Background: The shortage of autogenous grafts has often times been a problem in knee ligament reconstruction. There are little data concerning the use of the anterior half of the peroneus longus tendon (AHPLT) as an autograft.
Hypothesis: The AHPLT is a suitable graft with respect to its strength, safety, and donor site morbidity.
Study Design: Descriptive laboratory study and case series; Level of evidence, 4.
Methods: The safety and efficacy of using the AHPLT as an autograft source were evaluated. A cadaveric study was first done to reveal the anatomic profile of the AHPLT, to test its failure load, and to compare it with that of the semitendinosus and gracilis tendons. Then, a cadaveric harvest study was performed to show it was safe and reproducible. The space between the tendon stripper and the peroneal nerve during harvesting of the AHPLT was evaluated. Lastly, a clinical study was performed to evaluate donor site morbidity. The preoperative and postoperative foot and ankle functions of 92 patients who underwent a variety of knee ligament reconstructions with the AHPLT were followed for more than 2 years and were then evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) scale and the Foot and Ankle Disability Index (FADI) to determine the influence of tendon removal on ankle and foot function.
Results: The average failure load of the AHPLT was 322.35 ± 63.18 N, accounting for 97.69% ± 19.48% and 147.94% ± 41.30% of the semitendinosus and gracilis tendons, respectively. During tendon harvesting, the distance between the head of the tendon stripper and the branching point of the deep peroneus nerve was 4.6 to 10.4 cm. The clinical study showed that the preoperative and postoperative AOFAS scores were 97.4 ± 2.0 and 97.2 ± 1.6 (P = .85), respectively, while the FADI scores preoperatively and postoperatively were 96.8 ± 2.2 and 96.9 ± 2.5 (P = .91), respectively. No signs of peroneus nerve injury, peroneus longus tendon rupture, or tendinopathy were found.
Conclusion: The AHPLT is acceptable for use as an autograft with respect to its strength, safety, and donor site morbidity.
Background: The use of interference screw fixation for bone-patellar tendon-bone grafts in anterior cruciate ligament fixation is well established. No previous study has compared bovine bone screws and biodegradable interference screws or demonstrated their efficacy for requirements associated with early rehabilitation.
Hypothesis: There is no difference in tension loss and pull-out strength between bovine bone screws and biodegradable interference screws.
Study Design: Controlled laboratory study.
Methods: Anterior cruciate ligament reconstructions with bone-patellar tendon-bone allografts were performed in 40 human tibiae from 20 donors. A bovine bone screw and a polylevolactide interference screw were used for tibial fixation in each pair. A cyclic testing protocol with varying magnitude and orientation of the graft loading was developed. Cyclic tests were performed at 1 Hz for 5000 cycles with a peak force of 200 N applied to the graft. Survival rate and postcyclic–test pull-out strength were compared.
Results: Fifteen of 20 reconstructions fixed with bovine bone screws and 17 of 20 fixed with biodegradable screws reached 5000 cycles. Graft tension drop after the 5000 cycles averaged 19.7 N ( ± 12.9) for bovine bone screws and 18.9 N ( ± 16.3) for biodegradable screws. There were no significant differences in tension loss and pull-out strength between the 2 types of screws.
Conclusion: Bovine bone screws are comparable to biodegradable interference screws in providing stable tibial fixation in anterior cruciate ligament reconstruction using bone-patellar tendon-bone allografts.
Clinical Relevance: The use of bovine bone screws may be comparable to the popular biodegradable interference screws used for anterior cruciate ligament reconstruction in postsurgery rehabilitation.
Background: Although anterior cruciate ligament (ACL) reconstructions are frequently performed, little is known about the effect of initial tension on an ACL graft at the time of its fixation.
Purpose: The objective of this study was to evaluate the effects of initial tension on the relative position and the load between femur and tibia during passive motion.
Study Design: Controlled laboratory study.
Methods: Seven cadaveric knees underwent a passive flexion-extension movement from 0° to 90° with a robotic system developed in the authors’ laboratory under 6 degrees of freedom, while their 3-dimensional paths were recorded. A single-socket ACL reconstruction was performed with an autogenous quadrupled hamstring tendon graft, while the knees underwent the same movement as before with the initial graft tension of 22 N (group A), 44 N (group B), or 88 N (group C) at 20°. The relative position between the femur and the tibia was recorded, and the load in the femorotibial joint was calculated using the principle of superposition.
Results: The tibia in group C was most posteriorly positioned among the 3 groups (an average posterior translation of 0.6, 1.3, and 2.6 mm in groups A, B, and C, respectively). The tibia also moved proximally and laterally with external and valgus rotation with an increase in initial tension, and consequently the load in the femorotibial joint increased at all flexion angles.
Conclusion: With an increase in initial tension, the tibia moved posterolaterally with external and valgus rotation, and consequently the contact force in the femorotibial joint increased.
Clinical Relevance: Excessive initial tension at the time of ACL reconstruction may potentially bring deleterious effects to the articular surface, leading to cartilage degeneration.
Background: Although the literature has extensively discussed impingement after anterior cruciate ligament (ACL) reconstruction, the definition of impingement is vague, and impingement pressure has not been well investigated as a function of tunnel position.
Purpose: To determine the amount of impingement pressure between the ACL and posterior cruciate ligament (PCL) and between the ACL and notch roof in the native ACL, the single-bundle ACL reconstruction with different tunnel placements, and the anatomical double-bundle ACL reconstruction.
Study design: Controlled laboratory study.
Methods: Fifteen fresh-frozen nonpaired human cadaver knees were used. In each knee, different femoral and tibial tunnels were created, which allowed different graft placements. A single graft was placed in 3 positions: tibial anteromedial (AM) to femoral AM (anatomical), tibial posterolateral (PL) to femoral high AM (nonanatomical/mismatch), and tibial AM to femoral high AM. Double grafts were placed in an anatomical fashion (AM to AM and PL to PL). In each case, pressure-measuring films were inserted between the ACL and roof, the ACL and PCL, and the AM and PL bundles (for double-bundle group only). Knees were then moved with 40 N of force and from full flexion to full extension, and the pressure pattern on the film was analyzed.
Results: Compared with other groups, only the AM–high AM group showed significantly higher roof impingement pressure (P < .05). There was no significant difference in PCL impingement pressure between the intact ACL group and any of the reconstructed groups. No impingement pressure was observed between the grafts in the anatomical double-bundle ACL reconstruction.
Conclusion: This study evaluated the effect of different tunnel placements on the impingement pressure after ACL reconstruction. Anatomical single- or double-bundle ACL reconstruction and nonanatomical tibial PL–femoral high AM ACL reconstruction do not cause roof, PCL, and interbundle impingement.
Clinical relevance: Surgeons can perform the anatomical double-bundle ACL, anatomical single-bundle, and nonanatomical tibial PL–femoral high AM reconstructions as impingement-free reconstructions.
