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Document Title: Mannor-AJSM-Nov00
Article Title: Two-bundle posterior cruciate
ligament reconstruction: An in vitro analysis of graft placement and tension
Authors: Dana
A Mannor, Jason T. Shearn, Edward S. Grood, Frank R. Noyes, Martin S. Levy.
Publication: The American Journal of Sports Medicine
ISSN: 03635465
Date: November-December 2000.
(Figures included. Reference-denoting numbers appear in the same point size as document text.)
Volume: 28
Issue: 6
Pages: 833-845
Key Words: Knee, PCL, reconstruction, biomechanics.
ABSTRACT
This study
had two purposes: first, to determine how femoral attachment location affects
the load sharing between the two bundles of a Y-type posterior cruciate
ligament reconstruction, and second, to determine how the bundles, separately
and in combination, control posterior tibial translation throughout the full
range of knee flexion. One and two-bundle reconstructions were performed in 12
cadaveric knees. The one-bundle reconstructions were attached within the
femoral posterior cruciate ligament footprint at one of three locations, high
and shallow (S[subscript]1), mid and shallow (S[subscript]2), or mid and deep
(D). The two-bundle reconstructions comprised an S[subscript]1 bundle with either
an S[subscript]2 or a D bundle. Posterior translation and bundle tension were
measured as the knee was flexed from full extension to 120 degrees of flexion
while a posterior force of either 50 or 100 Newtons was applied to the proximal
tibia. The shallow one-bundle reconstruction restored posterior translation to
within 2 mm of that of the intact knee over the entire range of knee flexion.
The deep reconstruction did not control abnormal posterior translation above
45deg. The tension in the shallow bundles increased with knee flexion, and the
deep bundle tension remained nearly constant throughout knee flexion. Both
two-bundle reconstructions controlled posterior translation, but with different
load-sharing characteristics. The S[subscript]1-S[subscript]2 configuration
resisted posterior tibial translation as both bundles became taut in flexion.
In contrast, the S[subscript]1-D configuration resisted posterior translation
in a reciprocal fashion with the D bundle tension being the greatest in
extension and the S[subscript]1 bundle tension being the greatest tension in
flexion.
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