Can lateral tenodesis improve the rotational stability of the ACL reconstruction? A finite element analysis.
One of the most common knee injuries is the Anterior Cruciate Ligament (ACL) rupture with severe implications on knee stability. The usual treatment is the ACL Reconstruction (ACLR) surgery where the surgeon replaces the torn ligament with a graft in an effort to restore knee kinematics. In case of...
| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2024-01-01
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| Series: | PLoS ONE |
| Online Access: | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0293161&type=printable |
| _version_ | 1797279586107523072 |
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| author | Konstantinos Risvas Dimitar Stanev Konstantinos Moustakas |
| author_facet | Konstantinos Risvas Dimitar Stanev Konstantinos Moustakas |
| author_sort | Konstantinos Risvas |
| collection | DOAJ |
| description | One of the most common knee injuries is the Anterior Cruciate Ligament (ACL) rupture with severe implications on knee stability. The usual treatment is the ACL Reconstruction (ACLR) surgery where the surgeon replaces the torn ligament with a graft in an effort to restore knee kinematics. In case of excessive rotatory instability, Lateral Extra-Articular Tenodesis (LET) can be performed in combination with ACLR. Additionally, LET appears to reduce ACLR graft forces minimizing graft failure chances. However, there are concerns about overconstraining physiological rotation. To gain insight in this controversial topic, we developed an automatic, open-source tool to create a series of Finite Element (FE) models attempting to investigate the interactions of ACLR and LET through simulation. We started by creating a validated model of the healthy knee joint that served as reference for subsequent FE simulations. Then, we created FE models of standalone ACLR and combined ACLR-LET. Each model was assessed by applying a loading profile that resembles the reduction phase of the Pivot-Shift clinical exam. We measured the External Tibia Rotation (ETR), the Posterior Tibia Translation (PTT) of the lateral tibial compartment, and the ACLR graft stress developed around the femoral tunnel insertion site. We observed the following: a) LET reduces ETR and PTT compared to isolated ACLR, b) combined ACLR-LET is more sensitive to LET graft pretension with lower values showcasing performance closer to the healthy joint, c) LET reduces ACLR graft forces for the same pretension values, d) LET exhibits significant overconstraint for higher pretension values. In general, these findings are in agreement with relevant clinical studies and accentuate the potential of the developed framework as a tool that can assist orthopaedists during surgery planning. We provide open access for the FE models of this study to enhance research transparency, reproducibility and extensibility. |
| first_indexed | 2024-03-07T16:28:17Z |
| format | Article |
| id | doaj.art-154a180737b24d65a59c1cffb7d12084 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-03-07T16:28:17Z |
| publishDate | 2024-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-154a180737b24d65a59c1cffb7d120842024-03-03T12:55:51ZengPublic Library of Science (PLoS)PLoS ONE1932-62032024-01-01192e029316110.1371/journal.pone.0293161Can lateral tenodesis improve the rotational stability of the ACL reconstruction? A finite element analysis.Konstantinos RisvasDimitar StanevKonstantinos MoustakasOne of the most common knee injuries is the Anterior Cruciate Ligament (ACL) rupture with severe implications on knee stability. The usual treatment is the ACL Reconstruction (ACLR) surgery where the surgeon replaces the torn ligament with a graft in an effort to restore knee kinematics. In case of excessive rotatory instability, Lateral Extra-Articular Tenodesis (LET) can be performed in combination with ACLR. Additionally, LET appears to reduce ACLR graft forces minimizing graft failure chances. However, there are concerns about overconstraining physiological rotation. To gain insight in this controversial topic, we developed an automatic, open-source tool to create a series of Finite Element (FE) models attempting to investigate the interactions of ACLR and LET through simulation. We started by creating a validated model of the healthy knee joint that served as reference for subsequent FE simulations. Then, we created FE models of standalone ACLR and combined ACLR-LET. Each model was assessed by applying a loading profile that resembles the reduction phase of the Pivot-Shift clinical exam. We measured the External Tibia Rotation (ETR), the Posterior Tibia Translation (PTT) of the lateral tibial compartment, and the ACLR graft stress developed around the femoral tunnel insertion site. We observed the following: a) LET reduces ETR and PTT compared to isolated ACLR, b) combined ACLR-LET is more sensitive to LET graft pretension with lower values showcasing performance closer to the healthy joint, c) LET reduces ACLR graft forces for the same pretension values, d) LET exhibits significant overconstraint for higher pretension values. In general, these findings are in agreement with relevant clinical studies and accentuate the potential of the developed framework as a tool that can assist orthopaedists during surgery planning. We provide open access for the FE models of this study to enhance research transparency, reproducibility and extensibility.https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0293161&type=printable |
| spellingShingle | Konstantinos Risvas Dimitar Stanev Konstantinos Moustakas Can lateral tenodesis improve the rotational stability of the ACL reconstruction? A finite element analysis. PLoS ONE |
| title | Can lateral tenodesis improve the rotational stability of the ACL reconstruction? A finite element analysis. |
| title_full | Can lateral tenodesis improve the rotational stability of the ACL reconstruction? A finite element analysis. |
| title_fullStr | Can lateral tenodesis improve the rotational stability of the ACL reconstruction? A finite element analysis. |
| title_full_unstemmed | Can lateral tenodesis improve the rotational stability of the ACL reconstruction? A finite element analysis. |
| title_short | Can lateral tenodesis improve the rotational stability of the ACL reconstruction? A finite element analysis. |
| title_sort | can lateral tenodesis improve the rotational stability of the acl reconstruction a finite element analysis |
| url | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0293161&type=printable |
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