Arthroscopy: The Journal of Arthroscopic & Related Surgery
Original ArticleCadaveric Study Comparing the Biomechanical Properties of Grafts Used for Knee Anterolateral Ligament Reconstruction
Section snippets
Methods
Fifteen fresh-frozen cadaver knees (8 women, 7 men) were obtained from the pathology department of the Université Paul Sabatier (Toulouse, France). The donors had a mean age at death of 54 years (range: 37 to 70 years). The cadavers were stored at 4°C. The 15 cadaver knees were evaluated for signs of arthritis and restrictions by the lead author (E.C.). Any knees meeting one of the following exclusion criteria were not used: wounds or macroscopic signs of intra-articular lesions (Outbridge >
Results
The ALL had an average maximum load to failure of 141 N (range: 90 to 210 N). Its stiffness and elongation at failure were 21 N mm−1 (range: 9 to 34 N mm−1) and 6.2 mm (range: 1.1 to 10.5 mm), respectively. The ALL failed mid-substance in all the specimens. Table 1 summarizes the biomechanical properties of the ALL, gracilis, and ITB.
Discussion
Our hypothesis was confirmed: when the gracilis and ITB are prepared in the configuration used for LET, they have a higher maximum tensile load than the ALL. This difference was statistically significant for the gracilis. A two-strand gracilis graft had a significantly higher maximum load at failure and stiffness than the ALL.
Our results are consistent with previously published results. For the ALL, the average maximum load of 141 N (±40 N) and average stiffness of 21 N mm−1 (±8.2) found in our
Conclusions
The gracilis had the highest maximum load to failure. The ITB's mechanical properties most closely resemble those of the ALL.
Acknowledgment
The authors wish to thank Joanne Archambault, Ph.D., for the editorial assistance provided during the preparation of this manuscript.
References (42)
- et al.
The influence of hamstring autograft size on patient-reported outcomes and risk of revision after anterior cruciate ligament reconstruction: A Multicenter Orthopaedic Outcomes Network (MOON) Cohort Study
Arthroscopy
(2013) - et al.
Vertical femoral tunnel placement results in rotational knee laxity after anterior cruciate ligament reconstruction
Arthroscopy
(2007) - et al.
Morphology of anterior cruciate ligament attachments for anatomic reconstruction: A cadaveric dissection and radiographic study
Arthroscopy
(2006) - et al.
Femoral insertions of the anteromedial and posterolateral bundles of the anterior cruciate ligament: Morphometry and arthroscopic orientation models for double-bundle bone tunnel placement—A cadaver study
Arthroscopy
(2008) - et al.
Tibial insertions of the anteromedial and posterolateral bundles of the anterior cruciate ligament: Morphometry, arthroscopic landmarks, and orientation model for bone tunnel placement
Arthroscopy
(2008) - et al.
Lateral extra-articular tenodesis reduces rotational laxity when combined with anterior cruciate ligament reconstruction: A systematic review of the literature
Arthroscopy
(2015) - et al.
Ultrasonographic identification of the anterolateral ligament of the knee
Arthroscopy
(2016) - et al.
Effectiveness of reconstruction of the anterior cruciate ligament with quadrupled hamstrings and bone-patellar tendon-bone autografts: An in vivo study comparing tibial internal-external rotation
Am J Sports Med
(2007) - et al.
Prospective analysis of failure rate and predictors of failure after anatomic anterior cruciate ligament reconstruction with allograft
Am J Sports Med
(2012) - et al.
Younger patients are at increased risk for graft rupture and contralateral injury after anterior cruciate ligament reconstruction
Am J Sports Med
(2014)
Biomechanical Analysis of simulated clinical testing and reconstruction of the anterolateral ligament of the knee
Am J Sports Med
Biomechanical comparison of anatomic double-bundle, anatomic single-bundle, and nonanatomic single-bundle anterior cruciate ligament reconstructions
Am J Sports Med
Patellar tendon versus hamstring tendon autograft for anterior cruciate ligament rupture in adults
Cochrane Database Syst Rev
A meta-analysis of stability after anterior cruciate ligament reconstruction as a function of hamstring versus patellar tendon graft and fixation type
Arthroscopy
Pivot shift as an outcome measure for ACL reconstruction: A systematic review
Knee Surg Sports Traumatol Arthrosc
A cadaveric study of the anterolateral ligament: Re-introducing the lateral capsular ligament
Knee Surg Sports Traumatol Arthrosc
Classification of knee ligament instabilities. Part II. The lateral compartment
J Bone Joint Surg Am
An anatomic study of the iliotibial tract
Arthroscopy
The anterolateral ligament: Anatomy, length changes and association with the Segond fracture
Bone Joint J
The anterolateral ligament: An anatomic, radiographic, and biomechanical analysis
Am J Sports Med
The biomechanical function of the anterolateral ligament of the knee
Am J Sports Med
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The authors report that they have no conflicts of interest in the authorship and publication of this article.