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The Journal of Bone and Joint Surgery, Vol 72, Issue 2 259-267, Copyright © 1990 by Journal of Bone and Joint Surgery, Inc
Testing for isometry during reconstruction of the anterior cruciate ligament. Anatomical and biomechanical considerations
AA Sapega, RA Moyer, C Schneck and N Komalahiranya
Sports Medicine and Science Center, Temple University, Philadelphia, Pennsylvania 19140.
Instrumented tibiofemoral (bone-to-bone) excursion wires were implanted in
the mid-substance of the anteromedial, central, and posterior fiber-regions
of the anterior cruciate ligament through limited anterior and posterior
arthrotomies in eight fresh knees from cadavera. The change in the distance
of linear separation between each pair of osseous fiber-insertion sites was
measured and was plotted against the angle of flexion of the knee as the
knee was cycled through a 120-degree range of motion. Testing conditions
likely to be present during intraoperative testing for isometry were used
(anterior cruciate fibers transected, quadriceps relaxed, femur stabilized
with the patient in the supine position and the leg freely dependent, and
motion of the knee induced in neutral rotation by force applied at the
level of the foot). In no instance did the insertion-site centers of any
fiber-region exhibit isometric behavior (change in the distance of linear
separation of 1.0 millimeter or less). The least deviations from isometry
(range, 1.4 to 3.1 millimeters) were observed for the anteromedial sites,
under conditions when the gravitational dependency of the lower leg was
constrained. When the leg hung in a dependent manner during passive motion,
the deviation from isometry of the anteromedial sites of insertion
increased significantly (range, 2.8 to 5.6 millimeters). The central sites
of insertion were generally less isometric than the anteromedial sites, and
the posterior sites were the least isometric, regardless of testing
conditions.
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