gms | German Medical Science

Deutscher Kongress für Orthopädie und Unfallchirurgie
70. Jahrestagung der Deutschen Gesellschaft für Unfallchirurgie
92. Tagung der Deutschen Gesellschaft für Orthopädie und Orthopädische Chirurgie und
47. Tagung des Berufsverbandes der Fachärzte für Orthopädie

02. - 06.10.2006, Berlin

Current autografts used for ACL reconstruction do not restore tibial rotation during pivoting

Meeting Abstract

  • A. Georgoulis - Orthopaedic Sports Medicine Center, Department of Orthopaedic Surgery, University of Ioannina, Ioannina, Greece
  • V. Chouliaras - Orthopaedic Sports Medicine Center, Department of Orthopaedic Surgery, University of Ioannina, Ioannina, Greece
  • S. Ristanis - Orthopaedic Sports Medicine Center, Department of Orthopaedic Surgery, University of Ioannina, Ioannina, Greece
  • C. Moraiti - Orthopaedic Sports Medicine Center, Department of Orthopaedic Surgery, University of Ioannina, Ioannina, Greece
  • N. Stergiou - HPER Biomechanics Laboratory, University of Nebraska at Omaha, Omaha, NE, United States of America

Deutscher Kongress für Orthopädie und Unfallchirurgie. 70. Jahrestagung der Deutschen Gesellschaft für Unfallchirurgie, 92. Tagung der Deutschen Gesellschaft für Orthopädie und Orthopädische Chirurgie und 47. Tagung des Berufsverbandes der Fachärzte für Orthopädie. Berlin, 02.-06.10.2006. Düsseldorf, Köln: German Medical Science; 2006. DocW.3.2.1-914

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter: http://www.egms.de/de/meetings/dgu2006/06dgu0453.shtml

Veröffentlicht: 28. September 2006

© 2006 Georgoulis et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielf&aauml;ltigt, verbreitet und &oauml;ffentlich zug&aauml;nglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

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Introduction: The purpose of this study was to identify in-vivo the effectiveness of the two most frequently used autografts (semitendinosus/gracilis [ST/G] and bone-patellar tendon-bone [BPTB]) for ACL reconstruction, in restoring tibial rotation to normal physiological levels.

Methods: Eleven patients ACL reconstructed with a BPTB graft, eleven patients ACL reconstructed with an ST/G graft and eleven controls were assessed. Kinematic data were collected (50Hz) with a six-camera optoelectronic system, while the subjects descended stairs and immediately after, pivoted on their landing leg. The dependent variable examined was the tibial internal-external rotation during pivoting. All patients in both groups were also assessed clinically and with the use of a KT-1000 to evaluate anterior tibial translation.

Results: The results demonstrated that reconstructions with either graft, successfully restored anterior tibial translation. The statistical analysis though, that was performed between the three groups for the dependent variable, showed the existence of significant differences among the groups (p=0.001). The post-hoc comparisons revealed that both ACL reconstructed groups had significantly increased tibial rotation when compared with the control, while no significant differences were observed between the two reconstructed groups. The intact knees for both reconstructed groups had similar values of tibial rotation with the control.

Conclusions: Therefore, we found that neither graft is able to restore tibial rotation to normal levels. This conclusion gives further support to the in-vitro findings by Woo et al, that even though the two grafts are successful in limiting anterior tibial translation, none of them is effective in reducing tibial rotation. Current ACL reconstruction techniques using BPTB and ST/G grafts, anchored in one femoral and one tibial tunnel, seem to only partially achieve the goal of actual reinstatement of the true two-bundle anatomy of the ACL. Our results may also provide an intriguing explanation regarding the development of future pathology. It is possible that this increased tibial rotation could result in the application of loads at areas of the cartilage and are not commonly loaded in a healthy knee. Over time this could lead to knee osteoarthritis. The improvement and development of new surgical techniques that can better approximate the actual anatomy and function of the ACL may be able to provide a solution to this problem.

Level of Evidence:Therapeutic study, level II (prospective comparative study).