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The restoration of passive rotational tibio-femoral laxity after anterior cruciate ligament reconstruction

The restoration of passive rotational tibio-femoral laxity after anterior cruciate ligament reconstruction
The restoration of passive rotational tibio-femoral laxity after anterior cruciate ligament reconstruction

While the anterior cruciate ligament (ACL) is considered one of the most important ligaments for providing knee joint stability, its influence on rotational laxity is not fully understood and its role in resisting rotation at different flexion angles in vivo remains unknown. In this prospective study, we investigated the relationship between in vivo passive axial rotational laxity and knee flexion angle, as well as how they were altered with ACL injury and reconstruction. A rotometer device was developed to assess knee joint rotational laxity under controlled passive testing. An axial torque of ±2.5Nm was applied to the knee while synchronised fluoroscopic images of the tibia and femur allowed axial rotation of the bones to be accurately determined. Passive rotational laxity tests were completed in 9 patients with an untreated ACL injury and compared to measurements at 3 and 12 months after anatomical single bundle ACL reconstruction, as well as to the contralateral controls. Significant differences in rotational laxity were found between the injured and the healthy contralateral knees with internal rotation values of 8.7°±4.0° and 3.7°±1.4° (p = 0.003) at 30° of flexion and 9.3°±2.6° and 4.0°±2.0° (p = 0.001) at 90° respectively. After 3 months, the rotational laxity remained similar to the injured condition, and significantly different to the healthy knees. However, after 12 months, a considerable reduction of rotational laxity was observed towards the levels of the contralateral controls. The significantly greater laxity observed at both knee flexion angles after 3 months (but not at 12 months), suggests an initial lack of post-operative rotational stability, possibly due to reduced mechanical properties or fixation stability of the graft tissue. After 12 months, reduced levels of rotational laxity compared with the injured and 3 month conditions, both internally and externally, suggests progressive rotational stability of the reconstruction with time.

Adult, Anterior Cruciate Ligament Reconstruction, Female, Femur, Humans, Joint Instability, Male, Tibia, Young Adult, Journal Article
1932-6203
Moewis, Philippe
f7e4277b-8caf-47a8-a9df-bd78e6f59bee
Duda, Georg N.
ac4e207b-3e2e-4c84-a6c4-cb67531f890b
Jung, Tobias
22bc84ac-80a2-40c6-9e10-a52b19ab3db5
Heller, Markus O.
3da19d2a-f34d-4ff1-8a34-9b5a7e695829
Boeth, Heide
f06b3277-51ae-4f98-a76d-ba0a396ad1e0
Kaptein, Bart
a3174e5c-069d-418e-9616-d21fa931e596
Taylor, William R.
def46161-f2b9-4087-b228-26092f1f397b
Moewis, Philippe
f7e4277b-8caf-47a8-a9df-bd78e6f59bee
Duda, Georg N.
ac4e207b-3e2e-4c84-a6c4-cb67531f890b
Jung, Tobias
22bc84ac-80a2-40c6-9e10-a52b19ab3db5
Heller, Markus O.
3da19d2a-f34d-4ff1-8a34-9b5a7e695829
Boeth, Heide
f06b3277-51ae-4f98-a76d-ba0a396ad1e0
Kaptein, Bart
a3174e5c-069d-418e-9616-d21fa931e596
Taylor, William R.
def46161-f2b9-4087-b228-26092f1f397b

Moewis, Philippe, Duda, Georg N., Jung, Tobias, Heller, Markus O., Boeth, Heide, Kaptein, Bart and Taylor, William R. (2016) The restoration of passive rotational tibio-femoral laxity after anterior cruciate ligament reconstruction. PLoS ONE, 11 (7), [e0159600]. (doi:10.1371/journal.pone.0159600).

Record type: Article

Abstract

While the anterior cruciate ligament (ACL) is considered one of the most important ligaments for providing knee joint stability, its influence on rotational laxity is not fully understood and its role in resisting rotation at different flexion angles in vivo remains unknown. In this prospective study, we investigated the relationship between in vivo passive axial rotational laxity and knee flexion angle, as well as how they were altered with ACL injury and reconstruction. A rotometer device was developed to assess knee joint rotational laxity under controlled passive testing. An axial torque of ±2.5Nm was applied to the knee while synchronised fluoroscopic images of the tibia and femur allowed axial rotation of the bones to be accurately determined. Passive rotational laxity tests were completed in 9 patients with an untreated ACL injury and compared to measurements at 3 and 12 months after anatomical single bundle ACL reconstruction, as well as to the contralateral controls. Significant differences in rotational laxity were found between the injured and the healthy contralateral knees with internal rotation values of 8.7°±4.0° and 3.7°±1.4° (p = 0.003) at 30° of flexion and 9.3°±2.6° and 4.0°±2.0° (p = 0.001) at 90° respectively. After 3 months, the rotational laxity remained similar to the injured condition, and significantly different to the healthy knees. However, after 12 months, a considerable reduction of rotational laxity was observed towards the levels of the contralateral controls. The significantly greater laxity observed at both knee flexion angles after 3 months (but not at 12 months), suggests an initial lack of post-operative rotational stability, possibly due to reduced mechanical properties or fixation stability of the graft tissue. After 12 months, reduced levels of rotational laxity compared with the injured and 3 month conditions, both internally and externally, suggests progressive rotational stability of the reconstruction with time.

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journal.pone.0159600 - Version of Record
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More information

Accepted/In Press date: 1 June 2016
e-pub ahead of print date: 28 July 2016
Published date: July 2016
Keywords: Adult, Anterior Cruciate Ligament Reconstruction, Female, Femur, Humans, Joint Instability, Male, Tibia, Young Adult, Journal Article

Identifiers

Local EPrints ID: 415773
URI: http://eprints.soton.ac.uk/id/eprint/415773
ISSN: 1932-6203
PURE UUID: 22a7cded-d4e0-4770-92a9-a47f0591e6ee
ORCID for Markus O. Heller: ORCID iD orcid.org/0000-0002-7879-1135

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Date deposited: 23 Nov 2017 17:30
Last modified: 18 Feb 2021 17:19

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