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The Journal of Bone and Joint Surgery, Vol 76, Issue 4 520-531, Copyright © 1994 by Journal of Bone and Joint Surgery, Inc
The measurement of elongation of anterior cruciate-ligament grafts in vivo
BD Beynnon, RJ Johnson, BC Fleming, PA Renstrom, CE Nichols, MH Pope and LD Haugh
Department of Orthopaedics and Rehabilitation, McClure Musculoskeletal Research Center, University of Vermont College of Medicine, Burlington 05405.
Many investigators who have studied the mechanical behavior of anterior
cruciate-ligament grafts have attributed the increase in anterior
translation of the tibia relative to the femur (an increase in the anterior
laxity of the knee joint) to the temporal changes in the material behavior
(strength and elastic properties) of the graft that occur throughout the
process of remodeling. However, with the onset of motion of the joint, it
is unclear whether the repeatable mechanical behavior of the graft remains
unchanged immediately after fixation, if the fixation slips, or if the
length of the graft changes and produces an increase in anterior
translation of the tibia relative to the femur. It is also unknown if
procedures performed by different surgeons, using similar graft material
and similar operative techniques, can produce similar mechanical behavior
of the graft, or if the behavior of the graft is similar to that of the
normal anterior cruciate ligament. In an effort to address these questions,
two surgeons performed a reconstruction of the anterior cruciate ligament
on ten patients each (groups 1 and 2) with use of a bone-patellar
ligament-bone graft. Immediately after fixation of the graft, a Hall-effect
transducer was implanted to measure the changes in the length of the
mid-substance of the graft while the knee was moved through twenty cycles
of passive flexion-extension. Unlike the length pattern of the normal
anterior cruciate ligament, the length pattern of the graft changed during
the initial cycles of passive motion of the knee. We defined this
phenomenon as the cyclic response of the graft and characterized it by
calculation of the changes in the length of the graft at fixed positions of
the knee across the multiple cycles of passive motion. In some patients,
the length of the graft increased through the initial passive-motion
cycles, while in others, it decreased. With the knee nearly extended, the
predicted increase in anterior translation of the tibia relative to the
femur, resulting from the increase in the length of the graft, was a
maximum of 1.0 millimeter. This indicates that increases in anterior
translation of the tibia relative to the femur can occur immediately after
reconstruction of the anterior cruciate ligament and that changes in the
length of the graft occur after fixation at loads that are less than the
ultimate failure load of the graft or of the fixation.(ABSTRACT TRUNCATED
AT 400 WORDS)
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