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ORIGINAL RESEARCH article

Front. Bioeng. Biotechnol.
Sec. Biomechanics
Volume 12 - 2024 | doi: 10.3389/fbioe.2024.1437684
This article is part of the Research Topic Computational and Experimental Approaches on Soft Tissues Biomechanics and Mechanobiology View all 11 articles

ACL reconstruction combined with anterolateral structure reconstruction for treating ACL rupture and knee injuries: a finite element analysis

Provisionally accepted
Huizhi Wang Huizhi Wang 1Gai Yao Gai Yao 2Kaixin He Kaixin He 1Zimin Wang Zimin Wang 3*Cheng-Kung Cheng Cheng-Kung Cheng 1*
  • 1 School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
  • 2 Fifth Medical Center of the PLA General Hospital, Beijing, Beijing Municipality, China
  • 3 Department of Orthopaedic Surgery, Shanghai Ninth People’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China

The final, formatted version of the article will be published soon.

    The biomechanical indication for combining anterolateral structure reconstruction (ASLR) with ACL reconstruction (ACLR) to reduce pivot shift in the knee remains unclear.This study aims to investigate knee functionality after ACL rupture with different combinations of injuries, and to compare the effectiveness of ALSR with ACLR for treating these injuries. A validated finite element model of a human cadaveric knee was used to simulate pivot shift tests on the joint in different states, including i. an intact knee; ii. after isolated ACL rupture; iii. after ACL rupture combined with different knee injuries or defect, including a posterior tibial slope (PTS) of 20°, an injury to the anterolateral structures (ALS) and an injury to the posterior meniscotibial ligament of the lateral meniscus (LP); iv. after treating the different injuries using isolated ACLR; v. after treating the different injuries using ACLR with ALSR. The knee kinematics, maximum von Mises stress (Max.S) on the tibial articular cartilage (TC) and force in the ACL graft were compared among the different simulation groups. Comparing with isolated ACL rupture, combined injury to the ALS caused the largest knee laxity, when a combined PTS of 20°induced the largest Max.S on the TC. The joint stability and Max.S on the TC in the knee with an isolated ACL rupture or a combined rupture of ACL and LP were restored to the intact level after being treated with isolated ACLR. The knee biomechanics after a combined rupture of ACL and ALS were restored to the intact level only when being treated with a combination of ACLR and ALSR using a large graft diameter (6 mm) for ALSR.However, for the knee after ACL rupture combined with a PTS of 20°, the ATT and Max.S on the TC were still greater than the intact knee even after being treated with a combination of ACLR and ALSR. The finite element analysis showed that ACLR should include ALSR when treating ACL ruptures accompanied by ALS rupture. However, pivot shift in knees with a PTS of 20°was not eliminated even after a combined ACLR and ALSR.

    Keywords: Anterior Cruciate Ligament Reconstruction, anterolateral structure reconstruction, Pivot shift, Articular stress, Combined injury

    Received: 24 May 2024; Accepted: 12 Jul 2024.

    Copyright: © 2024 Wang, Yao, He, Wang and Cheng. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence:
    Zimin Wang, Department of Orthopaedic Surgery, Shanghai Ninth People’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200011, China
    Cheng-Kung Cheng, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China

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