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The Journal of Bone and Joint Surgery, Vol 70, Issue 1 88-97, Copyright © 1988 by Journal of Bone and Joint Surgery, Inc


JOURNAL CONTENTS

Limits of movement in the human knee. Effect of sectioning the posterior cruciate ligament and posterolateral structures

ES Grood, SF Stowers and FR Noyes
Noyes-Giannestras Biomechanics Laboratories, Department of Aerospace Engineering, University of Cincinnati, Ohio 45221-0048.

We applied specific forces and moments to the knees of fifteen whole lower limbs of cadavera and measured, with a six degrees-of-freedom electrogoniometer, the position of the tibia at which the ligaments and the geometry of the joint limited motion. The limits were determined for anterior and posterior tibial translation, internal and external rotation, and varus and valgus angulation from zero to 90 degrees of flexion. The limits were measured in the intact knee and then the changes that occurred with removal of the posterior cruciate ligament, the lateral collateral ligament, the popliteus tendon at its femoral attachment, and the arcuate complex were measured. The cutting order was varied, allowing us to determine the changes in the limits that occurred when each structure was cut alone and the amount of motion of the joint that was required for each structure to become taut and to limit additional motion when the other supporting structures had been removed. Removal of only the posterior cruciate ligament increased the limit for posterior tibial translation, with no change in the limits for tibial rotation or varus and valgus angulation. The additional posterior translation was least at full extension and increased progressively, reaching 11.4 millimeters at 90 degrees of flexion. The progressive increase in posterior translation with flexion was apparently due to slackening of the posterior portion of the capsule, as the translation nearly doubled when the posterolateral structures subsequently were removed. Removal of only the posterolateral extra-articular restraints increased the amount of external rotation and varus angulation. The average increase in external rotation depended on the angle of flexion; it was greatest at 30 degrees of flexion and decreased with additional flexion. At 90 degrees of flexion, the intact posterior cruciate ligament limited the increase in external rotation to only 5.3 degrees, less than one-half of the 13.0-degree increase that occurred at 30 degrees of flexion. Subsequent removal of the posterior cruciate ligament markedly increased external rotation at 90 degrees of flexion, resulting in a total increase of 20.9 degrees. The limit for varus angulation was normal as long as the lateral collateral ligament was intact. When the lateral collateral ligament was cut, the limit increased 4.5 degrees (approximately 4.5 millimeters of additional joint opening) when the knee was partially flexed (to 15 degrees).(ABSTRACT TRUNCATED AT 400 WORDS)
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Arthrometric Evaluation of Posterior Cruciate Ligament Injuries
Am. J. Sports Med., January 1, 1998; 26(1): 96 - 102.
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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.
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R. F. LaPrade and G. C. Terry
Injuries to the Posterolateral Aspect of the Knee: Association of Anatomic Injury Patterns with Clinical Instability
Am. J. Sports Med., July 1, 1997; 25(4): 433 - 438.
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F. R. Noyes and S. D. Barber-Westin
Surgical Restoration to Treat Chronic Deficiency of the Posterolateral Complex and Cruciate Ligaments of the Knee Joint
Am. J. Sports Med., July 1, 1996; 24(4): 415 - 426.
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D. M. Veltri, Xiang-Hua Deng, P. A. Torzilli, M. J. Maynard, and R. F. Warren
The Role of the Popliteofibular Ligament in Stability of the Human Knee: A Biomechanical Study
Am. J. Sports Med., January 1, 1996; 24(1): 19 - 27.
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F. R. Noyes, L. A. Dunworth, T. P. Andriacchi, M. Andrews, and T. E. Hewett
Knee Hyperextension Galt Abnormalities in Unstable Knees: Recognition and Preoperative Gait Retraining
Am. J. Sports Med., January 1, 1996; 24(1): 35 - 45.
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C. D. Harner, J. W. Xerogeanes, G. A. Livesay, G. J. Carlin, B. A. Smith, T. Kusayama, S. Kashiwaguchi, and S. L.-Y. Woo
The Human Posterior Cruciate Ligament Complex: An Interdisciplinary Study: Ligament Morphology and Biomechanical Evaluation
Am. J. Sports Med., December 1, 1995; 23(6): 736 - 745.
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W. C. Burns II, L. F. Draganich, M. Pyevich, and B. Reider
The Effect of Femoral Tunnel Position and Graft Tensioning Technique on Posterior Laxity of the Posterior Cruciate Ligament-Reconstructed Knee
Am. J. Sports Med., July 1, 1995; 23(4): 424 - 430.
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D. M. Veltri, X.-H. Deng, P. A. Torzilli, R. F. Warren, and M. J. Maynard
The Role of the Cruciate and Posterolateral Ligaments in Stability of the Knee: A Biomechanical Study
Am. J. Sports Med., July 1, 1995; 23(4): 436 - 443.
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F. R. Noyes and S. D. Barber-Westin
Surgical Reconstruction of Severe Chronic Posterolateral Complex Injuries of the Knee Using Allograft Tissues
Am. J. Sports Med., January 1, 1995; 23(1): 2 - 12.
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B. R. Bach JR, G. T. Jones, F. A. Sweet, and C. A. Hager
Arthroscopy-assisted Anterior Cruciate Ligament Reconstruction Using Patellar Tendon Substitution: Two- to Four-year Follow-up Results
Am. J. Sports Med., December 1, 1994; 22(6): 758 - 767.
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J. L. Haimes, R. R. Wroble, E. S. Grood, and F. R. Noyes
Role of the Medial Structures in the intact and Anterior Cruciate Ligament-Deficient Knee: Limits of Motion in the Human Knee
Am. J. Sports Med., June 1, 1994; 22(3): 402 - 409.
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D. C. Wascher, J. D. Grauer, and K. L. Markoff
Biceps tendon tenodesis for posterolateral instability of the knee: An in vitro study
Am. J. Sports Med., June 1, 1993; 21(3): 400 - 406.
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F. R. Noyes, S. F. Stowers, E. S. Grood, J. Cummings, and L. A. VanGinkel
Posterior subluxations of the medial and lateral tibiofemoral compartments: An in vitro ligament sectioning study in cadaveric knees
Am. J. Sports Med., June 1, 1993; 21(3): 407 - 414.
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R. R. Wroble, E. S. Grood, J. S. Cummings, J. M. Henderson, and F. R. Noyes
The role of the lateral extraarticular restraints in the anterior cruciate ligament-deficient knee
Am. J. Sports Med., March 1, 1993; 21(2): 257 - 263.
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F. R. Noyes, S. D. Barber, and R. Simon
High tibial osteotomy and ligament reconstruction in varus angulated, anterior cruciate ligament-deficient knees: A two- to seven-year follow-up study
Am. J. Sports Med., January 1, 1993; 21(1): 2 - 12.
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F. R. Noyes, O. D. Schipplein, T. P. Andriacchi, S. R. Saddemi, and M. Weise
The anterior cruciate ligament-deficient knee with varus alignment: An analysis of gait adaptations and dynamic joint loadings
Am. J. Sports Med., December 1, 1992; 20(6): 707 - 716.
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M. L. Gross, J. S. Grover, L. W. Bassett, L. L. Seeger, and G. A.M. Finerman
Magnetic resonance imaging of the posterior cruciate ligament: Clinical use to improve diagnostic accuracy
Am. J. Sports Med., December 1, 1992; 20(6): 732 - 737.
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S. L.-Y. Woo, J. M. Hollis, D. J. Adams, R. M. Lyon, and S. Takai
Tensile properties of the human femur-anterior cruciate ligament-tibia complex: The effects of specimen age and orientation
Am. J. Sports Med., June 1, 1991; 19(3): 217 - 225.
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D. M. Daniel
Assessing the limits of knee motion
Am. J. Sports Med., March 1, 1991; 19(2): 139 - 147.
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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.
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H. Jonsson, J. Karrholm, and L.-G. Elmqvist
Kinematics of active knee extension after tear of the anterior cruciate ligament
Am. J. Sports Med., December 1, 1989; 17(6): 796 - 802.
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M. S. Hefzy, E. S. Grood, and F. R. Noyes
Factors affecting the region of most isometric femoral attachments: Part II: The anterior cruciate ligament
Am. J. Sports Med., March 1, 1989; 17(2): 208 - 216.
[Abstract] [PDF]