A novel approach for optimal graft positioning and tensioning in anterior cruciate ligament reconstructive surgery based on the finite element modeling technique

Hamid Naghibi*, Dennis Janssen, Tony Van Tienen, Sebastiaan Van de Groes, Ton Van de Boogaard, Nico Verdonschot

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Background: In ACL-reconstructed patients the postoperative knee biomechanics may differ from the intact knee biomechanical behavior which can alter knee kinematics and kinetics, and as a result lead to the progression of knee osteoarthritis. The aim of this study was to demonstrate the potential of finite element models to define the optimal choices in surgical parameters in terms of optimal graft positioning in combination with graft type in order to restore the kinematic and kinetic behavior of the knee as best as possible. Methods: A workflow was proposed based on cadaveric experiments in order to restore the injured knee to a near normal physiological condition. Femoral and tibial graft insertion sites and graft fixation tension were optimized to obtain similar intact knee laxity, for three common single-bundle and one double-bundle reconstructions. To verify the success of the surgery with the variables calculated using the proposed workflow, a full walking cycle was simulated with the intact, ACL-ruptured, optimal ACL-reconstructed and non-optimal reconstructed knees. Results: Our results suggested that for patellar tendon and hamstring tendon grafts, anatomical positioning (fixation force: 40 N), and for quadriceps tendon graft, isometric positioning (fixation tension: 85 N) could recover the intact joint kinematics and kinetics. Also for double-bundle reconstruction, with the numerically calculated optimal insertion sites, both bundles needed 50-N fixation force. Conclusions: With optimal graft positioning parameters, following the proposed workflow in this study, any of the single-bundle graft types and surgical techniques (single vs. double-bundle) may be used to acceptably recover the intact knee joint biomechanical behavior.

Original languageEnglish
Pages (from-to)384-396
Number of pages13
JournalKnee
Volume27
Issue number2
Early online date2 Feb 2020
DOIs
Publication statusPublished - Mar 2020

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