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

Blache, Y., Dumas, R., de Guise, J., Saithna, A. ORCID: 0000-0002-2408-5307, Sonnery-Cottet, B. and Thaunat, M., 2019. 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. Clinical Biomechanics, 61, pp. 136-143. ISSN 0268-0033

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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.

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.

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.

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.

Item Type: Journal article
Publication Title: Clinical Biomechanics
Creators: Blache, Y., Dumas, R., de Guise, J., Saithna, A., Sonnery-Cottet, B. and Thaunat, M.
Publisher: Pergamon Press
Date: January 2019
Volume: 61
ISSN: 0268-0033
Identifiers:
NumberType
10.1016/j.clinbiomech.2018.12.011DOI
S0268003318303693Publisher Item Identifier
Divisions: Schools > School of Science and Technology
Record created by: Jonathan Gallacher
Date Added: 28 Feb 2019 11:08
Last Modified: 11 Dec 2019 03:00
URI: http://irep.ntu.ac.uk/id/eprint/35849

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