This Article
Right arrow Full Text Free
Right arrow Full Text (PDF) Free
Right arrow Letters to the Editor: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when Letters to the Editor are posted
Right arrow Alert me if a correction is posted
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrowReprints and Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by MARKOLF, K. L.
Right arrow Articles by FINERMAN, G. A. M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by MARKOLF, K. L.
Right arrow Articles by FINERMAN, G. A. M.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Technorati  
What's this?
The Journal of Bone and Joint Surgery 79:375-80 (1997)
© 1997 The Journal of Bone and Joint Surgery, Inc.

A Biomechanical Study of Replacement of the Posterior Cruciate Ligament with a Graft. Part I: Isometry, Pre-Tension of the Graft, and Anterior-Posterior Laxity*

KEITH L. MARKOLF, PH.D.{dagger}, JAMES R. SLAUTERBECK, M.D.{ddagger}, KEVIN L. ARMSTRONG, M.D.{dagger}, MATTHEW S. SHAPIRO, M.D.{dagger} and GERALD A. M. FINERMAN, M.D.{dagger}, LOS ANGELES, CALIFORNIA

Investigation performed at the Biomechanics Research Section, Department of Orthopaedic Surgery, University of California at Los Angeles, Los Angeles

Twelve fresh-frozen knee specimens from cadavera were subjected to anterior-posterior laxity testing with 200 newtons of force applied to the tibia; testing was performed before and after a femoral load-cell was connected to a mechanically isolated cylindrical cap of subchondral femoral bone containing the femoral origin of the posterior cruciate ligament. The posterior cruciate ligament then was removed, the proximal end of a thin trial isometer wire was attached to one of four points designated on the femur, and displacement of the distal end of the wire relative to the tibia was measured over a 120-degree range of motion. The potted end of a ten-millimeter-wide bone-patellar ligament-bone graft was centered over the femoral origin of the ligament and attached to the femoral load-cell. Isometry measurements were repeated with the wire attached to the bone block of the free end of the graft in the tibial tunnel. Force was recorded at the load-cell (representing force in the intra-articular portion of the graft) as pre-tension was applied, with use of a calibrated spring-scale, to the tibial end of the graft. A laxity-matched pre-tension of the graft was determined such that the anterior-posterior laxity of the reconstructed knee at 90 degrees of flexion was within one millimeter of the laxity that was measured after installation of the load-cell. Anterior-posterior testing was repeated after insertion of the graft at the laxity-matched pre-tension. The least amount of change in the relative displacement of the trial wire over the 120-degree range of flexion occurred when the wire was attached to the proximal point on the femur (a point on the proximal margin of the femoral origin of the posterior cruciate ligament, midway between the anterior and posterior borders of the ligament). The greatest change in the relative displacement was associated with the anterior point (a point on the anterior margin of the femoral origin of the ligament, midway between the proximal and distal borders). The mean relative displacements of the trial wire when it was attached to a point at the center of the femoral origin of the ligament were not significantly different from the corresponding mean displacements of the distal end of the graft when the proximal end of the graft was centered at this point. At 90 degrees of flexion, the force recorded by the load-cell averaged 64 to 74 per cent of the force applied to the tibial end of the graft. The laxity-matched pre-tension of the graft at 90 degrees of flexion (as recorded by the load-cell) ranged from six to 100 newtons (mean and standard deviation, 43.0 ± 33.4 newtons). With the numbers available, the mean laxities after insertion of the graft were not significantly different, at any angle of flexion, from the corresponding mean values after installation of the load-cell. CLINICAL RELEVANCE: Isometer readings from a trial wire attached to a point on the femur provided an accurate indication of the change in the length of a graft subsequently centered at that point. Anteriorly placed femoral tunnels should be avoided, as the isometer readings indicated increased tension, with flexion of the knee, in a graft placed in this region. The force in the intra-articular portion of the graft was always less than the force applied to the bone block in the tibial tunnel. Therefore, the femoral end of the graft should be tensioned to avoid frictional losses from the severe bend in the graft as it passes over the posterior tibial plateau. With correct pre-tensioning of a graft, normal anterior-posterior laxity at 0 to 90 degrees of flexion can be restored. However, because of the considerable range in the laxity-matched pre-tensions, we recommend that the pre-tension be greater than forty-three newtons for all patients to ensure that normal laxity is restored.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Technorati Technorati    What's this?


This article has been cited by other articles:


Home page
 J Am Acad Orthop SurgHome page
M. J. Matava, E. Ellis, and B. Gruber
Surgical Treatment of Posterior Cruciate Ligament Tears: An Evolving Technique
J. Am. Acad. Ortho. Surg., July 1, 2009; 17(7): 435 - 446.
[Abstract] [Full Text] [PDF]

Home page
 Am J Sports MedHome page
T. M. DeBerardino, K. T. Lonergan, and D. E. Brooks
Comparison of the Split Stacked Versus the Split Achilles Allograft for Dual Femoral Tunnel Posterior Cruciate Ligament Reconstruction
Am. J. Sports Med., January 1, 2008; 36(1): 142 - 148.
[Abstract] [Full Text] [PDF]

Home page
 JBJSHome page
K. L. Markolf, B. T. Feeley, S. R. Jackson, and D. R. McAllister
Biomechanical Studies of Double-Bundle Posterior Cruciate Ligament Reconstructions
J. Bone Joint Surg. Am., August 1, 2006; 88(8): 1788 - 1794.
[Abstract] [Full Text] [PDF]

Home page
 Am J Sports MedHome page
D. K. Davis, D. H. Goltz, D. C. Fithian, and D. D'Lima
Anatomical Posterior Cruciate Ligament Transplantation: A Biomechanical Analysis
Am. J. Sports Med., July 1, 2006; 34(7): 1126 - 1133.
[Abstract] [Full Text] [PDF]

Home page
 Am J Sports MedHome page
K. L. Markolf, B. T. Feeley, S. R. Jackson, and D. R. McAllister
Where Should the Femoral Tunnel of a Posterior Cruciate Ligament Reconstruction Be Placed to Best Restore Anteroposterior Laxity and Ligament Forces?
Am. J. Sports Med., April 1, 2006; 34(4): 604 - 611.
[Abstract] [Full Text] [PDF]

Home page
 Am J Sports MedHome page
J. A. Bergfeld, S. M. Graham, R. D. Parker, A. D. C. Valdevit, and H. E. Kambic
A Biomechanical Comparison of Posterior Cruciate Ligament Reconstructions Using Single- and Double-Bundle Tibial Inlay Techniques
Am. J. Sports Med., July 1, 2005; 33(7): 976 - 981.
[Abstract] [Full Text] [PDF]

Home page
 Am J Sports MedHome page
C. A. Fontbote, T. C. Sell, K. G. Laudner, M. Haemmerle, C. R. Allen, F. Margheritini, S. M. Lephart, and C. D. Harner
Neuromuscular and Biomechanical Adaptations of Patients With Isolated Deficiency of the Posterior Cruciate Ligament
Am. J. Sports Med., July 1, 2005; 33(7): 982 - 989.
[Abstract] [Full Text] [PDF]

Home page
 Am J Sports MedHome page
F. R. Noyes and S. D. Barber-Westin
Posterior Cruciate Ligament Revision Reconstruction, Part 1: Causes of Surgical Failure in 52 Consecutive Operations
Am. J. Sports Med., May 1, 2005; 33(5): 646 - 654.
[Abstract] [Full Text] [PDF]

Home page
 Am J Sports MedHome page
S. E. Park, B. D. Stamos, L. E. DeFrate, T. J. Gill, and G. Li
The Effect of Posterior Knee Capsulotomy on Posterior Tibial Translation During Posterior Cruciate Ligament Tibial Inlay Reconstruction
Am. J. Sports Med., September 1, 2004; 32(6): 1514 - 1519.
[Abstract] [Full Text] [PDF]

Home page
 Am J Sports MedHome page
K. L. Markolf, G. O'Neill, S. R. Jackson, and D. R. McAllister
Effects of Applied Quadriceps and Hamstrings Muscle Loads on Forces in the Anterior and Posterior Cruciate Ligaments
Am. J. Sports Med., July 1, 2004; 32(5): 1144 - 1149.
[Abstract] [Full Text] [PDF]

Home page
 Am J Sports MedHome page
L. E. DeFrate, A. van der Ven, T. J. Gill, and G. Li
The Effect of Length on the Structural Properties of an Achilles Tendon Graft as Used in Posterior Cruciate Ligament Reconstruction
Am. J. Sports Med., June 1, 2004; 32(4): 993 - 997.
[Abstract] [Full Text] [PDF]

Home page
 Am J Sports MedHome page
F. Margheritini, C. S. Mauro, J. A. Rihn, K. J. Stabile, S. L-Y. Woo, and C. D. Harner
Biomechanical Comparison of Tibial Inlay Versus Transtibial Techniques for Posterior Cruciate Ligament Reconstruction: Analysis of Knee Kinematics and Graft In Situ Forces
Am. J. Sports Med., April 1, 2004; 32(3): 587 - 593.
[Abstract] [Full Text] [PDF]

Home page
 Am J Sports MedHome page
T. J. Gill, L. E. DeFrate, C. Wang, C. T. Carey, S. Zayontz, B. Zarins, and G. Li
The Effect of Posterior Cruciate Ligament Reconstruction on Patellofemoral Contact Pressures in the Knee Joint Under Simulated Muscle Loads
Am. J. Sports Med., January 1, 2004; 32(1): 109 - 115.
[Abstract] [Full Text]

Home page
 JBJSHome page
K. L. Markolf, G. O'Neill, S. R. Jackson, and D. R. McAllister
Reconstruction of Knees with Combined Cruciate Deficiencies: A Biomechanical Study
J. Bone Joint Surg. Am., September 1, 2003; 85(9): 1768 - 1774.
[Abstract] [Full Text] [PDF]

Home page
 Am J Sports MedHome page
D. A. Oakes, K. L. Markolf, J. McWilliams, C. R. Young, and D. R. McAllister
The Effect of Femoral Tunnel Position on Graft Forces During Inlay Posterior Cruciate Ligament Reconstruction
Am. J. Sports Med., September 1, 2003; 31(5): 667 - 672.
[Abstract] [Full Text] [PDF]

Home page
 Am J Sports MedHome page
K. Markolf, M. Davies, B. Zoric, and D. McAllister
Effects of Bone Block Position and Orientation Within the Tibial Tunnel for Posterior Cruciate Ligament Graft Reconstructions: A Cyclic Loading Study of Bone-Patellar Tendon-Bone Allografts
Am. J. Sports Med., September 1, 2003; 31(5): 673 - 679.
[Abstract] [Full Text] [PDF]

Home page
 Am J Sports MedHome page
T. J. Gill, L. E. DeFrate, C. Wang, C. T. Carey, S. Zayontz, B. Zarins, and G. Li
The Biomechanical Effect of Posterior Cruciate Ligament Reconstruction on Knee Joint Function: Kinematic Response to Simulated Muscle Loads
Am. J. Sports Med., July 1, 2003; 31(4): 530 - 536.
[Abstract] [Full Text] [PDF]

Home page
 Am J Sports MedHome page
E. A. Mejia, F. R. Noyes, and E. S. Grood
Posterior Cruciate Ligament Femoral Insertion Site Characteristics: Importance for Reconstructive Procedures
Am. J. Sports Med., September 1, 2002; 30(5): 643 - 651.
[Abstract] [Full Text] [PDF]

Home page
 JBJSHome page
D. A. Oakes, K. L. Markolf, J. McWilliams, C. R. Young, and D. R. McAllister
Biomechanical Comparison of Tibial Inlay and Tibial Tunnel Techniques for Reconstruction of the Posterior Cruciate Ligament : Analysis of Graft Forces
J. Bone Joint Surg. Am., June 1, 2002; 84(6): 938 - 944.
[Abstract] [Full Text] [PDF]

Home page
 Am J Sports MedHome page
D. R. McAllister, K. L. Markolf, D. A. Oakes, C. R. Young, and J. McWilliams
A Biomechanical Comparison of Tibial Inlay and Tibial Tunnel Posterior Cruciate Ligament Reconstruction Techniques: Graft Pretension and Knee Laxity
Am. J. Sports Med., May 1, 2002; 30(3): 312 - 317.
[Abstract] [Full Text] [PDF]

Home page
 JBJSHome page
J. A. Bergfeld, D. R. McAllister, R. D. Parker, A. D. C. Valdevit, and H. Kambic
The Effects of Tibial Rotation on Posterior Translation in Knees in Which the Posterior Cruciate Ligament Has Been Cut
J. Bone Joint Surg. Am., September 1, 2001; 83(9): 1339 - 1343.
[Abstract] [Full Text] [PDF]

Home page
 Am J Sports MedHome page
J. A. Bergfeld, D. R. McAllister, R. D. Parker, A. D. C. Valdevit, and H. E. Kambic
A Biomechanical Comparison of Posterior Cruciate Ligament Reconstruction Techniques
Am. J. Sports Med., March 1, 2001; 29(2): 129 - 136.
[Abstract] [Full Text] [PDF]

Home page
 Am J Sports MedHome page
D. A. Mannor, J. T. Shearn, E. S. Grood, F. R. Noyes, and M. S. Levy
Two-Bundle Posterior Cruciate Ligament Reconstruction: An In Vitro Analysis of Graft Placement and Tension
Am. J. Sports Med., November 1, 2000; 28(6): 833 - 845.
[Abstract] [Full Text] [PDF]

Home page
 Am J Sports MedHome page
C. D. Harner, M. A. Janaushek, A. Kanamori, M. Yagi, T. M. Vogrin, and S. L.-Y. Woo
Biomechanical Analysis of a Double-Bundle Posterior Cruciate Ligament Reconstruction
Am. J. Sports Med., March 1, 2000; 28(2): 144 - 151.
[Abstract] [Full Text] [PDF]

Home page
 Am J Sports MedHome page
C. D. Harner, T. M. Vogrin, J. Hoher, C. B. Ma, and S. L-Y. Woo
Biomechanical Analysis of a Posterior Cruciate Ligament Reconstruction: Deficiency of the Posterolateral Structures as a Cause of Graft Failure
Am. J. Sports Med., January 1, 2000; 28(1): 32 - 39.
[Abstract] [Full Text] [PDF]

Home page
 JBJSHome page
K. L. MARKOLF, J. R. SLAUTERBECK, K. L. ARMSTRONG, M. S. SHAPIRO, and G. A. M. FINERMAN
A Biomechanical Study of Replacement of the Posterior Cruciate Ligament with a Graft. Part II: Forces in the Graft Compared with Forces in the Intact Ligament
J. Bone Joint Surg. Am., March 1, 1997; 79(3): 381 - 6.
[Abstract] [Full Text] [PDF]