Elmar Herbst1, Fabio V Arilla2, Daniel Guenther3, Carlos Yacuzzi4, Ata A Rahnemai-Azar5, Freddie H Fu6, Richard E Debski5, Volker Musahl7. 1. Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A.; Department of Orthopaedic Sports Medicine, Technical University Munich, Munich, Germany. 2. Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A.; Department of Orthopaedic Surgery, Hospital Universitário, Canoas, Brazil. 3. Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A.; Trauma Department, Hannover Medical School, Hannover, Germany. 4. Orthopaedic Robotics Laboratory, Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A. 5. Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A.; Orthopaedic Robotics Laboratory, Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A. 6. Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A. 7. Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A.; Orthopaedic Robotics Laboratory, Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.. Electronic address: musahlv@upmc.edu.
Abstract
PURPOSE: To investigate knee kinematics in response to physical examinations to determine the effect of anterolateral capsular injury and lateral extra-articular tenodesis (LET) in anterior cruciate ligament (ACL)-deficient and -reconstructed knees. METHODS: Seven human lower limb cadavers were used in this study (mean age, 60 years; age range, 56-63 years). Physical examinations were performed, including the pivot-shift test, Lachman test, anterior drawer at 90°, and internal and external tibial rotation at 30°, 60°, and 90° of knee flexion. ACL injury and reconstruction and LET, all with and without an injured anterolateral capsule, were investigated. Tibial translation and rotation relative to the femur were measured by an electromagnetic tracking system during the physical examination. RESULTS: Anterior translation of the lateral knee compartment and internal tibial rotation during the pivot-shift test were highest in combined ACL-deficient and anterolateral capsule-deficient knees (12.3 ± 7.4 mm and 16.3° ± 8.5°, respectively). With the presence of an anterolateral capsular injury, a combined ACL reconstruction and LET reduced the anterior translation of the lateral knee compartment during the pivot-shift test significantly (P = .042), whereas anatomic ACL reconstruction did not. Internal tibial rotation displayed overconstraint when a LET was performed, especially when the anterolateral capsule was intact. CONCLUSIONS: ACL reconstruction in combination with a LET was able to reduce anterior tibial translation and internal tibial rotation in response to different physical examinations. However, combined ACL reconstruction and LET led to overconstraint of internal tibial rotation when the anterolateral capsule was intact. CLINICAL RELEVANCE: On the basis of our results, LET with ACL reconstruction restores stability in a combined ACL-injured and anterolateral capsule-injured knee. However, LET with ACL reconstruction overconstrains the knee in an isolated ACL injury.
PURPOSE: To investigate knee kinematics in response to physical examinations to determine the effect of anterolateral capsular injury and lateral extra-articular tenodesis (LET) in anterior cruciate ligament (ACL)-deficient and -reconstructed knees. METHODS: Seven human lower limb cadavers were used in this study (mean age, 60 years; age range, 56-63 years). Physical examinations were performed, including the pivot-shift test, Lachman test, anterior drawer at 90°, and internal and external tibial rotation at 30°, 60°, and 90° of knee flexion. ACL injury and reconstruction and LET, all with and without an injured anterolateral capsule, were investigated. Tibial translation and rotation relative to the femur were measured by an electromagnetic tracking system during the physical examination. RESULTS: Anterior translation of the lateral knee compartment and internal tibial rotation during the pivot-shift test were highest in combined ACL-deficient and anterolateral capsule-deficient knees (12.3 ± 7.4 mm and 16.3° ± 8.5°, respectively). With the presence of an anterolateral capsular injury, a combined ACL reconstruction and LET reduced the anterior translation of the lateral knee compartment during the pivot-shift test significantly (P = .042), whereas anatomic ACL reconstruction did not. Internal tibial rotation displayed overconstraint when a LET was performed, especially when the anterolateral capsule was intact. CONCLUSIONS: ACL reconstruction in combination with a LET was able to reduce anterior tibial translation and internal tibial rotation in response to different physical examinations. However, combined ACL reconstruction and LET led to overconstraint of internal tibial rotation when the anterolateral capsule was intact. CLINICAL RELEVANCE: On the basis of our results, LET with ACL reconstruction restores stability in a combined ACL-injured and anterolateral capsule-injured knee. However, LET with ACL reconstruction overconstrains the knee in an isolated ACL injury.
Authors: Lena Eggeling; T C Drenck; J Frings; M Krause; Alexander Korthaus; Anna Krukenberg; Karl-Heinz Frosch; Ralph Akoto Journal: Arch Orthop Trauma Surg Date: 2021-08-29 Impact factor: 3.067