp SL (2006) Evaluation of a new algorithm to determine the hip joint center. J Biomech 39:125–130CrossRefPubMed

29.

Veltri DM, Deng XH, Torzilli PA, Warren RF, Maynard MJ (1995) The role of the cruciate and posterolateral ligaments in stability of the knee. A biomechanical study. Am J Sports Med 23:436–443CrossRefPubMed

30.

Vogrin TM, Hoher J, Aroen A, Woo SL, Harner CD (2000) Effects of sectioning the posterolateral structures on knee kinematics and in situ forces in the posterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc 8:93–98CrossRefPubMed

31.

Wang JH, Kato Y, Ingham SJ, Maeyama A, Linde-Rosen M, Smolinski P, Fu FH (2012) Measurement of the end-to-end distances between the femoral and tibial insertion sites of the anterior cruciate ligament during knee flexion and with rotational torque. Arthroscopy 28(10):1524–1532CrossRefPubMed

32.

Wroble RR, Grood ES, Cummings JS, Henderson JM, Noyes FR (1993) The role of the lateral extraarticular restraints in the anterior cruciate ligament-deficient knee. Am J Sports Med 21:257–263CrossRefPubMed

33.

Zaffagnini S, Bignozzi S, Martelli S, Imakiire N, Lopomo N, Marcacci M (2006) New intraoperative protocol for kinematic evaluation of ACL reconstruction: preliminary results. Knee Surg Sports Traumatol Arthrosc 14:811–816CrossRefPubMed

34.

Zaffagnini S, Marcheggiani Muccioli GM, Signorelli C, Lopomo N, Grassi A, Bonanzinga T, Nitri M, Marcacci M (2014) Anatomic and nonanatomic double-bundle anterior cruciate ligament reconstruction: an in vivo kinematic analysis. Am J Sports Med 42(3):708–715CrossRefPubMed

35.

Zantop T, Schumacher T, Diermann N, Schanz S, Raschke MJ, Petersen W (2007) Anterolateral rotational knee instability: role of posterolateral structures. Winner of the AGA-DonJoy Award 2006. Arch Orthop Trauma Surg 127(9):743–752CrossRefPubMed

Title: Biomechanical effect of posterolateral corner sectioning after ACL injury and reconstruction
Authors: Tommaso Bonanzinga
Cecilia Signorelli
Nicola Lopomo
Alberto Grassi
Maria Pia Neri
Giuseppe Filardo
Stefano Zaffagnini
Maurilio Marcacci
Publication date: 01-10-2015
Publisher: Springer Berlin Heidelberg
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 10/2015
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-015-3696-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Biomechanical effect of posterolateral corner sectioning after ACL injury and reconstruction

Abstract

Purpose

Method

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Method

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 10/2015

Outcomes following anatomic fibular (lateral) collateral ligament reconstruction

Intra-articular peroneal nerve incarceration following multi-ligament knee injury

The role of the meniscotibial ligament in posteromedial rotational knee stability

Novel approach to dynamic knee laxity measurement using capacitive strain gauges

Subclinical cartilage degeneration in young athletes with posterior cruciate ligament injuries detected with T1ρ magnetic resonance imaging mapping

MRI injury patterns in surgically confirmed and reconstructed posterolateral corner knee injuries