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Computational modelling of the graft-tunnel interaction in single-bundle ACL reconstructed knee

  • Junjun Zhu ORCID logo EMAIL logo , Weimin Zhu and Qijie Zhao
Published/Copyright: July 19, 2023
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Biomedical Engineering / Biomedizinische Technik
From the journal Biomedical Engineering / Biomedizinische Technik Volume 68 Issue 6

Abstract

Objectives

Tunnel enlargement and graft failure are common complications associated with ACL reconstruction. The mechanical interaction between the graft and the tunnel aperture may play a more important role. This study aims to evaluate graft position within femoral tunnel and the graft force under external loads.

Methods

An FE model of the femur-graft-tibia complex was constructed from CT images of an anatomically reconstructed knee specimen. The model was subjected to kinematics of passive flexion extension, anterior/posterior translation, internal/external rotation and valgus kinematics, which were collected from experimental testing. Graft shift and rotation of graft-tunnel contact region during flexion/extension and external loadings were recorded and compared to experimental measurements.

Results

Model showed that the graft shifted in the femoral tunnel during flexion and under external loads. The graft-tunnel contact area rotated by up to 55° during flexion from full extension to 90° of extension implying that the so-called “wiper effect” occurs during most of flexion angles.

Conclusions

Different regions of the femoral tunnel aperture, particularly the anterior region, were under significantly more contact force from the graft than other areas of the aperture during the anterior translation test, potentially leading to femoral tunnel enlargement to the anterior side of the aperture.

Keywords: ACL graft; bone tunnel enlargement; finite element analysis; wind-shield wiper effect
Corresponding author: Junjun Zhu, PhD, Shanghai Key Laboratory of Intelligent Manufacturing and Robotics, School of Mechatronic Engineering and Automation, Shanghai University, Shanghai 200444, China, E-mail:

Funding source: National Natural Science Foundation of China

Award Identifier / Grant number: 62203287

  1. Research funding: This work was supported by a grant from the National Natural Science Foundation of China (No. 62203287).

  2. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: Authors state no conflict of interest.

  4. Informed consent: Not applicable.

  5. Ethical approval: The local Institutional Review Board deemed the study exempt from review.

References

1. Dargel, J, Gotter, M, Mader, K, Pennig, D, Koebke, J, Schmidt-Wiethoff, R. Biomechanics of the anterior cruciate ligament and implications for surgical reconstruction. Strateg Trauma Limb Reconstr 2007;2:1–12. https://doi.org/10.1007/s11751-007-0016-6.Search in Google Scholar PubMed PubMed Central

2. Siegel, L, Vandenakker-Albanese, C, Siegel, D. Anterior cruciate ligament injuries: anatomy, physiology, biomechanics, and management. Clin J Sport Med 2012;22:349–55. https://doi.org/10.1097/jsm.0b013e3182580cd0.Search in Google Scholar

3. Nebelung, W, Becker, R, Merkel, M, Ropke, M. Bone tunnel enlargement after anterior cruciate ligament reconstruction with semitendinosus tendon using endobutton fixation on the femoral side. Arthroscopy 1998;14:810–5. https://doi.org/10.1016/s0749-8063(98)70015-5.Search in Google Scholar PubMed

4. Wilson, TC, Kantaras, A, Atay, A, Johnson, DL. Tunnel enlargement after anterior cruciate ligament surgery. Am J Sports Med 2004;32:543–9. https://doi.org/10.1177/0363546504263151.Search in Google Scholar PubMed

5. Mutsuzaki, H, Kinugasa, T, Ikeda, K, Sakane, M. Morphological changes in the femoral and tibial bone tunnels after anatomic single-bundle anterior cruciate ligament reconstruction using a calcium phosphate-hybridized tendon graft in 2years of follow-up. Orthop Traumatol Surg Res 2019;105:653–60. https://doi.org/10.1016/j.otsr.2019.01.005.Search in Google Scholar PubMed

6. Biswal, UK, Balaji, G, Nema, S, Poduval, M, Menon, J, Patro, DK. Correlation of tunnel widening and tunnel positioning with short-term functional outcomes in single-bundle anterior cruciate ligament reconstruction using patellar tendon versus hamstring graft: a prospective study. Eur J Orthop Surg Traumatol 2016;26:647–55. https://doi.org/10.1007/s00590-016-1809-4.Search in Google Scholar PubMed

7. Fahey, M, Indelicato, PA. Bone tunnel enlargement after anterior cruciate ligament replacement. Am J Sports Med 1994;22:410–4. https://doi.org/10.1177/036354659402200318.Search in Google Scholar PubMed

8. Silva, A, Sampaio, R, Pinto, E. Femoral tunnel enlargement after anatomic ACL reconstruction: a biological problem? Knee Surg Sports Traumatol Arthrosc 2010;18:1189–94. https://doi.org/10.1007/s00167-010-1046-z.Search in Google Scholar PubMed

9. Hoshino, Y, Kuroda, R, Nishizawa, Y, Nakano, N, Nagai, K, Araki, D, et al.. Stress distribution is deviated around the aperture of the femoral tunnel in the anatomic anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2018;26:1145–51. https://doi.org/10.1007/s00167-017-4543-5.Search in Google Scholar PubMed

10. Zhu, J, Marshall, B, Tang, X, Linde, MA, Fu, FH, Smolinski, P. ACL graft with extra-cortical fixation rotates around the femoral tunnel aperture during knee flexion. Knee Surg Sports Traumatol Arthrosc 2022;30:116–23. https://doi.org/10.1007/s00167-021-06703-8.Search in Google Scholar PubMed

11. Clatworthy, MG, Annear, P, JU, B, Bartlett, RJ. Tunnel widening in anterior cruciate ligament reconstruction: a prospective evaluation of hamstring and patella tendon grafts. Knee Surg Sports Traumatol Arthrosc 1999;7:138–45. https://doi.org/10.1007/s001670050138.Search in Google Scholar PubMed

12. Limbert, G, Taylor, M, Middleton, J. Three-dimensional finite element modelling of the human ACL: simulation of passive knee flexion with a stressed and stress-free ACL. J Biomech 2004;37:1723–31. https://doi.org/10.1016/j.jbiomech.2004.01.030.Search in Google Scholar PubMed

13. Park, HS, Ahn, C, Fung, DT, Ren, Y, Zhang, LQ. A knee-specific finite element analysis of the human anterior cruciate ligament impingement against the femoral intercondylar notch. J Biomech 2010;43:2039–42. https://doi.org/10.1016/j.jbiomech.2010.03.015.Search in Google Scholar PubMed PubMed Central

14. Ristaniemi, A, Tanska, P, Stenroth, L, Finnila, MAJ, Korhonen, RK. Comparison of material models for anterior cruciate ligament in tension: from poroelastic to a novel fibril-reinforced nonlinear composite model. J Biomech 2021;114:110141. https://doi.org/10.1016/j.jbiomech.2020.110141.Search in Google Scholar PubMed

15. Naghibi, H, Janssen, D, Van Tienen, T, Van de Groes, S, Van de Boogaard, T, Verdonschot, N. A novel approach for optimal graft positioning and tensioning in anterior cruciate ligament reconstructive surgery based on the finite element modeling technique. Knee 2020;27:384–96. https://doi.org/10.1016/j.knee.2020.01.010.Search in Google Scholar PubMed

16. Sasaki, Y, Chang, SS, Fujii, M, Araki, D, Zhu, J, Marshall, B, et al.. Effect of fixation angle and graft tension in double-bundle anterior cruciate ligament reconstruction on knee biomechanics. Knee Surg Sports Traumatol Arthrosc 2016;24:2892–8. https://doi.org/10.1007/s00167-015-3552-5.Search in Google Scholar PubMed

17. Tang, X, Marshall, B, Wang, JH, Zhu, J, Li, J, Smolinski, P, et al.. Lateral meniscal posterior root repair with anterior cruciate ligament reconstruction better restores knee stability. Am J Sports Med 2019;47:59–65. https://doi.org/10.1177/0363546518808004.Search in Google Scholar PubMed

18. Daniel, DM, Stone, ML, Sachs, R, Malcom, L. Instrumented measurement of anterior knee laxity in patients with acute anterior cruciate ligament disruption. Am J Sports Med 1985;13:401–7. https://doi.org/10.1177/036354658501300607.Search in Google Scholar PubMed

19. Rangger, C, Daniel, DM, Stone, ML, Kaufman, K. Diagnosis of an ACL disruption with KT-1000 arthrometer measurements. Knee Surg Sports Traumatol Arthrosc 1993;1:60–6. https://doi.org/10.1007/bf01552161.Search in Google Scholar PubMed

20. Surer, L, Michail, K, Koken, M, Yapici, C, Zhu, J, Marshall, BD, et al.. The effect of anterior cruciate ligament graft rotation on knee biomechanics. Knee Surg Sports Traumatol Arthrosc 2017;25:1093–100. https://doi.org/10.1007/s00167-016-4381-x.Search in Google Scholar PubMed

21. Zhu, W, Zhu, J, Marshall, B, Linde, MA, Smolinski, P, Fu, FH. Single-bundle MCL reconstruction with anatomic single-bundle ACL reconstruction does not restore knee kinematics. Knee Surg Sports Traumatol Arthrosc 2020;28:2687–96. https://doi.org/10.1007/s00167-020-05934-5.Search in Google Scholar PubMed

22. Lee, BH, Bansal, S, Park, SH, Wang, JH. Eccentric graft positioning within the femoral tunnel aperature in anatomic double-bundle anterior cruciate ligament reconstruction using the transportal and outside-in techniques. Am J Sports Med 2015;43:1180–8. https://doi.org/10.1177/0363546514568278.Search in Google Scholar PubMed

23. Zheng, L, Sabzevari, S, Marshall, B, Zhu, J, Linde, MA, Smolinski, P, et al.. Anterior cruciate ligament graft fixation first in anterior and posterior cruciate ligament reconstruction best restores knee kinematics. Knee Surg Sports Traumatol Arthrosc 2018;26:1237–44. https://doi.org/10.1007/s00167-017-4615-6.Search in Google Scholar PubMed

24. Zhu, J, Dong, J, Marshall, B, Linde, MA, Smolinski, P, Fu, FH. Medial collateral ligament reconstruction is necessary to restore anterior stability with anterior cruciate and medial collateral ligament injury. Knee Surg Sports Traumatol Arthrosc 2018;26:550–7. https://doi.org/10.1007/s00167-017-4575-x.Search in Google Scholar PubMed

25. Takeuchi, R, Saito, T, Mituhashi, S, Suzuki, E, Yamada, I, Koshino, T. Double-bundle anatomic anterior cruciate ligament reconstruction using bone-hamstring-bone composite graft. Arthroscopy 2002;18:550–5. https://doi.org/10.1053/jars.2002.30680.Search in Google Scholar PubMed

26. Wang, H, Zhang, B, Cheng, CK. Stiffness and shape of the ACL graft affects tunnel enlargement and graft wear. Knee Surg Sports Traumatol Arthrosc 2020;28:2184–93. https://doi.org/10.1007/s00167-019-05772-0.Search in Google Scholar PubMed

27. Kim, JG, Kang, KT, Wang, JH. Biomechanical difference between conventional transtibial single-bundle and anatomical transportal double-bundle anterior cruciate ligament reconstruction using three-dimensional finite element model analysis. J Clin Med 2021;10:1625. https://doi.org/10.3390/jcm10081625.Search in Google Scholar PubMed PubMed Central

28. Veronda, DR, Westmann, RA. Mechanical characterization of skin-finite deformations. J Biomech 1970;3:111–24. https://doi.org/10.1016/0021-9290(70)90055-2.Search in Google Scholar PubMed

29. Pioletti, DP, Rakotomanana, LR, Benvenuti, JF, Leyvraz, PF. Viscoelastic constitutive law in large deformations: application to human knee ligaments and tendons. J Biomech 1998;31:753–7. https://doi.org/10.1016/s0021-9290(98)00077-3.Search in Google Scholar PubMed

30. Song, Y, Debski, RE, Musahl, V, Thomas, M, Woo, SL. A three-dimensional finite element model of the human anterior cruciate ligament: a computational analysis with experimental validation. J Biomech 2004;37:383–90. https://doi.org/10.1016/s0021-9290(03)00261-6.Search in Google Scholar PubMed

31. Bae, JY, Kim, GH, Seon, JK, Jeon, I. Finite element study on the anatomic transtibial technique for single-bundle anterior cruciate ligament reconstruction. Med Biol Eng Comput 2016;54:811–20. https://doi.org/10.1007/s11517-015-1372-x.Search in Google Scholar PubMed

32. Barber, FA, Spruill, B, Sheluga, M. The effect of outlet fixation on tunnel widening. Arthroscopy 2003;19:485–92. https://doi.org/10.1053/jars.2003.50170.Search in Google Scholar PubMed

33. Cheung, P, Chan, WL, Yen, CH, Cheng, SC, Woo, SB, Wong, TK, et al.. Femoral tunnel widening after quadrupled hamstring anterior cruciate ligament reconstruction. J Orthop Surg 2010;18:198–202. https://doi.org/10.1177/230949901001800213.Search in Google Scholar PubMed

34. Hoher, J, Moller, HD, Fu, FH. Bone tunnel enlargement after anterior cruciate ligament reconstruction: fact or fiction? Knee Surg Sports Traumatol Arthrosc 1998;6:231–40. https://doi.org/10.1007/s001670050105.Search in Google Scholar PubMed

35. Webster, KE, Feller, JA, Hameister, KA. Bone tunnel enlargement following anterior cruciate ligament reconstruction: a randomised comparison of hamstring and patellar tendon grafts with 2-year follow-up. Knee Surg Sports Traumatol Arthrosc 2001;9:86–91. https://doi.org/10.1007/s001670100191.Search in Google Scholar PubMed

36. Fauno, P, Kaalund, S. Tunnel widening after hamstring anterior cruciate ligament reconstruction is influenced by the type of graft fixation used: a prospective randomized study. Arthroscopy 2005;21:1337–41. https://doi.org/10.1016/j.arthro.2005.08.023.Search in Google Scholar PubMed

37. Beynnon, BD, Johnson, RJ, Fleming, BC, Kannus, P, Kaplan, M, Samani, J, et al.. Anterior cruciate ligament replacement: comparison of bone-patellar tendon-bone grafts with two-strand hamstring grafts. A prospective, randomized study. J Bone Jt Surg 2002;84:1503–13. https://doi.org/10.2106/00004623-200209000-00001.Search in Google Scholar PubMed

38. Fleming, B, Beynnon, B, Howe, J, McLeod, W, Pope, M. Effect of tension and placement of a prosthetic anterior cruciate ligament on the anteroposterior laxity of the knee. J Orthop Res 1992;10:177–86. https://doi.org/10.1002/jor.1100100204.Search in Google Scholar PubMed

39. Lewis, JL, Lew, WD, Hill, JA, Hanley, P, Ohland, K, Kirstukas, S, et al.. Knee joint motion and ligament forces before and after ACL reconstruction. J Biomech Eng 1989;111:97–106. https://doi.org/10.1115/1.3168361.Search in Google Scholar PubMed

40. Ma, R, Schaer, M, Chen, T, Nguyen, J, Voigt, C, Deng, XH, et al.. The effects of tensioning of the anterior cruciate ligament graft on healing after soft tissue reconstruction. J Knee Surg 2021;34:561–9. https://doi.org/10.1055/s-0039-1700842.Search in Google Scholar PubMed

41. Kim, SJ, Song, SY, Kim, TS, Kim, YS, Jang, SW, Seo, YJ. Creating a femoral tunnel aperture at the anteromedial footprint versus the central footprint in ACL reconstruction: comparison of contact stress patterns. Orthop J Sports Med 2021;9:23259671211001802. https://doi.org/10.1177/23259671211001802.Search in Google Scholar PubMed PubMed Central

42. van Kampen, A, Wymenga, AB, van der Heide, HJ, Bakens, HJ. The effect of different graft tensioning in anterior cruciate ligament reconstruction: a prospective randomized study. Arthroscopy 1998;14:845–50. https://doi.org/10.1016/s0749-8063(98)70022-2.Search in Google Scholar PubMed

43. Pena, E, Martinez, MA, Calvo, B, Palanca, D, Doblare, M. A finite element simulation of the effect of graft stiffness and graft tensioning in ACL reconstruction. Clin Biomech 2005;20:636–44. https://doi.org/10.1016/j.clinbiomech.2004.07.014.Search in Google Scholar PubMed

44. Suggs, J, Wang, C, Li, G. The effect of graft stiffness on knee joint biomechanics after ACL reconstruction--a 3D computational simulation. Clin Biomech 2003;18:35–43. https://doi.org/10.1016/s0268-0033(02)00137-7.Search in Google Scholar PubMed

45. Lee, BH, Seo, DY, Bansal, S, Kim, JH, Ahn, JH, Wang, JH. Comparative magnetic resonance imaging study of the cross-sectional area of anatomic double bundle ligament reconstruction grafts and the contralateral uninjured knn. Arthroscopy 2016;32:321–9. https://doi.org/10.1016/j.arthro.2015.08.009.Search in Google Scholar PubMed

46. Iorio, R, Vadala, A, Argento, G, Di Sanzo, V, Ferretti, A. Bone tunnel enlargement after ACL reconstruction using autologous hamstring tendons: a CT study. Int Orthop 2007;31:49–55. https://doi.org/10.1007/s00264-006-0118-7.Search in Google Scholar PubMed PubMed Central

47. Fujii, M, Sasaki, Y, Araki, D, Furumatsu, T, Miyazawa, S, Ozaki, T, et al.. Evaluation of the semitendinosus tendon graft shift in the bone tunnel: an experiemental study. Knee Surg Sports Traumatol Arthrosc 2016;24:2773–7. https://doi.org/10.1007/s00167-014-3461-z.Search in Google Scholar PubMed

48. Tampere, T, Devriendt, W, Cromheecke, M, Luyckx, T, Verstraete, M, Victor, J. Tunnel placement in ACL reconstruction surgery: smaller inter-tunnel angles and higher peak forces at the femoral tunnel using anteromedial portal femoral drilling-a 3D and finite element analysis. Knee Surg Sports Traumatol Arthrosc 2019;27:2568–76. https://doi.org/10.1007/s00167-018-5272-0.Search in Google Scholar PubMed

Received: 2022-04-05
Accepted: 2023-07-06
Published Online: 2023-07-19
Published in Print: 2023-12-15

© 2023 Walter de Gruyter GmbH, Berlin/Boston

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https://doi.org/10.1515/bmt-2022-0136
Keywords for this article
ACL graft; bone tunnel enlargement; finite element analysis; wind-shield wiper effect

Articles in the same Issue

  1. Frontmatter
  2. Review
  3. Biomechanical testing of osteosynthetic locking plates for proximal humeral shaft fractures – a systematic literature review
  4. Research Articles
  5. Instrumented treadmill for run biomechanics analysis: a comparative study
  6. Computational modelling of the graft-tunnel interaction in single-bundle ACL reconstructed knee
  7. Biomechanical effects of inclined implant shoulder design in all-on-four treatment concept: a three-dimensional finite element analysis
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