2015 ISAKOS Biennial Congress ePoster #1349

The Effect of High Compressive Loading on Anterior Tibial Translation in Intact and Anterior Cruciate Ligament-Deficient Knees

Jae Gyoon Kim, MD, PhD, Prof., Ansan, Gyeonggi KOREA, REPUBLIC OF
Tae-Soo Bae, PhD, Kyunggi KOREA, REPUBLIC OF
Sang Hak Lee, MD, PhD, Seoul KOREA, REPUBLIC OF
Hong Chul Lim, MD, Seoul KOREA, REPUBLIC OF
Jin-Hwan Ahn, MD, Seoul KOREA, REPUBLIC OF
Jun-Ho Kim, MD, Seoul KOREA, REPUBLIC OF
Keon Woo Kim, MD, Seoul KOREA, REPUBLIC OF
Yoon Kwang Bae, MD, Ansan-Si KOREA, REPUBLIC OF
Joon Ho Wang, MD, PhD, Seoul KOREA, REPUBLIC OF
Samsung Medical Center, Seoul, KOREA

FDA Status Not Applicable

Summary: The anterior tibial translation (ATT) increased significantly after high compressive loading (CL) under anterior loading (AL) in both the intact and anterior cruciate ligament (ACL)-deficient knees compared to that of under only anterior loading (AL), and it increased steadily in ACL-deficient knees after high CL between 0° and 60°of flexion.

Abstract:

Background

The compressive loading (CL) applied to the flexed knee joint can increase anterior tibial translation (ATT).

Purpose

The purpose of this study was to evaluate the effect of the high compressive loading (CL) on the ATT according to the knee flexion angle and to evaluate the ATT in relation to knee flexion after the application of other external loads, such as tibiofemoral valgus rotation (VR) and tibial internal rotation (IR), during high CL in ACL intact and –deficient knee. We hypothesized that the ATT would increase after high CL and after VR and IR under high CL.
Study Design: Controlled laboratory study

Methods

We used 10 fresh-frozen, human cadaveric knees from the left side of male donors (mean, 57 years). Different loading conditions (134-N AL, 1000-N CL, 10-Nm of VR, and 5-Nm of IR) were sequentially combined (AL, AL/CL, AL/VR/CL, AT/VR/IR/CL), and the ATT was measured at 0°, 15°, 30°, 45°, and 60° of flexion in the intact and ACL-deficient knees. Mean values were used for all analyses. Because all variables were measured within each specimen, statistical analysis of the knee kinematics was performed using a repeated- measures analysis of variance (ANOVA) or 2-way repeated measures ANOVA with post hoc test with flexion angle, loading condition and ACL status variables after test of normality using Shapiro-Wilk test. All analyses were performed with the Statistical Package for the Social Sciences (SPSS) software version 12.0 (SPSS, Chicago, IL, US).

Results

In the intact and ACL-deficient knees, the ATT increased significantly after high CL under AL according to knee flexion angle compared to the ATT under only AL (P<0.05). From 0° to 60° of flexion under high CL, the ATT significantly increased steadily in the ACL-deficient knees. The addition of VR or IR under high CL caused the ATT to increase significantly at all or part of the flexion angle from 0° to 60° in both the intact and ACL-deficient knees (P<0.05).

Conclusion

The ATT increased significantly after high CL under AL in both the intact and ACL-deficient knees. As the flexion angle increased under high CL, the ATT significantly increased steadily in the ACL-deficient knees. The addition of VR or IR to the test protocol increased the ATT significantly at all or part of the flexion angle from 0° to 60° in both the intact and ACL-deficient knees.
Clinical relevance: These findings may help improve the treatment of ACL injury because they suggest that immediate weight-bearing and knee flexion after ACL injury or ACL reconstruction should only be performed with caution.