The Effects of a Popliteus Muscle Load on In Situ Forces in the Posterior Cruciate Ligament and on Knee Kinematics

1998 ◽  
Vol 26 (5) ◽  
pp. 669-673 ◽  
Author(s):  
Christopher D. Harner ◽  
Jürgen Höher ◽  
Tracy M. Vogrin ◽  
Gregory J. Carlin ◽  
Savio L-Y. Woo
Keyword(s):  
Posterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Knee Kinematics ◽  
Tibial Rotation ◽  
Posterior Tibial Translation ◽  
Posterior Tibial ◽  
Tibial Translation ◽  
Intact Knee ◽  
Popliteus Muscle

To investigate the effect of simulated contraction of the popliteus muscle on the in situ forces in the posterior cruciate ligament and on changes in knee kinematics, we studied 10 human cadaveric knees (donor age, 58 to 89 years) using a robotic manipulator/universal force moment sensor system. Under a 110-N posterior tibial load (simulated posterior drawer test), the kinematics of the intact knee and the in situ forces in the ligament were determined. The test was repeated with the addition of a 44-N load to the popliteus muscle. The posterior cruciate ligament was then sectioned and the knee was subjected to the same tests. The additional popliteus muscle load significantly reduced the in situ forces in the ligament by 9% to 36% at 90° and 30° of flexion, respectively. No significant effects on posterior tibial translation of the intact knee were found. However, in the ligament-deficient knee, posterior tibial translation was reduced by up to 36% of the translation caused by ligament transection. A coupled internal tibial rotation of 2° to 4° at 60° to 90° of knee flexion was observed in both the intact and ligament-deficient knees when the popliteus muscle load was added. Our results indicate that the popliteus muscle shares the function of the posterior cruciate ligament in resisting posterior tibial loads and can contribute to knee stability when the ligament is absent.

The Position of the Tibia during Graft Fixation Affects Knee Kinematics and Graft Forces for Anterior Cruciate Ligament Reconstruction

2001 ◽  
Vol 29 (6) ◽  
pp. 771-776 ◽  
Author(s):  
Jürgen Höher ◽  
Akihiro Kanamori ◽  
Jennifer Zeminski ◽  
Freddie H. Fu ◽  
Savio L-Y. Woo
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Knee Kinematics ◽  
Anterior Tibial Translation ◽  
Posterior Tibial ◽  
Anterior Tibial ◽  
Anterior Cruciate ◽  
Tibial Translation ◽  
Intact Knee

Ten cadaveric knees (donor ages, 36 to 66 years) were tested at full extension, 15°, 30°, and 90° of flexion under a 134-N anterior tibial load. In each knee, the kinematics as well as in situ force in the graft were compared when the graft was fixed with the tibia in four different positions: full knee extension while the surgeon applied a posterior tibial load (Position 1), 30° of flexion with the tibia at the neutral position of the intact knee (Position 2), 30° of flexion with a 67-N posterior tibial load (Position 3), and 30° of flexion with a 134-N posterior tibial load (Position 4). For Positions 1 and 2, the anterior tibial translation and the in situ forces were up to 60% greater and 36% smaller, respectively, than that of the intact knee. For Position 3, knee kinematics and in situ forces were closest to those observed in the intact knee. For Position 4, anterior tibial translation was significantly decreased by up to 2 mm and the in situ force increased up to 31 N. These results suggest that the position of the tibia during graft fixation is an important consideration for the biomechanical performance of an anterior cruciate ligament-reconstructed knee.

Anatomy and Biomechanics of the Posterior Cruciate Ligament

2021 ◽  
Vol 34 (05) ◽  
pp. 499-508
Author(s):  
Thomas B. Lynch ◽  
Jorge Chahla ◽  
Clayton W. Nuelle
Keyword(s):  
Posterior Cruciate Ligament ◽  
Clinical Decision Making ◽  
Cruciate Ligament ◽  
Primary Role ◽  
X Rays ◽  
Posterior Tibial Translation ◽  
Posterior Tibial ◽  
Knee Pathology ◽  
Tibial Translation

AbstractPosterior cruciate ligament (PCL) injuries are often encountered in the setting of other knee pathology and sometimes in isolation. A thorough understanding of the native PCL anatomy is crucial in the successful treatment of these injuries. The PCL consists of two independent bundles that function in a codominant relationship to perform the primary role of resisting posterior tibial translation relative to the femur. A secondary role of the PCL is to provide rotatory stability. The anterolateral (AL) bundle has a more vertical orientation when compared with the posteromedial (PM) bundle. The AL bundle has a more anterior origin than the PM bundle on the lateral wall of the medial femoral condyle. The tibial insertion of AL bundle on the PCL facet is medial and anterior to the PM bundle. The AL and PM bundles are 12-mm apart at the center of the femoral origins, while the tibial insertions are more tightly grouped. The different spatial orientation of the two bundles and large distance between the femoral centers is responsible for the codominance of the PCL bundles. The AL bundle is the dominant restraint to posterior tibial translation throughout midrange flexion, while the PM bundle is the primary restraint in extension and deep flexion. Biomechanical testing has shown independent reconstruction of the two bundles that better reproduces native knee biomechanics, while significant differences in clinical outcomes remain to be seen. Stress X-rays may play an important role in clinical decision-making process for operative versus nonoperative management of isolated PCL injuries. Strong understanding of PCL anatomy and biomechanics can aid surgical management.

Measurement of Posterior Tibial Translation in the Posterior Cruciate Ligament-Reconstructed Knee

2003 ◽  
Vol 31 (6) ◽  
pp. 843-848 ◽  
Author(s):  
C. Benjamin Ma ◽  
Akihiro Kanamori ◽  
Tracy M. Vogrin ◽  
Savio L-Y. Woo ◽  
Christopher D. Harner
Keyword(s):  
Posterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Posterior Tibial Translation ◽  
Posterior Tibial ◽  
Tibial Translation ◽  
Reconstructed Knee

scholarly journals Vascular Complications in Arthroscopic Repair Of Posterior Cruciate Ligament

2017 ◽  
Vol 5 (1_suppl) ◽  
pp. 2325967117S0001
Author(s):  
Juan Ignacio Agotegaray ◽  
Ignacio Comba ◽  
Luciana Bisiach ◽  
María Emilia Grignaffini
Keyword(s):  
Vascular Surgery ◽  
Posterior Cruciate Ligament ◽  
Popliteal Artery ◽  
Cruciate Ligament ◽  
Vascular Complications ◽  
Arthroscopic Repair ◽  
Vascular Lesions ◽  
Posterior Tibial Translation ◽  
Posterior Tibial ◽  
Tibial Translation

Introduction: Posterior cruciate ligament is the primary stabilizer of the knee. Among the potential complications in arthroscopic repair of this ligament, there are vascular lesions, due to laceration, thrombosis and injury of the intima of the popliteal artery. We used one case to show the vascular complications that may arise in arthroscopic repair of the posterior cruciate ligament, how to handle it and the results. Methods: One patient, 33 years old, with a history of traffic accident. In a physical exam the patient shows pain and swelling of the knee, positive posterior drawer test and positive Godfrey test. X-rays on the knee show posterior tibial translation and MRI a complete fibers rupture at the middle third of the posterior cruciate ligament. An arthroscopic repair surgery was scheduled three weeks after trauma, with PCL reconstruction using simple band technique.After surgical intervention, hemostatic cuff was released, no peripheral pulse, paleness and coldness of the member was confirmed. An arteriography was carried out, which confirmed absences of distal vascular filling in the popliteal artery. An urgent referral was carried out with Vascular Surgery Services, who had been informed of the surgery previously (a notification that is part of our routine for this kind of interventions). Arteriorrhaphy and venorrhaphy of the popliteal arteries was fulfilled 12 hours later, with a leg fasciotomy. Daily monitoring was performed, and after 72 hours, muscle necrosis is seen with wound drainage, analysis shows presence of gram-negative bacilli, Proteus Mirabilis-Pseudomonas spp and the lab results showed leukocytes: 8.700/ml, ESR: 58, CRP: 48. A new surgery is performed with complete resection of the anterior external compartment of the leg, and a system of continuous cleansing is applied with physiological saline solution and boric acid for 14 days until drainage is eliminated. Vancomycin and ceftazidime EV was indicated for 14 days and, after a good evolution of the wounds, patient is discharged from hospital with Sulfamethoxazole/trimethoprim 160mg/800mg to be taken orally for 14 days. Results: After treatment with oral antibiotic is completed, wounds progress positively. Foot in equinus position, has positive distal pulses with distal sensibility. Use of a thermoforming brace is indicated for movement. Vascular Surgery Services are currently following patient’s evolution. An ankle arthrodesis surgery is evaluated for the future. Conclusion: Combined injuries that result in a posterior tibial translation over 15 mm and, those that come along with injuries in the anterior cruciate ligament or posterior lateral structures of the knee, should be repaired through surgery. Vascular lesion caused by laceration, thrombosis or injury of the intima of the popliteal artery, mainly during perforation and preparation of tibial tunnel, is a serious lesion. Although these vascular lesions during arthroscopy are complications relatively rare, a potential risk should be considered, with consequences that could be fatal for the extremity and for patient’s life when bleeding is involved. In those cases, urgent treatment is imperative, that is the reason we believe it is safe to coordinate with Vascular Surgery Services before the surgery is carried out.

scholarly journals Sequential Changes in Posterior Tibial Translation After Posterior Cruciate Ligament Reconstruction: Risk Factors for Residual Posterior Sagging

2021 ◽  
Vol 9 (6) ◽  
pp. 232596712110098
Author(s):  
Yuta Tachibana ◽  
Yoshinari Tanaka ◽  
Kazutaka Kinugasa ◽  
Masayuki Hamada ◽  
Shuji Horibe
Keyword(s):  
Risk Factors ◽  
Posterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Multivariate Logistic Regression Analysis ◽  
Radiographic Findings ◽  
Posterior Tibial Translation ◽  
Posterior Tibial ◽  
Grade 3 ◽  
Tibial Translation

Background: Residual posterior sagging may occur after posterior cruciate ligament (PCL) reconstruction (PCLR), yet when it mainly occurs is not fully understood. Purpose: To elucidate sequential changes in radiographic posterior tibial translation (PTT) after PCLR. Study Design: Case-control study; Level of evidence, 3. Methods: The authors retrospectively investigated the radiographic findings from 22 patients who underwent bisocket double-bundle PCLR for isolated PCL injury with at least 2 years of follow-up (mean, 4.5 years; range, 2-10 years). Injury severity was assessed using PTT on lateral radiographs with gravity sag views and was stratified according to side-to-side difference in the tibial-femoral stepoff: grade 1 (<5 mm), grade 2 (5 to <10 mm), or grade 3 (≥10 mm). Measurements were taken preoperatively and then immediately, 3 months, 6 months, 1 year, and ≥2 years postoperatively. The authors also investigated the risk factors for residual posterior sagging, indicated when PTT was ≥5 mm (grade ≥2) at the minimum 2-year follow-up. Results: Preoperatively, 13 patients had a grade 2 injury, and 9 had grade 3 injury. The PTT, restored immediately after PCLR, significantly increased at 3 months ( P < .001) but remained unchanged thereafter ≥2 years. There were 7 cases of postoperative PTT ≥5 mm on radiographs. Patients with residual posterior sagging had significantly larger mean PTT than did those without residual posterior sagging at all time points except for immediately postoperatively (preoperatively, 9.1 ± 1.6 vs 12.2 ± 2.3 mm; 3-month follow-up, 2.7 ± 1.6 vs 7.0 ± 1.8 mm; ≥2-year follow-up, 3.4 ± 1.0 vs 6.5 ± 1.4 mm; P < .001 for all). Multivariate logistic regression analysis showed that preoperative grade 3 injury was independently associated with residual posterior sagging (OR, 26.809; 95% CI, 1.257-571.963; P < .001). Conclusion: The initially reduced postoperative PTT significantly increased within 3 months using conventional rehabilitation protocols, but no progression was observed up to 4.5 years after PCLR. Preoperative grade 3 injury was independently associated with residual posterior sagging.

Biomechanical Analysis of a Double-Bundle Posterior Cruciate Ligament Reconstruction

2000 ◽  
Vol 28 (2) ◽  
pp. 144-151 ◽  
Author(s):  
Christopher D. Harner ◽  
Marsie A. Janaushek ◽  
Akihiro Kanamori ◽  
Masayoshi Yagi ◽  
Tracy M. Vogrin ◽  
...  
Keyword(s):  
Posterior Cruciate Ligament ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Double Bundle ◽  
Single Bundle ◽  
Posterior Cruciate Ligament Reconstruction ◽  
Cruciate Ligament Reconstruction ◽  
Posterior Tibial ◽  
Tibial Translation ◽  
Intact Knee

The objective of this study was to experimentally evaluate a single-bundle versus a double-bundle posterior cruciate ligament reconstruction by comparing the resulting knee biomechanics with those of the intact knee. Ten human cadaveric knees were tested using a robotic/universal force-moment sensor testing system. The knees were subjected to a 134-N posterior tibial load at five flexion angles. Three knee conditions were tested: 1) intact knee, 2) single-bundle reconstruction, and 3) double-bundle reconstruction. Posterior tibial translation of the intact knee ranged from 4.9 2.7 mm at 90° to 7.2 1.5 mm at full extension. After the single-bundle reconstruction, posterior tibial translation increased to 7.3 3.9 mm and 9.2 2.8 mm at 90° and full extension, respectively, while the corresponding in situ forces in the graft were up to 44 19 N lower than those in the intact ligament. Conversely, with double-bundle reconstruction, the posterior tibial translation did not differ significantly from the intact knee at any flexion angle tested. This reconstruction also restored in situ forces more closely than did the single-bundle reconstruction. These data suggest that a double-bundle posterior cruciate ligament reconstruction can more closely restore the biomechanics of the intact knee than can the single-bundle reconstruction throughout the range of knee flexion.

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