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. 2007 Apr;2(1):1-12.
doi: 10.1007/s11751-007-0016-6.

Biomechanics of the anterior cruciate ligament and implications for surgical reconstruction

J Dargel  1 , M Gotter, K Mader, D Pennig, J Koebke, R Schmidt-Wiethoff
Affiliations

Biomechanics of the anterior cruciate ligament and implications for surgical reconstruction

J Dargel et al. Strategies Trauma Limb Reconstr. 2007 Apr.

Abstract

Injury to the anterior cruciate ligament (ACL) is regarded as critical to the physiological kinematics of the femoral-tibial joint, its disruption eventually causing long-term functional impairment. Both the initial trauma and the pathologic motion pattern of the injured knee may result in primary degenerative lesions of the secondary stabilisers of the knee, each of which are associated with the early onset of osteoarthritis. Consequently, there is a wide consensus that young and active patients may profit from reconstructing the ACL. Several factors have been identified as significantly influencing the biomechanical characteristics and the functional outcome of an ACL reconstructed knee joint. These factors are: (1) individual choice of autologous graft material using either patellar tendon-bone grafts or quadrupled hamstring tendon grafts, (2) anatomical bone tunnel placement within the footprints of the native ACL, (3) adequate substitute tension after cyclic graft preconditioning, and (4) graft fixation close to the joint line using biodegradable graft fixation materials that provide an initial fixation strength exceeding those loads commonly expected during rehabilitation. Under observance of these factors, the literature encourages mid-to long-term clinical and functional outcomes after ACL reconstruction.

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Figures

Fig. 1
Fig. 1
Fibre arrangement of the anteromedial (a, black arrow) and the posterolateral (b, white arrow) during extension (a) and flexion (b) of the knee
Fig. 2
Fig. 2
Anatomical footprint of the ACL. a Femoral origin of the anteromedial (black) and posterolateral (white) bundle. b Tibial insertion of the anteromedial (black) and posterolateral (white) bundle
Fig. 3
Fig. 3
In situ force of the intact ACL, the anteromedial bundle (AMB) and the posterolateral bundle (PLB) under 110 N of anterior tibial load. Adapted from [23]
Fig. 4
Fig. 4
Radiographic analysis of femoral bone tunnel placement. a 60% of the anterioposterior diameter of the lateral femoral condyle ([69]); b 80% of the anteroposterior length of Blumensaat’s line ([70]); c 65% of the anteroposterior cortical depth of the distal femur in line with Blumensaat’s line ([71]); d anteroinferior corner of the most proximal and posterior quadrant adapted to the height and length of the lateral femoral condyle ([72])
See this image and copyright information in PMC

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