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Document Title: VandeVelde-AJSM-Feb07.shtml
Article Title: The Effect of Anterior Cruciate Ligament Deficiency on the In Vivo Elongation of the Medial and Lateral Collateral Ligaments
Authors: Samuel K. Van de Velde, MD, Louis E. DeFrate, ScD, Thomas J. Gill, MD, Jeremy M. Moses, MD, Ramprasad Papannagari, MS and Guoan Li, PhD.
Publication: American Journal of Sports Medicine, Baltimore, Maryland
Date: February 2007
Volume 35, pages 294-300
Keywords: anterior cruciate ligament (ACL), medial collateral ligament (MCL), lateral/fibular collateral ligament (LCL/FCL), ACL injury, biomechanics, stability, kinematics, kinetics, knee motion, ligament elongation, stretching-out.
(Reference-denoting numbers appear in the same font and point size as the document text. As with all Knee Library documents, this article is provided in full-text form, complete with all figures and tables.)
Comments: In this study, the authors looked at how knee motion was affected by loss of the ACL. They found that unaddressed ACL deficiency predisposes the knee to further ligamentous injuries, most notably MCL injury. Leaving the ACL chronically torn results in increased MCL stresses, therefore eventually causing the MCL to stretch out, hence worsening the joint looseness (laxity) and exacerbating instability. They note that an ACL reconstruction should aim to restore normal knee motion in all six degrees of freedom. (A good discussion of the six degrees of freedom can be found in DeFrate-AJSM-Aug06.shtml.)
ABSTRACT
Background: Although anterior cruciate ligament deficiency has been shown to lead to joint degeneration, few quantitative data have been reported on its effect on soft tissue structures surrounding the knee joint.
Hypothesis: Anterior cruciate ligament deficiency will alter the deformation of both collateral ligaments during in vivo weight-bearing knee function from 0°to 90°.
Study Design: Controlled laboratory study.
Methods: Six patients who had acute anterior cruciate ligament injury in 1 knee with the contralateral side intact participated in this study. Using magnetic resonance and dual orthogonal fluoroscopic imaging techniques, we measured the length of the fiber bundles of the superficial medial collateral ligament, deep medial collateral ligament, and lateral collateral ligament of the 6 patients; the healthy contralateral knee of each patient served as a control.
Results: Anterior cruciate ligament injury caused a significant elongation of the fiber bundles of the superficial and deep medial collateral ligament at every flexion angle. In contrast, the lateral collateral ligament fiber bundles shortened after anterior cruciate ligament injury.
Conclusion: The altered deformations of the collateral ligaments associated with the changes in tibiofemoral joint kinematics after anterior cruciate ligament injury demonstrate that deficiency of 1 of the knee joint structures upsets the in vivo knee homeostasis.
Clinical Relevance: Restoring normal knee kinematics after anterior cruciate ligament reconstruction is critical to restore the normal function of the collateral ligaments.
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