Dynamic intraligamentary stabilization (DIS) has been introduced for the repair of acute anterior cruciate ligament (ACL) tears as an alternative to delayed reconstruction. The aim of the present study was to compare knee joint kinematics after DIS to those of the ACL-intact and ACL-deficient knee under simulated Lachman/KT-1000 and pivot-shift tests. We hypothesized that DIS provides knee joint kinematics equivalent to an intact ACL.
With the use of a robotic knee simulator, knee kinematics were determined in simulated Lachman/KT-1000 and pivot-shift tests at 0°, 15°, 30°, 60°, and 90° of flexion in eight cadaveric knees under the following conditions: (1) intact ACL, (2) ACL deficiency, (3) DIS with a preload of 60 N, and (4) DIS with a preload of 80 N. Statistical analyses were performed using two-factor repeated-measures analysis of variance. The significance level was set at a p value of <0.05.
After DIS with a preload of either 60 N or 80 N, the anterior translation was significantly reduced in the simulated Lachman/KT-1000 and pivot-shift tests when compared to the ACL-deficient knee (p < 0.05). No significant differences were observed between the DIS reconstruction with a preload of 80 N and the intact ACL with regard to anterior laxity in either test. However, DIS with a preload of only 60 N was not able to restore knee joint kinematics to that of an intact knee in all degrees of flexion.
DIS with a preload of 80 N restores knee joint kinematics comparable to that of an ACL-intact knee and is therefore capable of providing knee joint stability during ACL healing. DIS therefore provides a new technique for primary ACL repair with superior biomechanical properties in comparison with other techniques that have been described previously, although further clinical studies are required to determine its usefulness in clinical settings.
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Ahlden M, Samuelsson K, Sernert N, Forssblad M, Karlsson J, Kartus J (2012) The Swedish national anterior cruciate ligament register: a report on baseline variables and outcomes of surgery for almost 18,000 patients. Am J Sports Med 40(10):2230–2235
Aune AK, Holm I, Risberg MA, Jensen HK, Steen H (2001) Four-strand hamstring tendon autograft compared with patellar tendon-bone autograft for anterior cruciate ligament reconstruction. A randomized study with two-year follow-up. Am J Sports Med 29(6):722–728
Bach BR Jr, Tradonsky S, Bojchuk J, Levy ME, Bush-Joseph CA, Khan NH (1998) Arthroscopically assisted anterior cruciate ligament reconstruction using patellar tendon autograft. Five- to nine-year follow-up evaluation. Am J Sports Med 26(1):20–29
Barenius B, Forssblad M, Engstrom B, Eriksson K (2013) Functional recovery after anterior cruciate ligament reconstruction, a study of health-related quality of life based on the Swedish national knee ligament register. Knee Surg Sports Traumatol Arthrosc 21(4):914–927
Barrack RL, Skinner HB, Buckley SL (1989) Proprioception in the anterior cruciate deficient knee. Am J Sports Med 17(1):1–6
Daniel DM, Stone ML, Dobson BE, Fithian DC, Rossman DJ, Kaufman KR (1994) Fate of the ACL-injured patient. A prospective outcome study. Am J Sports Med 22(5):632–644
Eggli S, Kohlhof H, Zumstein M, Henle P, Hartel M, Evangelopoulos DS, Bonel H, Kohl S (2014) Dynamic intraligamentary stabilization: novel technique for preserving the ruptured ACL. Knee Surg Sports Traumatol Arthrosc 23(4):1215–1221
Fleming BC, Carey JL, Spindler KP, Murray MM (2008) Can suture repair of ACL transection restore normal anteroposterior laxity of the knee? An ex vivo study. J Orthop Res 26(11):1500–1505
Harilainen A, Linko E, Sandelin J (2006) Randomized prospective study of ACL reconstruction with interference screw fixation in patellar tendon autografts versus femoral metal plate suspension and tibial post fixation in hamstring tendon autografts: 5-year clinical and radiological follow-up results. Knee Surg Sports Traumatol Arthrosc 14(6):517–528
Heitmann M, Dratzidis A, Jagodzinski M, Wohlmuth P, Hurschler C, Puschel K, Giannakos A, Preiss A, Frosch KH (2014) Ligament bracing–augmented cruciate ligament sutures: biomechanical studies of a new treatment concept. Unfallchirurg 117(7):650–657
Henle P, Roder C, Perler G, Heitkemper S, Eggli S (2015) Dynamic Intraligamentary Stabilization (DIS) for treatment of acute anterior cruciate ligament ruptures: case series experience of the first three years. BMC Musculoskelet Disord 16:27. doi:10.1186/s12891-015-0484-7
Herbort M, Heletta S, Raschke MJ, Schliemann B, Osada N, Petersen W, Zantop T (2012) Accidental perforation of the lateral femoral cortex in ACL reconstruction: an investigation of mechanical properties of different fixation techniques. Arthroscopy 28(3):382–389
Herbort M, Lenschow S, Fu FH, Petersen W, Zantop T (2010) ACL mismatch reconstructions: influence of different tunnel placement strategies in single-bundle ACL reconstructions on the knee kinematics. Knee Surg Sports Traumatol Arthrosc 18(11):1551–1558
Herbort M, Tecklenburg K, Zantop T, Raschke MJ, Hoser C, Schulze M, Petersen W, Fink C (2013) Single-bundle anterior cruciate ligament reconstruction: a biomechanical cadaveric study of a rectangular quadriceps and bone–patellar tendon–bone graft configuration versus a round hamstring graft. Arthroscopy 29(12):1981–1990
Holm I, Oiestad BE, Risberg MA, Aune AK (2010) No difference in knee function or prevalence of osteoarthritis after reconstruction of the anterior cruciate ligament with 4-strand hamstring autograft versus patellar tendon-bone autograft: a randomized study with 10-year follow-up. Am J Sports Med 38(3):448–454
Jerosch J, Prymka M (1996) Knee joint proprioception in normal volunteers and patients with anterior cruciate ligament tears, taking special account of the effect of a knee bandage. Arch Orthop Trauma Surg 115(3–4):162–166
Kohl S, Evangelopoulos DS, Ahmad SS, Kohlhof H, Herrmann G, Bonel H, Eggli S (2014) A novel technique, dynamic intraligamentary stabilization creates optimal conditions for primary ACL healing: a preliminary biomechanical study. Knee 21(2):477–480
Kohl S, Evangelopoulos DS, Kohlhof H, Hartel M, Bonel H, Henle P, von Rechenberg B, Eggli S (2013) Anterior crucial ligament rupture: self-healing through dynamic intraligamentary stabilization technique. Knee Surg Sports Traumatol Arthrosc 21(3):599–605
Loh JC, Fukuda Y, Tsuda E, Steadman RJ, Fu FH, Woo SL (2003) Knee stability and graft function following anterior cruciate ligament reconstruction: comparison between 11 o’clock and 10 o’clock femoral tunnel placement. 2002 Richard O’Connor Award paper. Arthroscopy 19(3):297–304
Lubowitz JH (2014) Anatomic ACL reconstruction produces greater graft length change during knee range-of-motion than transtibial technique. Knee Surg Sports Traumatol Arthrosc 22(5):1190–1195
Marshall JL, Warren RF, Wickiewicz TL (1982) Primary surgical treatment of anterior cruciate ligament lesions. Am J Sports Med 10(2):103–107
Marshall JL, Warren RF, Wickiewicz TL, Reider B (1979) The anterior cruciate ligament: a technique of repair and reconstruction. Clin Orthop Relat Res 143:97–106
Meunier A, Odensten M, Good L (2007) Long-term results after primary repair or non-surgical treatment of anterior cruciate ligament rupture: a randomized study with a 15-year follow-up. Scand J Med Sci Sports 17(3):230–237
Murawski CD, van Eck CF, Irrgang JJ, Tashman S, Fu FH (2014) Operative treatment of primary anterior cruciate ligament rupture in adults. J Bone Joint Surg Am 96(8):685–694
Nguyen DT, Ramwadhdoebe TH, van der Hart CP, Blankevoort L, Tak PP, van Dijk CN (2014) Intrinsic healing response of the human anterior cruciate ligament: an histological study of reattached ACL remnants. J Orthop Res 32(2):296–301
Paessler HH, Deneke J, Dahners LE (1992) Augmented repair and early mobilization of acute anterior cruciate ligament injuries. Am J Sports Med 20(6):667–674
Petersen W, Tretow H, Weimann A, Herbort M, Fu FH, Raschke M, Zantop T (2007) Biomechanical evaluation of two techniques for double-bundle anterior cruciate ligament reconstruction: one tibial tunnel versus two tibial tunnels. Am J Sports Med 35(2):228–234
Sandberg R, Balkfors B, Nilsson B, Westlin N (1987) Operative versus non-operative treatment of recent injuries to the ligaments of the knee. A prospective randomized study. J Bone Joint Surg Am 69(8):1120–1126
Steadman JR, Matheny LM, Briggs KK, Rodkey WG, Carreira DS (2012) Outcomes following healing response in older, active patients: a primary anterior cruciate ligament repair technique. J Knee Surg 25(3):255–260
Woo SL, Debski RE, Wong EK, Yagi M, Tarinelli D (1999) Use of robotic technology for diathrodial joint research. J Sci Med Sport 2(4):283–297
Woo SL, Kanamori A, Zeminski J, Yagi M, Papageorgiou C, Fu FH (2002) The effectiveness of reconstruction of the anterior cruciate ligament with hamstrings and patellar tendon. A cadaveric study comparing anterior tibial and rotational loads. J Bone Joint Surg Am 84-A(6):907–914
Zantop T, Diermann N, Schumacher T, Schanz S, Fu FH, Petersen W (2008) Anatomical and nonanatomical double-bundle anterior cruciate ligament reconstruction: importance of femoral tunnel location on knee kinematics. Am J Sports Med 36(4):678–685
Zantop T, Schumacher T, Schanz S, Raschke MJ, Petersen W (2010) Double-bundle reconstruction cannot restore intact knee kinematics in the ACL/LCL-deficient knee. Arch Orthop Trauma Surg 130(8):1019–1026
B.S. and C.D. were supported by a research fellowship from the Faculty of Medicine, Westfälische Wilhelms-Universität Münster, Germany. The implants were provided by Mathys AG, Bettlach, Switzerland. The manuscript was edited by American Journal Experts (www.aje.com).
Conflicts of interest
JH. is an employee of the Mathys Company and was involved in the development of the implant. All other authors declare that they have no conflicts of interest.
Benedikt Schliemann and Simon Lenschow have contributed equally to this paper.
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Schliemann, B., Lenschow, S., Domnick, C. et al. Knee joint kinematics after dynamic intraligamentary stabilization: cadaveric study on a novel anterior cruciate ligament repair technique. Knee Surg Sports Traumatol Arthrosc 25, 1184–1190 (2017). https://doi.org/10.1007/s00167-015-3735-0
- ACL instability
- Knee joint kinematics
- Dynamic intraligamentary stabilization
- ACL reconstruction
- ACL repair