The effect of anterior cruciate ligament reconstruction on knee joint kinematics under simulated muscle loads

Abstract

Background: Numerous studies have investigated anterior stability of the knee during the anterior drawer test after anterior cruciate ligament reconstruction. Few studies have evaluated anterior cruciate ligament reconstruction under physiological loads. Purpose: To determine whether anterior cruciate ligament reconstruction reproduced knee motion under simulated muscle loads. Study Design: Controlled laboratory study. Methods: Eight human cadaveric knees were tested with the anterior cruciate ligament intact, transected, and reconstructed (using a bone-patellar tendon-bone graft) on a robotic testing system. Tibial translation and rotation were measured at 0°, 15°, 30°, 60°, and 90° of flexion under anterior drawer loading (130 N), quadriceps muscle loading (400 N), and combined quadriceps and hamstring muscle loading (400 N and 200 N, respectively). Repeated-measures analysis of variance and the Student-Newman-Keuls test were used to detect statistically significant differences between knee states. Results: Anterior cruciate ligament reconstruction resulted in a clinically satisfactory anterior tibial translation. The anterior tibial translation of the reconstructed knee was 1.93 mm larger than the intact knee at 30° of flexion under anterior load. Anterior cruciate ligament reconstruction overconstrained tibial rotation, causing significantly less internal tibial rotation in the reconstructed knee at low flexion angles (0°-30°) under muscle loads (P < .05). At 30° of flexion, under muscle loads, the tibia of the reconstructed knee was 1.9° externally rotated compared to the intact knee. Conclusions: Anterior cruciate ligament reconstruction may not restore the rotational kinematics of the intact knee under muscle loads, even though anterior tibial translation was restored to a clinically satisfactory level under anterior drawer loads. These data suggest that reproducing anterior stability under anterior tibial loads may not ensure that knee joint kinematics is restored under physiological loading conditions. Clinical Relevance: Decreased internal rotation of the knee after anterior cruciate ligament reconstruction may lead to increased patellofemoral joint contact pressures. Future anterior cruciate ligament reconstruction techniques should aim at restoring 3-dimensional knee kinematics under physiological loads.