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Abstract
Objectives Given the common occurrence of residual laxity and re-injury post anterior cruciate ligament reconstruction (ACLR), additional anterolateral procedures are increasingly used in combination with an ACLR. Despite the perception that there is a risk of over-constraining the lateral tibiofemoral (LTF) compartment, potentially leading to osteoarthritis, assessment on their effect on intra-articular compartment pressures is still lacking. Our objective was therefore, through a pilot biomechanical study, to compare LTF contact pressures after the most commonly used anterolateral procedures.
Methods A controlled laboratory pilot study was performed using 4 fresh-frozen cadaveric whole lower limbs. Through 0° to 90° of flexion, LTF contact pressures were measured with a Tekscan sensor, located under the lateral meniscus. Knee kinematics were obtained in 3 conditions of rotation (NR: neutral, ER: external and IR: internal rotation) to record the position of the knees for each loading condition. A Motion Analysis system with a coordinate system based on CT scans 3D bone modelling was used. After an ACLR, defined as the reference baseline, 5 anterolateral procedures were compared: anterolateral ligament reconstruction (ALLR), modified Ellison, deep Lemaire, superficial Lemaire and modified MacIntosh procedures. The last 3 procedures were randomised. For each procedure, the graft was fixed in NR at 30° of flexion and with a tension of 20 N.
Results Compared with isolated ACLR, addition of either ALLR or modified Ellison procedure did not increased the overall LTF contact pressure (all p>0.05) through the full range of flexion for the IR condition. Conversely, deep Lemaire, superficial Lemaire and modified MacIntosh procedure (all p<0.05) did increase the overall LTF contact pressure compared with ACLR in IR. No significant difference was observed in ER and NR conditions.
Conclusion This pilot study, comparing the main anterolateral procedures, revealed that addition of either ALLR or modified Ellison procedure did not change the overall contact pressure in the LTF compartment through 0° to 90° of knee flexion. In contrast, the deep and superficial Lemaire, and modified MacIntosh procedures significantly increased overall LTF contact pressures when the knee was internally rotated.
- knee
- ACL / PCL
- repair / reconstruction
- biomechanics
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Footnotes
Presented at Finalist of the ISAKOS Jan I. Gillquist Scientific Award 2019
Contributors All authors were fully involved in the study. They have read and approved the manuscript. TN: conception, acquisition, analysis, data interpretation, work drafting, final approval, final agreement. JC: acquisition, analysis, work drafting, final approval, final agreement. AB: conception, acquisition, analysis, work drafting, final approval, final agreement. SG: conception, analysis, data interpretation, work drafting, final approval, final agreement. DD: analysis, work drafting, final approval, final agreement. SP: acquisition, data interpretation, work drafting, final approval, final agreement. TO: acquisition, work drafting, final approval, final agreement. BD: conception, work drafting, final approval, final agreement. MC: conception, work drafting, final approval, final agreement. BF: conception, work drafting, final approval, final agreement. RA: conception, analysis, work drafting, final approval, final agreement. DP: conception, analysis, data interpretation, work drafting, final approval, final agreement.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Commissioned; externally peer reviewed.
Data availability statement Data are available on reasonable request.
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