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Anterior cruciate ligament graft fixation first in anterior and posterior cruciate ligament reconstruction best restores knee kinematics

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To evaluate the effect of different graft fixation sequences in one-stage anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) reconstruction on (1) knee biomechanics and (2) tibiofemoral alignment.

Methods

Twelve porcine knees were used in this study. Five fixation sequences were performed (angle indicating knee flexion): (a) PCL at 30° and ACL at 30°, (b) PCL at 90° and ACL at 30°, (c) ACL at 30° and PCL at 30°, (d) ACL at 30° and PCL at 90°, and (e) ACL and PCL simultaneous fixation at 30°. Anterior and posterior tibial translation was measured under an 89 N load. A 3-D digitizer was used to measure the change in anteroposterior (AP) tibiofemoral position.

Results

None of the graft fixation sequences restored the AP laxity of the intact knee, and there are minimal differences in the in situ tissue forces in the ACL and PCL grafts. The reconstructions with fixation of the PCL graft first resulted in a significantly larger change in AP tibiofemoral position from the intact knee at 60° and 90° of knee flexion than the reconstructions with fixation of the ACL graft first (p < 0.05).

Conclusion

Fixation of the ACL graft at 30° of knee flexion followed by fixation of the PCL graft can best restore the tibiofemoral position of the intact knee. This study has clinical relevance in regard to the effect of graft fixation sequence on the position of the tibia relative to the femur in one-stage ACL and PCL reconstruction.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Suite 1011, Pittsburgh, PA, 15213, USA

    Libin Zheng, Soheil Sabzevari, Monica A. Linde, Patrick Smolinski & Freddie H. Fu

  2. Department of Orthopaedic Surgery, Xiamen Chang Gung Hospital, Xiamen, China

    Libin Zheng

  3. Department of Orthopedic Surgery, Mashhad University of Medical Sciences, Mashhad, Iran

    Soheil Sabzevari

  4. Department of Mechanical Engineering and Material Science, University of Pittsburgh, Pittsburgh, PA, USA

    Brandon Marshall, Junjun Zhu, Patrick Smolinski & Freddie H. Fu

Authors
  1. Libin Zheng
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  2. Soheil Sabzevari
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  4. Junjun Zhu
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  5. Monica A. Linde
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  6. Patrick Smolinski
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  7. Freddie H. Fu
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Corresponding author

Correspondence to Freddie H. Fu.

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The authors declared that they have no conflicts of interest in the authorship and publication of this contribution.

Funding

This study was funded by the Department of Orthopedic Surgery at the University of Pittsburgh.

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No ethical approval was required from IACUC.

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Additional information

Investigation performed at the University of Pittsburgh, Pittsburgh, PA, USA.

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Zheng, L., Sabzevari, S., Marshall, B. et al. Anterior cruciate ligament graft fixation first in anterior and posterior cruciate ligament reconstruction best restores knee kinematics. Knee Surg Sports Traumatol Arthrosc 26, 1237–1244 (2018). https://doi.org/10.1007/s00167-017-4615-6

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  • DOI: https://doi.org/10.1007/s00167-017-4615-6

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