A millimeter-for-millimeter relation between an increase in length of an anterior cruciate ligament graft construct and an increase in anterior laxity has been demonstrated in multiple in vitro studies. Based on this relation, a 3 mm increase in length of the graft construct following surgery could manifest as a 3 mm increase in anterior laxity in vivo, which is considered clinically unstable. Hence, the two primary objectives were to determine whether the millimeter-for-millimeter relation exists in vivo for slippage-resistant fixation of a soft-tissue graft and, if it does not exist, then to what extent the increase in stiffness caused by biologic healing of the graft to the bone tunnel offsets the potential increase in anterior laxity resulting from lengthening at the sites of fixation. Sixteen subjects were treated with a fresh-frozen, nonirradiated, nonchemically processed tibialis allograft. Tantalum markers were injected into the graft, fixation devices, and bones. On the day of surgery and at 1, 2, 3, and 4 months, Roentgen stereophotogrammetric analysis was used to compute anterior laxity at 150 N of anterior force and the total slippage from both sites of fixation. A simple linear regression was performed to determine whether the millimeter-for-millimeter relation existed and a springs-in-series model of the graft construct was used to determine the extent to which the increase in stiffness caused by biological healing of the graft to the bone tunnel offset the increase in anterior laxity resulting from lengthening at the sites of fixation. There was no correlation between lengthening at the sites of fixation and the increase in anterior laxity at 1 month (, ). Also, the increase in stiffness of the graft construct caused by biologic healing of the graft to the bone tunnel offset 0.7 mm of the 1.5 mm potential increase in anterior laxity resulting from lengthening at the sites of fixation. This relatively large offset of nearly 50% occurred because lengthening at the sites of fixation was small.
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August 2010
Research Papers
Does Graft Construct Lengthening at the Fixations Cause an Increase in Anterior Laxity Following Anterior Cruciate Ligament Reconstruction in vivo?
Conrad K. Smith,
Conrad K. Smith
Biomedical Engineering Program, One Shields Avenue,
University of California
, Davis, CA 95616
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M. L. Hull,
M. L. Hull
Department of Biomedical Engineering, One Shields Avenue,
e-mail: mlhull@ucdavis.edu
University of California
, Davis, CA 95616; Department of Mechanical Engineering, One Shields Avenue, University of California
, Davis, CA 95616
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S. M. Howell
S. M. Howell
Department of Mechanical Engineering, One Shields Avenue,
University of California
, Davis, CA 95616
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Conrad K. Smith
Biomedical Engineering Program, One Shields Avenue,
University of California
, Davis, CA 95616
M. L. Hull
Department of Biomedical Engineering, One Shields Avenue,
University of California
, Davis, CA 95616; Department of Mechanical Engineering, One Shields Avenue, University of California
, Davis, CA 95616e-mail: mlhull@ucdavis.edu
S. M. Howell
Department of Mechanical Engineering, One Shields Avenue,
University of California
, Davis, CA 95616J Biomech Eng. Aug 2010, 132(8): 081001 (8 pages)
Published Online: June 15, 2010
Article history
Received:
July 13, 2009
Revised:
January 5, 2010
Posted:
January 18, 2010
Published:
June 15, 2010
Online:
June 15, 2010
Citation
Smith, C. K., Hull, M. L., and Howell, S. M. (June 15, 2010). "Does Graft Construct Lengthening at the Fixations Cause an Increase in Anterior Laxity Following Anterior Cruciate Ligament Reconstruction in vivo?." ASME. J Biomech Eng. August 2010; 132(8): 081001. https://doi.org/10.1115/1.4001027
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