Hans Van Der Bracht1, Thomas Tampere2, Pieter Beekman3, Alexander Schepens1, Wouter Devriendt4, Michiel Cromheecke2, Peter Verdonk5, Jan Victor2. 1. Department of Orthopaedic Surgery and Traumatology, AZ Sint-Lucas Gent, Groenebriel 1, 9000, Ghent, Belgium. 2. Department of Orthopaedics and Traumatology, University Hospital Ghent, De pintelaan 185, 9000, Ghent, Belgium. 3. Department of Orthopaedics and Traumatology, University Hospital Ghent, De pintelaan 185, 9000, Ghent, Belgium. pieterbeekman@gmail.com. 4. Department of Biofluid, Tissue and Solid Mechanics for Medical Applications, bioMMeda, Ghent University, De Pintelaan 185, 9000, Ghent, Belgium. 5. Department of Orthopaedics and Traumatology, AZ Monica, Harmoniestraat 68, 2018, Antwerp, Belgium.
Abstract
PURPOSE: To investigate the effect of tibial tunnel orientation on graft-bending angle and stress distribution in the ACL graft. METHODS: Eight cadaveric knees were scanned in extension, 45°, 90°, and full flexion. 3D reconstructions with anatomically placed anterior cruciate ligament (ACL) grafts were constructed with Mimics 14.12®. 3D graft-bending angles were measured for classic medial tibial tunnels (MTT) and lateral tibial tunnels (LTT) with different drill-guide angles (DGA) (45°, 55°, 65°, and 75°). A pivot shift was performed on 1 knee in a finite-element analysis. The peak stresses in the graft were calculated for eight different tibial tunnel orientations. RESULTS: In a classic anatomical ACL repair, the largest graft-bending angle and peak stresses are seen at the femoral tunnel aperture. The use of a different DGA at the tibial side does not change the graft-bending angle at the femoral side or magnitude of peak stresses significantly. When using LTT, the largest graft-bending angles and peak stresses are seen at the tibial tunnel aperture. CONCLUSION: In a classic anatomical ACL repair, peak stresses in the ACL graft are found at the femoral tunnel aperture. When an LTT is used, peak stresses are similar compared to classic ACL repairs, but the location of the peak stress will shift from the femoral tunnel aperture towards the tibial tunnel aperture. CLINICAL RELEVANCE: the risk of graft rupture is similar for both MTTs and LTTs, but the location of graft rupture changes from the femoral tunnel aperture towards the tibial tunnel aperture, respectively. LEVEL OF EVIDENCE: I.
PURPOSE: To investigate the effect of tibial tunnel orientation on graft-bending angle and stress distribution in the ACL graft. METHODS: Eight cadaveric knees were scanned in extension, 45°, 90°, and full flexion. 3D reconstructions with anatomically placed anterior cruciate ligament (ACL) grafts were constructed with Mimics 14.12®. 3D graft-bending angles were measured for classic medial tibial tunnels (MTT) and lateral tibial tunnels (LTT) with different drill-guide angles (DGA) (45°, 55°, 65°, and 75°). A pivot shift was performed on 1 knee in a finite-element analysis. The peak stresses in the graft were calculated for eight different tibial tunnel orientations. RESULTS: In a classic anatomical ACL repair, the largest graft-bending angle and peak stresses are seen at the femoral tunnel aperture. The use of a different DGA at the tibial side does not change the graft-bending angle at the femoral side or magnitude of peak stresses significantly. When using LTT, the largest graft-bending angles and peak stresses are seen at the tibial tunnel aperture. CONCLUSION: In a classic anatomical ACL repair, peak stresses in the ACL graft are found at the femoral tunnel aperture. When an LTT is used, peak stresses are similar compared to classic ACL repairs, but the location of the peak stress will shift from the femoral tunnel aperture towards the tibial tunnel aperture. CLINICAL RELEVANCE: the risk of graft rupture is similar for both MTTs and LTTs, but the location of graft rupture changes from the femoral tunnel aperture towards the tibial tunnel aperture, respectively. LEVEL OF EVIDENCE: I.
Authors: Hans Van der Bracht; Luk Verhelst; Yannick Goubau; Steffen Fieuws; Peter Verdonk; Johan Bellemans Journal: Arthroscopy Date: 2012-02-09 Impact factor: 4.772
Authors: Jae Gyoon Kim; Min Ho Chang; Hong Chul Lim; Ji Hoon Bae; Jin Hwan Ahn; Joon Ho Wang Journal: Am J Sports Med Date: 2013-08-27 Impact factor: 6.202
Authors: Andrew Duffee; Robert A Magnussen; Angela D Pedroza; David C Flanigan; Christopher C Kaeding Journal: J Bone Joint Surg Am Date: 2013-11-20 Impact factor: 5.284
Authors: Thomas Tampere; Tom Van Hoof; Michiel Cromheecke; Hans Van der Bracht; Jorge Chahla; Peter Verdonk; Jan Victor Journal: Knee Surg Sports Traumatol Arthrosc Date: 2016-09-13 Impact factor: 4.342
Authors: Carola F van Eck; Eric J Kropf; James R Romanowski; Bryson P Lesniak; Michael J Tranovich; C Niek van Dijk; Freddie H Fu Journal: Knee Surg Sports Traumatol Arthrosc Date: 2011-02-11 Impact factor: 4.342