2015 ISAKOS Biennial Congress ePoster #1302

Biomechanical Evaluation of Double Bundle Anterior Cruciate Ligament Reconstruction with Pivot Shift Test During Surgery

Suguru Kuwata, MD, PhD, Hamada, Shimane JAPAN
Nobuyuki Kumahashi, MD, PhD, Izumo, Shimane JAPAN
Hiroshi Takuwa, MD, Izumo, Shimane JAPAN
Yuji Uchio, MD, PhD, Izumo, Shimane JAPAN
Department of Orthopaedics, Shimane University, Izumo, JAPAN

FDA Status Not Applicable

Summary: The tension pattern of the AM and PL grafts of the ACL at the pivot shift test during surgery was investigated. PL graft was especially functional at pivot shift test.

Abstract:

Aim

To evaluate a role of the anteromedial graft (AMG) and posterolateral graft (PLG) of the anterior cruciate ligament (ACL) reconstruction with pivot shift test during surgery

Materials And Methods

An anatomical double bundle reconstruction using hamstring tendon autografts was performed in 50 patients with an ACL-deficient knee. We investigated the tension pattern of the AMG and PLG of the ACL at knee-flexion angles of 0 - 120°and at the pivot shift test during surgery using the custom-made tension meter.

Results

The magnitude of PLG tension increased sharply from 30° to 0° and registered the highest value at full extension. The magnitude of AMG tension was almost equal to that of PLG at full extension, but decreased slightly with increasing flexion (differed from PLG), and changed little at 30 - 120°. During pivot shift test, the tension change of AMG was almost the same as that during knee extension-flexion at neutral position. On the other hand, the tension change of PLG was large during pivot shift test, and the magnitude of PLG tension accounts for up to 60 % of the total magnitude of ACL graft tension.

Conclusions

AMG was functional at all knee-flexion angles, while PLG was especially functional at full extension and pivot shift. The force distribution between AMG and PLG of the ACL varied with knee-flexion angle. To improve the outcome of the ACL reconstruction, it may be necessary to restore normal knee kinematics and to reproduce normal ligament function. Our data coincided with the normal tension patterns of AM and PL bundles reported previously. Our anatomical reconstruction may produce a better biomechanical outcome.