The Journal of Bone and Joint Surgery, Vol 58, Issue 5 583-594, Copyright © 1976 by Journal of Bone and Joint Surgery, Inc

JOURNAL CONTENTS

Stiffness and laxity of the knee--the contributions of the supporting structures. A quantitative in vitro study

KL Markolf, JS Mensch and HC Amstutz

Thirty-five normal cadaver knees were tested manually in six positions of the knee using apparatus designed to measure the moment-rotation responses for both varus-valgus angulation and torsion of the tibia, as well as the force-displacement responses for anterior-posterior movement of the tibia. The responses of all knees to all modes of loading were non-linear, reflecting increasing stiffness. With the knee at full extension, stiffness was maximum and laxity was minimum. Hence, it was in this position that changes in stability (laxity and stiffness) were best demonstrated when ligament structures were sectioned. Differences in laxity were observed between right and left knees of intact paired specimens. Torsional laxity and internal rotation stiffness were most affected by sectioning the medial collateral ligament, while external rotation stiffness was only affected by division of both the lateral collateral ligament and the posterior capsule. Varus-valgus laxity was relatively unaffected by removal of the menisci or section of the cruciate ligaments but increased greatly when either collateral ligament was cut. The medial collateral ligament was the main contributor to valgus stiffness, whereas the lateral collateral ligament had no measurable effect on varus stiffness. Anterior-posterior stability was affected to some extent by virtually every sectioning procedure. Isolated section of the anterior cruciate ligament produced the greatest increase in anterior-posterior laxity at full extension and section of the posterior cruciate, the greatest increase at 90 degrees of flexion. Large increases in anterior-posterior laxity were also observed when the medial collateral ligament and posterior capsule were sectioned in combination.
CiteULike    Connotea    Del.icio.us    Technorati    What's this?

This article has been cited by other articles:

				A. L. Bryant, R. A. Clark, S. Bartold, A. Murphy, K. L. Bennell, E. Hohmann, S. Marshall-Gradisnik, C. Payne, and K. M. Crossley Effects of estrogen on the mechanical behavior of the human Achilles tendon in vivo J Appl Physiol, October 1, 2008; 105(4): 1035 - 1043. [Abstract] [Full Text] [PDF]

				R. J. Schmitz, T. K. Ficklin, Y. Shimokochi, A.-D. Nguyen, B. D. Beynnon, D. H. Perrin, and S. J. Shultz Varus/Valgus and Internal/External Torsional Knee Joint Stiffness Differs Between Sexes Am. J. Sports Med., July 1, 2008; 36(7): 1380 - 1388. [Abstract] [Full Text] [PDF]

				T. W. Kernozek, M. R. Torry, and M. Iwasaki Gender Differences in Lower Extremity Landing Mechanics Caused by Neuromuscular Fatigue Am. J. Sports Med., March 1, 2008; 36(3): 554 - 565. [Abstract] [Full Text] [PDF]

				W. Petersen, S. Loerch, S. Schanz, M. Raschke, and T. Zantop The Role of the Posterior Oblique Ligament in Controlling Posterior Tibial Translation in the Posterior Cruciate Ligament-Deficient Knee Am. J. Sports Med., March 1, 2008; 36(3): 495 - 501. [Abstract] [Full Text] [PDF]

				B. R. Coobs, R. F. LaPrade, C. J. Griffith, and B. J. Nelson Biomechanical Analysis of an Isolated Fibular (Lateral) Collateral Ligament Reconstruction Using an Autogenous Semitendinosus Graft Am. J. Sports Med., September 1, 2007; 35(9): 1521 - 1527. [Abstract] [Full Text] [PDF]

				J. Rubenson, D. G. Lloyd, T. F. Besier, D. B. Heliams, and P. A. Fournier Running in ostriches (Struthio camelus): three-dimensional joint axes alignment and joint kinematics J. Exp. Biol., July 15, 2007; 210(14): 2548 - 2562. [Abstract] [Full Text] [PDF]

				J. R. Robinson, A. M. J. Bull, R. R. deW. Thomas, and A. A. Amis The Role of the Medial Collateral Ligament and Posteromedial Capsule in Controlling Knee Laxity Am. J. Sports Med., November 1, 2006; 34(11): 1815 - 1823. [Abstract] [Full Text] [PDF]

				W.-H. Hsu, J. A. Fisk, Y. Yamamoto, R. E. Debski, and S. L-Y. Woo Differences in Torsional Joint Stiffness of the Knee Between Genders: A Human Cadaveric Study Am. J. Sports Med., May 1, 2006; 34(5): 765 - 770. [Abstract] [Full Text] [PDF]

				T. C. Sell, C. M. Ferris, J. P. Abt, Y.-S. Tsai, J. B. Myers, F. H. Fu, and S. M. Lephart The Effect of Direction and Reaction on the Neuromuscular and Biomechanical Characteristics of the Knee During Tasks That Simulate the Noncontact Anterior Cruciate Ligament Injury Mechanism Am. J. Sports Med., January 1, 2006; 34(1): 43 - 54. [Abstract] [Full Text] [PDF]

				G. Van Damme, K. Defoort, Y. Ducoulombier, F. Van Glabbeek, J. Bellemans, and J. Victor What Should the Surgeon Aim for When Performing Computer-Assisted Total Knee Arthroplasty? J. Bone Joint Surg. Am., December 1, 2005; 87(suppl_2): 52 - 58. [Full Text] [PDF]

				R. V. West and C. D. Harner Graft Selection in Anterior Cruciate Ligament Reconstruction J. Am. Acad. Ortho. Surg., May 1, 2005; 13(3): 197 - 207. [Abstract] [Full Text] [PDF]

				M. J. Belanger, D. C. Moore, J. J. Crisco III, P. D. Fadale, M. J. Hulstyn, and M. G. Ehrlich Knee Laxity Does Not Vary With the Menstrual Cycle, Before or After Exercise Am. J. Sports Med., July 1, 2004; 32(5): 1150 - 1157. [Abstract] [Full Text] [PDF]

				O.-E. Olsen, G. Myklebust, L. Engebretsen, and R. Bahr Injury Mechanisms for Anterior Cruciate Ligament Injuries in Team Handball: A Systematic Video Analysis Am. J. Sports Med., June 1, 2004; 32(4): 1002 - 1012. [Abstract] [Full Text] [PDF]

				J. R. Giffin, T. M. Vogrin, T. Zantop, S. L-Y. Woo, and C. D. Harner Effects of Increasing Tibial Slope on the Biomechanics of the Knee Am. J. Sports Med., March 1, 2004; 32(2): 376 - 382. [Abstract] [Full Text] [PDF]

				J. K. Sekiya, J. R. Giffin, J. J. Irrgang, F. H. Fu, and C. D. Harner Clinical Outcomes after Combined Meniscal Allograft Transplantation and Anterior Cruciate Ligament Reconstruction Am. J. Sports Med., November 1, 2003; 31(6): 896 - 906. [Abstract] [Full Text] [PDF]

				E. M. Wojtys, L. J. Huston, H. J. Schock, J. P. Boylan, and J. A. Ashton-Miller Gender Differences in Muscular Protection of the Knee in Torsion in Size-Matched Athletes J. Bone Joint Surg. Am., May 1, 2003; 85(5): 782 - 789. [Abstract] [Full Text] [PDF]

				W. H. Wu, T. Hackett, and J. C. Richmond Effects of Meniscal and Articular Surface Status on Knee Stability, Function, and Symptoms after Anterior Cruciate Ligament Reconstruction: A Long-term Prospective Study Am. J. Sports Med., November 1, 2002; 30(6): 845 - 850. [Abstract] [Full Text] [PDF]

				E. M. Wojtys, J. A. Ashton-Miller, and L. J. Huston A Gender-Related Difference in the Contribution of the Knee Musculature to Sagittal-Plane Shear Stiffness in Subjects with Similar Knee Laxity J. Bone Joint Surg. Am., January 1, 2002; 84(1): 10 - 16. [Abstract] [Full Text]

				R. A. Ottaviani, J. A. Ashton-Miller, and E. M. Wojtys Inversion and Eversion Strengths in the Weightbearing Ankle of Young Women: Effects of Plantar Flexion and Basketball Shoe Height Am. J. Sports Med., March 1, 2001; 29(2): 219 - 225. [Abstract] [Full Text] [PDF]

				J. J. Callaghan, J. N. Insall, A. S. Greenwald, D. A Dennis, R. D. Komistek, D. W. Murray, R. B. Bourne, C. H. Rorabeck, and L. D. Dorr Mobile-Bearing Knee Replacement : Concepts and Results*{{dagger}} J. Bone Joint Surg. Am., July 1, 2000; 82(7): 1020 - 1020. [Full Text]

				K. Donald Shelbourne and T. Gray Results of Anterior Cruciate Ligament Reconstruction Based on Meniscus and Articular Cartilage Status at the Time of Surgery: Five- to Fifteen-Year Evaluations Am. J. Sports Med., July 1, 2000; 28(4): 446 - 452. [Abstract] [Full Text] [PDF]

				F. H. Fu, C. H. Bennett, C. Lattermann, and C. B. Ma Current Trends in Anterior Cruciate Ligament Reconstruction: Part 1: Biology and Biomechanics of Reconstruction Am. J. Sports Med., November 1, 1999; 27(6): 821 - 830. [Abstract] [Full Text] [PDF]

				W. E. Nordt III, P. Lotfi, E. Plotkin, and B. Williamson The In Vivo Assessment of Tibial Motion in the Transverse Plane in Anterior Cruciate Ligament-Reconstructed Knees Am. J. Sports Med., September 1, 1999; 27(5): 611 - 616. [Abstract] [Full Text] [PDF]

				Y. Kaneda, H. Moriya, K. Takahashi, Y. Shimada, and T. Tamaki Experimental Study on External Tibial Rotation of the Knee Am. J. Sports Med., December 1, 1997; 25(6): 796 - 800. [Abstract] [PDF]

				M. Lundberg and K. Messner Ten-Year Prognosis of Isolated and Combined Medial Collateral Ligament Ruptures: A Matched Comparison in 40 Patients Using Clinical and Radiographic Evaluations Am. J. Sports Med., January 1, 1997; 25(1): 2 - 6. [Abstract] [PDF]

				M.L. Hull Analysis of Skiing Accidents Involving Combined Injuries to the Medial Collateral and Anterior Cruciate Ligaments Am. J. Sports Med., January 1, 1997; 25(1): 35 - 40. [Abstract] [PDF]

				L. J. Huston and E. M. Wojtys Neuromuscular Performance Characteristics in Elite Female Athletes Am. J. Sports Med., July 1, 1996; 24(4): 427 - 436. [Abstract] [PDF]

				D. HILLARD-SEMBELL, D. M. DANIEL, M. L. STONE, B. E. DOBSON, and D. C. FITHIAN Combined Injuries of the Anterior Cruciate and Medial Collateral Ligaments of the Knee. Effect of Treatment on Stability and Function of the Joint J. Bone Joint Surg. Am., February 1, 1996; 78(2): 169 - 76. [Abstract] [Full Text]

				C. Guanche, T. Knatt, M. Solomonow, Yun Lu, and R. Baratta The Synergistic Action of the Capsule and the Shoulder Muscles Am. J. Sports Med., June 1, 1995; 23(3): 301 - 306. [Abstract] [PDF]

				R. Zatterstrom, T. Friden, A. Lindstrand, and U. Moritz The Effect of Physiotherapy on Standing Balance in Chronic Anterior Cruciate Ligament Insufficiency Am. J. Sports Med., July 1, 1994; 22(4): 531 - 536. [Abstract] [PDF]

				E. M. Wojtys and L. J. Huston Neuromuscular Performance in Normal and Anterior Cruciate Ligament-Deficient Lower Extremities Am. J. Sports Med., January 1, 1994; 22(1): 89 - 104. [Abstract] [PDF]

				T. Friden, A. Lindstrand, and N. Eglund Authors' Reply Am. J. Sports Med., September 1, 1993; 21(5): 763 - 763. [PDF]

				R. S. Brower, A. Melby, M. J. Askew, and D. C. Beringer In vitro comparison of over-the-top and through-the-condyle anterior cruciate ligament reconstructions Am. J. Sports Med., September 1, 1992; 20(5): 567 - 574. [Abstract] [PDF]

				A. F. Anderson, R. B. Snyder, C. F. Federspiel, and A. B. Lipscomb Instrumented evaluation of knee laxity: A comparison of five arthrometers Am. J. Sports Med., March 1, 1992; 20(2): 135 - 140. [Abstract] [PDF]

				W. O. Thompson, F. L. Thaete, F. H. Fu, and S. F. Dye Tibial meniscal dynamics using three-dimensional reconstruction of magnetic resonance images Am. J. Sports Med., June 1, 1991; 19(3): 210 - 216. [Abstract] [PDF]

				D. J. Drez JR, J. DeLee, J. P. Holden, S. Arnoczky, F. R. Noyes, and T. S. Roberts Anterior cruciate ligament reconstruction using bone-patellar tendon-bone allografts: A biological and biomechanical evaluation in goats Am. J. Sports Med., June 1, 1991; 19(3): 256 - 263. [Abstract] [PDF]

				D. M. Daniel Assessing the limits of knee motion Am. J. Sports Med., March 1, 1991; 19(2): 139 - 147. [Abstract] [PDF]

				F. R. Noyes, J. F. Cummings, E. S. Grood, K. A. Walz-Hasselfeld, and R. R. Wroble The diagnosis of knee motion limits, subluxations, and ligament injury Am. J. Sports Med., March 1, 1991; 19(2): 163 - 171. [Abstract] [PDF]

				S. Hagood, M. Solomonow, R. Baratta, B.H. Zhou, and R. D'Ambrosia The effect of joint velocity on the contribution of the antagonist musculature to knee stiffness and laxity Am. J. Sports Med., March 1, 1990; 18(2): 182 - 187. [Abstract] [PDF]

				A. F. Anderson and A. B. Lipscomb Preoperative instrumented testing of anterior and posterior knee laxity Am. J. Sports Med., June 1, 1989; 17(3): 387 - 392. [Abstract] [PDF]

				J. M. Czerniecki, F. Lippert, and J. E. Olerud A biomechanical evaluation of tibiofemoral rotation in anterior cruciate deficient knees during walking and running Am. J. Sports Med., July 1, 1988; 16(4): 327 - 331. [Abstract] [PDF]

				D.W. Jackson, E.S. Grood, P. Wilcox, D.L. Butler, T.M. Simon, and J.P. Holden The effects of processing techniques on the mechanical properties of bone-anterior cruciate ligament-bone allografts: An experimental study in goats Am. J. Sports Med., March 1, 1988; 16(2): 101 - 105. [Abstract] [PDF]

				D.W. Jackson, E.S. Grood, S.P. Arnoczky, D.L. Butler, and T.M. Simon Cruciate reconstruction using freeze dried anterior cruciate ligament allograft and a ligament augmentation device (LAD): An experimental study in a goat model Am. J. Sports Med., December 1, 1987; 15(6): 528 - 538. [Abstract] [PDF]

				D.W. Jackson, E.S. Grood, S.P. Arnoczky, D.L. Butler, and T.M. Simon Freeze dried anterior cruciate ligament allografts: Preliminary studies in a goat model Am. J. Sports Med., July 1, 1987; 15(4): 295 - 303. [Abstract] [PDF]

				M. Inoue, E. McGurk-Burleson, J. M. Hollis, and S. L.-Y. Woo Treatment of the medial collateral ligament injury: I: The importance of anterior cruciate ligament on the varus-valgus knee laxity Am. J. Sports Med., January 1, 1987; 15(1): 15 - 21. [Abstract] [PDF]

				M. Gibson, R. Mikosz, B. Reider, and T. Andriacchi Analysis of the Muller anterolateral femorotibial ligament reconstruction using a computerized knee model Am. J. Sports Med., September 1, 1986; 14(5): 371 - 375. [Abstract] [PDF]

				M. R. Colville, C. L. Lee, and J. V. Ciullo The Lenox Hill brace: An evaluation of effectiveness in treating knee instability Am. J. Sports Med., July 1, 1986; 14(4): 257 - 261. [Abstract] [PDF]

				D. M. Daniel, M. L. Stone, R. Sachs, and L. Malcom Instrumented measurement of anterior knee laxity in patients with acute anterior cruciate ligament disruption Am. J. Sports Med., December 1, 1985; 13(6): 401 - 407. [Abstract] [PDF]

				K. A. Jurist and J. C. Otis Anteroposterior tibiofemoral displacements during isometric extension efforts: The roles of external load and knee flexion angle Am. J. Sports Med., July 1, 1985; 13(4): 254 - 258. [Abstract] [PDF]

				T.D. Rosenberg and G.L. Rasmussen The function of the anterior cruciate ligament during anterior drawer and Lachman's testing: An in vivo analysis in normal knees Am. J. Sports Med., July 1, 1984; 12(4): 318 - 322. [Abstract] [PDF]

				B. F. Morrey and K.-N. An Articular and ligamentous contributions to the stability of the elbow joint Am. J. Sports Med., September 1, 1983; 11(5): 315 - 319. [Abstract] [PDF]

				B. Zarins, C. R. Rowe, B. A. Harris, and M. P. Watkins Rotational motion of the knee Am. J. Sports Med., June 1, 1983; 11(3): 152 - 156. [Abstract] [PDF]