Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2011 Mar 15;44(5):924-9.
doi: 10.1016/j.jbiomech.2010.11.028. Epub 2011 Jan 11.

The effects of femoral graft placement on in vivo knee kinematics after anterior cruciate ligament reconstruction

E S Abebe  1 , G M Utturkar, D C Taylor, C E Spritzer, J P Kim, C T Moorman 3rd, W E Garrett, L E DeFrate
Affiliations

The effects of femoral graft placement on in vivo knee kinematics after anterior cruciate ligament reconstruction

E S Abebe et al. J Biomech. .

Abstract

Achieving anatomical graft placement remains a concern in Anterior Cruciate Ligament (ACL) reconstruction. The purpose of this study was to quantify the effect of femoral graft placement on the ability of ACL reconstruction to restore normal knee kinematics under in vivo loading conditions. Two different groups of patients were studied: one in which the femoral tunnel was placed near the anterior and proximal border of the ACL (anteroproximal group, n=12) and another where the femoral tunnel was placed near the center of the ACL (anatomic group, n=10) MR imaging and biplanar fluoroscopy were used to measure in vivo kinematics in these patients during a quasi-static lunge. Patients with anteroproximal graft placement had up to 3.4mm more anterior tibial translation, 1.1mm more medial tibial translation and 3.7° more internal tibial rotation compared to the contralateral side. Patients with anatomic graft placement had motion that more closely replicated that of the intact knee, with anterior tibial translation within 0.8mm, medial tibial translation within 0.5mm, and internal tibial rotation within 1°. Grafts placed anteroproximally on the femur likely provide insufficient restraint to these motions due to a more vertical orientation. Anatomical femoral placement of the graft is more likely to reproduce normal ACL orientation, resulting in a more stable knee. Therefore, achieving anatomical graft placement on the femur is crucial to restoring normal knee function and may decrease the rates of joint degeneration after ACL reconstruction.

PubMed Disclaimer

Figures

Figure 1
Figure 1
In the anatomic placement group (top), the graft was placed near the center of the native ACL footprint on the femur, while in the anteroproximal placement group (bottom), the graft was centered near the anteroproximal border of the femoral footprint (Abebe 2009), as demonstrated in two subjects.
Figure 2
Figure 2
High resolution MR images were segmented to create 3D models of the knee (top left). Next, the patients were imaged using biplanar fluoroscopy while performing a quasi-static lunge (top right). The fluoroscopic images and 3D models were then used to reproduce the motion of each subject's knee during the lunge (bottom).
Figure 3
Figure 3
The increase in anterior tibial translation of the reconstructed knee relative to the contralateral intact knee was measured as a function of flexion (mean and 95% confidence intervals). Zero denotes a knee that exactly mimics the motion of the contralateral side. Patients with grafts placed anteroproximally on the femur had increased anterior tibial translation relative to the contralateral side between 0 and 60° of flexion, while the anatomically placed grafts more closely restored normal knee motion. (*p < 0.05)
Figure 4
Figure 4
The increase in medial tibial translation of the reconstructed knee relative to the contralateral intact knee was measured as a function of flexion (mean and 95% confidence intervals). Zero denotes a knee that exactly mimics the motion of the contralateral side. Patients with grafts placed anteroproximally on the femur had significantly increased medial tibial translation relative to the contralateral side between 0 and 75° of flexion, while the anatomically placed grafts more closely restored normal knee motion. (*p < 0.05)
Figure 5
Figure 5
The increase in internal tibial rotation of the reconstructed knee relative to the contralateral intact knee was measured as a function of flexion (mean and 95% confidence intervals). Zero denotes a knee that exactly mimics the motion of the contralateral side. Patients with grafts placed anteroproximally on the femur had increased internal tibial rotation relative to the contralateral side between 0 and 60° of flexion, while the anatomically placed grafts more closely restored normal knee motion. (*p < 0.05)
See this image and copyright information in PMC

References

    1. Abebe ES, Kim JP, Utturkar GM, Spritzer CE, Moorman CT, 3rd, Taylor DC, Garrett WE, Jr., DeFrate LE. In vivo graft deformation in transtibial and tibial tunnel independent ACL reconstruction techniques. Trans Orthop Res Soc. 2010
    1. Abebe ES, Moorman CT, 3rd, Dziedzic TS, Spritzer CE, Cothran RL, Taylor DC, Garrett WE, Jr., DeFrate LE. Femoral tunnel placement during anterior cruciate ligament reconstruction: an in vivo imaging analysis comparing transtibial and 2-incision tibial tunnel-independent techniques. Am J Sports Med. 2009;37(10):1904–11. - PubMed
    1. Andriacchi TP, Briant PL, Bevill SL, Koo S. Rotational changes at the knee after ACL injury cause cartilage thinning. Clin Orthop Relat Res. 2006;442:39–44. - PubMed
    1. Andriacchi TP, Dyrby CO. Interactions between kinematics and loading during walking for the normal and ACL deficient knee. J Biomech. 2005;38(2):293–8. - PubMed
    1. Andriacchi TP, Mundermann A, Smith RL, Alexander EJ, Dyrby CO, Koo S. A framework for the in vivo pathomechanics of osteoarthritis at the knee. Ann Biomed Eng. 2004;32(3):447–57. - PubMed

Publication types