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Document Title: Almekinders-AJSM-May01
Article Title: Fixed tibial subluxation after successful anterior cruciate ligament reconstruction
Authors: Louis C Almekinders, Donny de Castro.
Publication: American Journal of Sports Medicine, Baltimore, Maryland
Date: May/Jun 2001
Volume 29, Number 3, pages 280-283
(Figures included. Reference-denoting numbers appear in the same point size as the document text.)
This study discusses the biomechanical problems and consequent long-term concerns associated with tibial subluxation in the ACL-reconstructed knee. Although modern tendon-graft ACL-reconstruction methods are good for restoring the kinematics of the knee, the fact that a natural ACL has a multifascicular structure makes exact replication its function with a single-bundle graft infeasible.
Abstract
Anterior cruciate ligament reconstruction results in improved function and stability in many patients. However, it is not known whether the improved stability is associated with an improved tibiofemoral relationship. We used stress radiographs to determine not only stability but also the tibiofemoral relationship in 15 patients who had a clinically successful anterior cruciate ligament reconstruction. Their results were compared with those of 14 volunteers with normal knees. The average Lysholm score for the patients was 94. None of the patients had more than 3 mm of side-to- side difference on KT-1000 arthrometer testing. Maximal anteroposterior tibial translation as measured by stress radiography was slightly increased in the reconstructed knees but was not statistically significantly different (6.6 +/- 3.2 mm versus 5.0+ /- 3.3 mm). However, with a posteriorly directed stress the tibia in the reconstructed knees did not translate posteriorly to the same extent as did the control knees, resulting in a significant difference in tibial position (-1.2 +/- 3.0 mm versus -4.0 +/- 3.3 mm). Surgical anterior cruciate ligament reconstruction may result in reduced anteroposterior tibial translation, accomplished, in part, through restraining posterior translation, leaving the tibia with persistent subluxation. Fibrosis and contracture of the posterior structures may explain this phenomenon.
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