1. Lateral extra-articular reconstruction length changes during weightbearing knee flexion and pivot shift: A simulation study
- Author
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Mathieu Thaunat, Jacques A. de Guise, Adnan Saithna, Yoann Blache, Biova Kouevidjin, Raphaël Dumas, Bertrand Sonnery-Cottet, Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM ), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Université Jean Monnet [Saint-Étienne] (UJM)-Université Savoie Mont Blanc (USMB [Université de Savoie] [Université de Chambéry]), Group Ramsay-générale de santé, Centre orthopédique Santy , hôpital privé Jean-Mermoz, Laboratoire de recherche en imagerie et orthopédie [Montréal] (LIO), Ecole de Technologie Supérieure [Montréal] (ETS)-Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal (UdeM)-Université de Montréal (UdeM), Laboratoire de Biomécanique et Mécanique des Chocs (LBMC UMR T9406), Université de Lyon-Université de Lyon-Institut Français des Sciences et Technologies des Transports, de l'Aménagement et des Réseaux (IFSTTAR), Southport and Ormskirk Hospitals, Centre orthopédique Santy, hôpital privé Jean-Mermoz, and this workwas performed within the framework of the LABEX PRIMES (ANR-11-LABX-0063) of Université de Lyon, within the 'Investissementsd'Avenir' program (ANR-11-IDEX-0007) operated by the FrenchNational Research Agency (ANR). The study was supported by the'Ramsay-Générale de Santé' group in Paris, France (COS-RGDS-2017-06-014-P-THAUNAT-M).
- Subjects
Adult ,Male ,musculoskeletal diseases ,Anterolateral ligament ,medicine.medical_specialty ,Knee Joint ,Anterior cruciate ligament ,Pivot shift ,Knee flexion ,Knee kinematics ,Weight-Bearing ,BIOMECANIQUE ,[SPI]Engineering Sciences [physics] ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Computer Simulation ,Orthopedics and Sports Medicine ,Femur ,GENOU ,Range of Motion, Articular ,Physical Examination ,Orthodontics ,030222 orthopedics ,ANTEROLATERAL LIGAMENT ,Anterior Cruciate Ligament Reconstruction ,Tibia ,business.industry ,Biomechanics ,[SPI.MECA.BIOM]Engineering Sciences [physics]/Mechanics [physics.med-ph]/Biomechanics [physics.med-ph] ,food and beverages ,030229 sport sciences ,COMPUTER MODELING ,musculoskeletal system ,Biomechanical Phenomena ,Surgery ,medicine.anatomical_structure ,Ligaments, Articular ,Squatting position ,KNEE ,business ,Epicondyle ,ANTERIOR CRUCIATE LIGAMENT - Abstract
Introduction Variations in the length of lateral extra-articular reconstruction (LER) have been widely investigated during knee flexion but there is no information about length changes during pivot shift. This study sought to assess the changes in LER tension during weightbearing knee flexion in a normal knee and in a computer-simulated pivot-shift scenario. Hypothesis Placing the femoral tunnel posterior and proximal to the lateral femoral epicondyle allows the LER to tighten early in the flexion range during weightbearing (squatting motion) and simulated pivot-shift. Material and methods A computer model was used to simulate weightbearing knee flexion and pivot shift scenarios. Changes in LER tension were calculated in both scenarios by estimating the distance between six femoral attachment sites (posterior and proximal to the lateral femoral epicondyle) and two tibial tunnel locations: Gerdy's tubercle (GT) and the anterolateral ligament (ALL) anatomic attachment site. Results Independent of the location of the femoral and tibial tunnels, the LER tightened by up to 22% of its resting length during the early portion of weightbearing knee flexion and then relaxed from 40° to 60° of knee flexion. The ALL tibial tunnel position allowed complete LER relaxation at 60° flexion whereas LER using the GT tibial tunnel position remained tighter. In the simulated pivot-shift test, and for all femoral tunnel locations, the LER tightened by 20% to 34% of its resting value for the GT tibial tunnel position and by 11% to 26% for the ALL tibial tunnel position. Discussion During weightbearing knee flexion, placing the femoral tunnel proximal and posterior to the femoral epicondyle was associated with LER tightening in the early degrees of flexion and LER relaxation between 40 and 60° flexion. LER tightening occurred during a simulated pivot-shift test supporting the concept that a posterior and proximal femoral LER tunnel position is most effective during weightbearing knee flexion and altered knee kinematics.
- Published
- 2019