1. Technical considerations in lateral extra-articular reconstruction coupled with anterior cruciate ligament reconstruction: A simulation study evaluating the influence of surgical parameters on control of knee stability
- Author
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J. A. de Guise, Mathieu Thaunat, Adnan Saithna, Bertrand Sonnery-Cottet, Yoann Blache, Raphaël Dumas, Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM ), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Université Jean Monnet [Saint-Étienne] (UJM)-Université Savoie Mont Blanc (USMB [Université de Savoie] [Université de Chambéry]), Laboratoire de Biomécanique et Mécanique des Chocs (LBMC UMR T9406), Université de Lyon-Université de Lyon-Institut Français des Sciences et Technologies des Transports, de l'Aménagement et des Réseaux (IFSTTAR), Laboratoire de recherche en imagerie et orthopédie [Montréal] (LIO), Ecole de Technologie Supérieure [Montréal] (ETS)-Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal (UdeM)-Université de Montréal (UdeM), Advanced Orthopedics and Sports Medicine, Centre Orthopédique Santy-Group Ramsay-Générale de Santé, and Hôpital privé Jean Mermoz
- Subjects
musculoskeletal diseases ,Adult ,Joint Instability ,Male ,GRAFT TENSION AT SURGERY ,Anterior cruciate ligament reconstruction ,Knee Joint ,Rotation ,medicine.medical_treatment ,Anterior cruciate ligament ,Biophysics ,Femoral attachment ,BIOMECANIQUE ,03 medical and health sciences ,Fixation (surgical) ,0302 clinical medicine ,FEMORAL ATTACHMENT SITE ,Medicine ,Humans ,Orthopedics and Sports Medicine ,Computer Simulation ,Knee ,GENOU ,Full extension ,Femur ,Graft fixation ,Range of Motion, Articular ,Orthodontics ,Anterior Cruciate Ligament Reconstruction ,Tibia ,business.industry ,Anterior Cruciate Ligament Injuries ,[SPI.MECA.BIOM]Engineering Sciences [physics]/Mechanics [physics.med-ph]/Biomechanics [physics.med-ph] ,TIBIAL ATTACHMENT SITE ,030229 sport sciences ,musculoskeletal system ,Biomechanical Phenomena ,SIMULATED PIVOT-SHIFT ,medicine.anatomical_structure ,ANTERIOR-CRUCIATE LIGAMENT ,KNEE FLEXION AT SURGERY ,business ,Epicondyle ,030217 neurology & neurosurgery - Abstract
Background: Surgical parameters such as the selection of tibial and femoral attachment site, graft tension, and knee flexion angle at the time of fixation may influence the control of knee stability after lateral extra-articular reconstruction. This study aimed to determine how sensitive is the control of knee rotation and translation, during simulated pivot-shift scenarios, to these four surgery settings.\ud \ud Methods: A computer model was used to simulate 625 lateral extra-articular reconstructions based upon five different variations of each of the following parameters: femoral and tibial attachment sites, knee flexion angle and graft tension at the time of fixation. For each simulated surgery, the lateral extra-articular reconstruction external rotation moment at the knee joint center was computed during simulated pivot-shift scenarios. The sensitivity of the control of knee rotation and translation to a given surgery setting was assessed by calculating the coefficient of variation of the lateral extra-articular reconstruction external rotation moment.\ud \ud Findings: Graft tension had minimal influence on the control of knee rotation and translation with less than 2.4% of variation across the scenarios tested. Control of knee rotation and translation was the least affected by the femoral attachment site if the knee was close to full extension at the time of graft fixation. The choice of the tibial attachment site was crucial when the femoral fixation was proximal and posterior to the femoral epicondyle since 15 to 67% of variation was observed in the control of knee rotation and translation.\ud \ud Interpretation: Femoral and tibial attachment sites as well as knee flexion angle at the time of fixation should be considered by surgeons when performing lateral extra-articular reconstruction. Variation in graft tension between the ranges 20–40 N has minimal influence on the control of knee rotation and translation.
- Published
- 2018