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Knee joint kinematics after dynamic intraligamentary stabilization: cadaveric study on a novel anterior cruciate ligament repair technique

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Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusion

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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Acknowledgments

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).

Author information

Correspondence to Benedikt Schliemann.

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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.

Additional information

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

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Keywords

  • ACL instability
  • Knee joint kinematics
  • Dynamic intraligamentary stabilization
  • ACL reconstruction
  • ACL repair