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- Scopus: eid_2-s2.0-85102296166
- PMID: 33689503
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Article: Posterior Tibial Loading Results in Significant Increase of Peak Contact Pressure in the Patellofemoral Joint During Anterior Cruciate Ligament Reconstruction: A Cadaveric Study
Title | Posterior Tibial Loading Results in Significant Increase of Peak Contact Pressure in the Patellofemoral Joint During Anterior Cruciate Ligament Reconstruction: A Cadaveric Study |
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Authors | |
Keywords | anterior cruciate ligament reconstruction biomechanics graft tension patellofemoral joint posterior tibial loading |
Issue Date | 2021 |
Citation | American Journal of Sports Medicine, 2021, v. 49, n. 5, p. 1286-1295 How to Cite? |
Abstract | Background: Inappropriate posterior tibial loading and initial graft tension during anterior cruciate ligament (ACL) reconstruction may cause altered patellofemoral joint (PFJ) contact mechanics, potentially resulting in pain and joint degeneration. Hypothesis: PFJ contact pressure would increase with the increases in posterior tibial loading and graft tension during ACL reconstruction. Study Design: Controlled laboratory study. Methods: Nine fresh-frozen, nonpaired human cadaveric knees were tested in a customized jig from 0° to 120° of knee flexion. First, the knee was tested in the ACL-intact state. Second, reconstruction of the ACLs using different posterior tibial loadings and graft tensions were performed. The posterior tibial loading was evaluated at 2 levels: 33.5 and 67 N. Graft tension was assessed at 3 levels: low tension (20 N), medium tension (60 N), and high tension (80 N). Maximum values of peak contact pressure in the medial and lateral patellar facets were compared between ACL-intact and ACL-reconstructed knees. The PFJ kinematics between ACL-intact knees and ACL-reconstructed knees were compared during knee flexion at 30°, 60°, 90°, and 120°. Results: Reconstruction of ACLs with both low and high posterior tibial loading resulted in significant increases of peak contact pressure in the medial (range of differences, 0.46-0.92 MPa; P <.05) and lateral (range of differences, 0.51-0.83 MPa; P <.05) PFJ compared with the ACL-intact condition. However, no significant differences in PFJ kinematics were identified between ACL-reconstructed knees and ACL-intact knees. In ACL-reconstructed knees, it was found that a high posterior tibial loading resulted in high peak contact pressure on the medial patellar side (range of differences, 0.37-0.46 MPa; P <.05). No significant difference in peak contact pressure was observed among the differing graft tensions. Conclusion: In this cadaveric model, ACL reconstruction resulted in significant increases of peak contact pressure in the PFJ facet when compared with the ACL-intact condition. A high posterior tibial loading can lead to high medial PFJ peak contact pressure. Graft tension was found to not significantly affect PFJ contact pressure during ACL reconstruction. Clinical Relevance: An excessive posterior tibial loading during ACL reconstruction resulted in increased PFJ contact pressures at time of surgery. These data suggest that a low posterior tibial loading might be preferred during ACL reconstruction surgery to reduce the PFJ contact pressure close to that of the ACL-intact condition. |
Persistent Identifier | http://hdl.handle.net/10722/334737 |
ISSN | 2021 Impact Factor: 7.010 2020 SCImago Journal Rankings: 3.021 |
DC Field | Value | Language |
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dc.contributor.author | Huang, Wenhan | - |
dc.contributor.author | Ong, Michael Tim Yun | - |
dc.contributor.author | Man, Gene Chi Wai | - |
dc.contributor.author | Liu, Yang | - |
dc.contributor.author | Lau, Lawrence Chun Man | - |
dc.contributor.author | Yung, Patrick Shu Hang | - |
dc.date.accessioned | 2023-10-20T06:50:17Z | - |
dc.date.available | 2023-10-20T06:50:17Z | - |
dc.date.issued | 2021 | - |
dc.identifier.citation | American Journal of Sports Medicine, 2021, v. 49, n. 5, p. 1286-1295 | - |
dc.identifier.issn | 0363-5465 | - |
dc.identifier.uri | http://hdl.handle.net/10722/334737 | - |
dc.description.abstract | Background: Inappropriate posterior tibial loading and initial graft tension during anterior cruciate ligament (ACL) reconstruction may cause altered patellofemoral joint (PFJ) contact mechanics, potentially resulting in pain and joint degeneration. Hypothesis: PFJ contact pressure would increase with the increases in posterior tibial loading and graft tension during ACL reconstruction. Study Design: Controlled laboratory study. Methods: Nine fresh-frozen, nonpaired human cadaveric knees were tested in a customized jig from 0° to 120° of knee flexion. First, the knee was tested in the ACL-intact state. Second, reconstruction of the ACLs using different posterior tibial loadings and graft tensions were performed. The posterior tibial loading was evaluated at 2 levels: 33.5 and 67 N. Graft tension was assessed at 3 levels: low tension (20 N), medium tension (60 N), and high tension (80 N). Maximum values of peak contact pressure in the medial and lateral patellar facets were compared between ACL-intact and ACL-reconstructed knees. The PFJ kinematics between ACL-intact knees and ACL-reconstructed knees were compared during knee flexion at 30°, 60°, 90°, and 120°. Results: Reconstruction of ACLs with both low and high posterior tibial loading resulted in significant increases of peak contact pressure in the medial (range of differences, 0.46-0.92 MPa; P <.05) and lateral (range of differences, 0.51-0.83 MPa; P <.05) PFJ compared with the ACL-intact condition. However, no significant differences in PFJ kinematics were identified between ACL-reconstructed knees and ACL-intact knees. In ACL-reconstructed knees, it was found that a high posterior tibial loading resulted in high peak contact pressure on the medial patellar side (range of differences, 0.37-0.46 MPa; P <.05). No significant difference in peak contact pressure was observed among the differing graft tensions. Conclusion: In this cadaveric model, ACL reconstruction resulted in significant increases of peak contact pressure in the PFJ facet when compared with the ACL-intact condition. A high posterior tibial loading can lead to high medial PFJ peak contact pressure. Graft tension was found to not significantly affect PFJ contact pressure during ACL reconstruction. Clinical Relevance: An excessive posterior tibial loading during ACL reconstruction resulted in increased PFJ contact pressures at time of surgery. These data suggest that a low posterior tibial loading might be preferred during ACL reconstruction surgery to reduce the PFJ contact pressure close to that of the ACL-intact condition. | - |
dc.language | eng | - |
dc.relation.ispartof | American Journal of Sports Medicine | - |
dc.subject | anterior cruciate ligament reconstruction | - |
dc.subject | biomechanics | - |
dc.subject | graft tension | - |
dc.subject | patellofemoral joint | - |
dc.subject | posterior tibial loading | - |
dc.title | Posterior Tibial Loading Results in Significant Increase of Peak Contact Pressure in the Patellofemoral Joint During Anterior Cruciate Ligament Reconstruction: A Cadaveric Study | - |
dc.type | Article | - |
dc.description.nature | link_to_subscribed_fulltext | - |
dc.identifier.doi | 10.1177/0363546521995546 | - |
dc.identifier.pmid | 33689503 | - |
dc.identifier.scopus | eid_2-s2.0-85102296166 | - |
dc.identifier.volume | 49 | - |
dc.identifier.issue | 5 | - |
dc.identifier.spage | 1286 | - |
dc.identifier.epage | 1295 | - |
dc.identifier.eissn | 1552-3365 | - |