TY - JOUR
T1 - Osseous valgus alignment and posteromedial ligament complex deficiency lead to increased ACL graft forces
AU - Mehl, Julian
AU - Otto, Alexander
AU - Kia, Cameron
AU - Murphy, Matthew
AU - Obopilwe, E.
AU - Imhoff, Florian B.
AU - Feucht, Matthias J.
AU - Imhoff, Andreas B.
AU - Arciero, Robert A.
AU - Beitzel, Knut
N1 - Publisher Copyright:
© 2019, European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA).
PY - 2020/4/1
Y1 - 2020/4/1
N2 - Purpose: To biomechanically investigate the influence of osseous valgus alignment, with and without deficiency of the posteromedial ligament complex (PMC), on ACL-graft forces under axial load. Methods: ACL reconstruction was performed on ten cadaveric knee joints. A lateral distal femur osteotomy was then done to adjust for three different alignment conditions according to the position, where the axial weight bearing line (WBL) dissected the tibial plateau (% from medial to lateral): 50%, 85% and 115%. Each alignment was tested with the PMC intact, deficient and reconstructed. Axial loads of 400 N were applied in 15° of knee flexion and changes of ACL-graft forces and dynamic valgus angle (DVA) were recorded. Results: In the PMC intact state, lateralization of the WBL to 85% and to 115% led to significantly increased ACL graft forces (85%: p = 0.010; 115%: p < 0.001) and DVAs (85%: p = 0.027; 115%: p = 0.027). Dissection of the PMC led to a significant increase of ACL graft forces and DVAs at 85% and 115% valgus alignment (p < 0.001) only. In comparison to valgus aligned knees with additional PMC deficiency, ligament reconstruction alone was able to significantly decrease ACL graft forces (p < 0.001) and DVAs (p < 0.001). However, alignment correction alone was significantly more effective in reducing ACL graft forces (p < 0.001) and DVAs (p = 0.010). Conclusion: Osseous valgus alignment led to significantly increased forces on ACL grafts under axial joint compression, which was even further enhanced, when the PMC was deficient. In the valgus aligned and PMC deficient knee, correction to a straight leg axis was significantly more effective in decreasing forces on the ACL graft than reconstruction of the PMC. In patients with valgus alignment and combined injuries of the ACL and PMC, a correction osteotomy to a straight leg axis as well as reconstruction of the PMC should be considered to protect the reconstructed ACL.
AB - Purpose: To biomechanically investigate the influence of osseous valgus alignment, with and without deficiency of the posteromedial ligament complex (PMC), on ACL-graft forces under axial load. Methods: ACL reconstruction was performed on ten cadaveric knee joints. A lateral distal femur osteotomy was then done to adjust for three different alignment conditions according to the position, where the axial weight bearing line (WBL) dissected the tibial plateau (% from medial to lateral): 50%, 85% and 115%. Each alignment was tested with the PMC intact, deficient and reconstructed. Axial loads of 400 N were applied in 15° of knee flexion and changes of ACL-graft forces and dynamic valgus angle (DVA) were recorded. Results: In the PMC intact state, lateralization of the WBL to 85% and to 115% led to significantly increased ACL graft forces (85%: p = 0.010; 115%: p < 0.001) and DVAs (85%: p = 0.027; 115%: p = 0.027). Dissection of the PMC led to a significant increase of ACL graft forces and DVAs at 85% and 115% valgus alignment (p < 0.001) only. In comparison to valgus aligned knees with additional PMC deficiency, ligament reconstruction alone was able to significantly decrease ACL graft forces (p < 0.001) and DVAs (p < 0.001). However, alignment correction alone was significantly more effective in reducing ACL graft forces (p < 0.001) and DVAs (p = 0.010). Conclusion: Osseous valgus alignment led to significantly increased forces on ACL grafts under axial joint compression, which was even further enhanced, when the PMC was deficient. In the valgus aligned and PMC deficient knee, correction to a straight leg axis was significantly more effective in decreasing forces on the ACL graft than reconstruction of the PMC. In patients with valgus alignment and combined injuries of the ACL and PMC, a correction osteotomy to a straight leg axis as well as reconstruction of the PMC should be considered to protect the reconstructed ACL.
KW - Anterior cruciate ligament
KW - Instability
KW - Knee
KW - Medial collateral ligament
KW - Valgus
UR - http://www.scopus.com/inward/record.url?scp=85074682680&partnerID=8YFLogxK
U2 - 10.1007/s00167-019-05770-2
DO - 10.1007/s00167-019-05770-2
M3 - Article
C2 - 31679070
AN - SCOPUS:85074682680
SN - 0942-2056
VL - 28
SP - 1119
EP - 1129
JO - Knee Surgery, Sports Traumatology, Arthroscopy
JF - Knee Surgery, Sports Traumatology, Arthroscopy
IS - 4
ER -