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. 2017 Apr;25(4):1177-1183.
doi: 10.1007/s00167-016-4180-4. Epub 2016 Jun 2.

In vivo posterior cruciate ligament elongation in running activity after anatomic and non-anatomic anterior cruciate ligament reconstruction

Jing Tang  1 , Eric Thorhauer  2 , Karl Bowman  3 , Freddie H Fu  3 , Scott Tashman  4
Affiliations

In vivo posterior cruciate ligament elongation in running activity after anatomic and non-anatomic anterior cruciate ligament reconstruction

Jing Tang et al. Knee Surg Sports Traumatol Arthrosc. 2017 Apr.

Abstract

Purpose: The goals of this study were to (1) investigate the in vivo elongation behaviour of the posterior cruciate ligament (PCL) during running in the uninjured knee and (2) evaluate changes in PCL elongation during running after anatomic or non-anatomic anterior cruciate ligament (ACL) reconstruction.

Methods: Seventeen unilateral ACL-injured subjects were recruited after undergoing anatomic (n = 9) or non-anatomic (n = 8) ACL reconstruction. Bilateral high-resolution CT scans were obtained to produce 3D models. Anterolateral (AL) and posteromedial (PM) bundles insertion sites of the PCL were identified on the 3D CT scan reconstructions. Dynamic knee function was assessed during running using a dynamic stereo X-ray (DSX) system. The lengths of the AL and PM bundles were estimated from late swing through mid-stance. The contralateral knees served as normal controls.

Results: Control knees demonstrated a slight decrease in AL bundle and a significant decrease in PM bundle length following foot strike. Length and elongation patterns of the both bundles of the PCL in the anatomic ACL reconstruction group were similar to the controls. However, the change in dynamic PCL length was significantly greater in the non-anatomic group than in the anatomic reconstruction group after foot strike (p < 0.05).

Conclusion: The AL bundle length decreased slightly, and the PM bundle length significantly decreased after foot strike during running in uninjured knees. Anatomic ACL reconstruction maintained normal PCL elongation patterns more effectively than non-anatomic ACL reconstruction during high-demand, functional loading. These results support the use of anatomic ACL reconstruction to achieve normal knee function in high-demand activities.

Level of evidence: Case-control study, Level III.

Keywords: Anterior cruciate ligament (ACL); Anterior cruciate ligament reconstruction; In vivo knee kinematics; Posterior cruciate ligament (PCL); Soft tissue biomechanics.

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Figures

Figure 1
Figure 1
Top: The length of AL and PM bundles was determined by measuring the three-dimensional distance from the tibial to femoral insertions, as shown in this example of a typical subject (heel strike: A and B; 0.1 s after heel strike: C and D). Relative length of the graft is indicated by color (blue/green/yellow/ orange/red, from shortest to longest). Bottom: 3D CT reconstruction of the distal femur demonstrating ACL femoral tunnel position: anatomic SB (E), anatomic DB (F), non-anatomic high tunnel SB (G) and non-anatomic vertical/high AM tunnel DB (H).
Figure 2
Figure 2
3D CT models of the femur (A) and tibia (b), showing the landmarks used as reference for estimating insertion sites of the AL and PM bundles.
Figure 3
Figure 3
After heel strike (time=0) a decrease in the length of the of AL and PM bundles was observed for the control knees (*P<0.05 for PM bundle).
Figure 4
Figure 4
Length and elongation patterns of the AL and PM bundles of the PCL in the ACL-reconstructed knees were similar to the contralateral (uninjured) knees in the anatomical ACL patients (P>0.05). However, in the non-anatomical ACL group (B), AL and PM bundle lengths and elongation patterns changed severely following foot strike (P>0.05).
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