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Technical variables of ACL surgical reconstruction: effect on post-operative static laxity and clinical implication

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The hypothesis was that an alteration of different surgical variables of ACL reconstruction would produce significant changes in post-operative static laxity of knee joint.

Methods

Joint laxity was acquired by a surgical navigation system for 17 patients just after graft fixation during single-bundle reconstruction with extra-articular lateral tenodesis. The analysed laxity parameters were: internal/external rotation at 30° (IE30) and 90° (IE90) of flexion, varus/valgus rotation at 0° (VV0) and 30° (VV30) of flexion and anterior/posterior displacement at 30° (AP30) and 90° (AP90) of flexion. As surgical variables, the angles between the tibial tunnel and the three planes were defined as well as the lengths of the tunnel and the relationship between native footprints and tunnels. The same analysis was performed for the femoral side. All surgical variables were combined in a multivariate analysis to assess for predictive factors between them and post-operative laxities values. To quantify the performance of each multivariate model, the correlation ratio (η 2) and the corresponding P value (*P < 0.050) have been evaluated.

Results

Multivariate analysis underlined statistically significant models for the estimation of: AP30 (η 2 = 0.987; P = 0.014), IE30 (η 2 = 0.995; P = 0.005), IE90 (η 2 = 0.568; P = 0.010), VV0 (η 2 = 0.932; P = 0.003). The parameters that greatly affected the identified models were the orientation of the tibial tunnel with respect to the three anatomical planes. The estimation of AP30, IE30 and IE90 got lower value as the orientation of the tibial tunnel with respect to transverse plane decreases. Considering the orientation to sagittal (\(\theta_{\text{SAG}}^{T}\)) and coronal (\(\theta_{\text{COR}}^{T}\)) plane, we found that their reduction provoked a decrease in the estimation of AP30, IE30 and IE90 (except \(\theta_{\text{SAG}}^{T}\) that did not appear in the estimation of AP30). The estimation of VV0 got an increase of \(\theta_{\text{SAG}}^{T}\), and \(\theta_{\text{COR}}^{T}\) which led to a laxity reduction.

Conclusion

The main finding of the present in vivo study was the possibility to determine significant effects on post-operative static laxity level of different surgical variables of ACL reconstruction. In particular, the present study defined the conditions that minimize the different aspects of post-operative laxity at time-zero after surgery.

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Authors and Affiliations

  1. Laboratorio di Biomeccanica ed Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Via Di Barbiano 1/10, 40136, Bologna (BO), Italy

    S. Zaffagnini, C. Signorelli, T. Bonanzinga, T. Roberti Di Sarsina, A. Grassi, G. M. Marcheggiani Muccioli, F. Raggi, L. Bragonzoni, N. Lopomo & M. Marcacci

  2. Clinica Ortopedica e Traumatologica I, Istituto Ortopedico Rizzoli, Bologna (BO), Italy

    S. Zaffagnini, T. Bonanzinga, T. Roberti Di Sarsina, G. M. Marcheggiani Muccioli, F. Raggi & M. Marcacci

  3. Dipartimento Rizzoli Sicilia, Istituto Ortopedico Rizzoli, Bagheria (PA), Italy

    S. Zaffagnini, A. Grassi & G. M. Marcheggiani Muccioli

  4. Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna (BO), Italy

    S. Zaffagnini, G. M. Marcheggiani Muccioli, L. Bragonzoni & M. Marcacci

  5. Orthopaedics and Traumatology, SANKO University, Gaziantep, Turkey

    A. Budeyri

  6. Ingegneria dell’Informazione, Università degli Studi di Brescia, Brescia (BS), Italy

    N. Lopomo

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  1. S. Zaffagnini
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Corresponding author

Correspondence to S. Zaffagnini.

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The authors declare that they have no conflict of interest.

Funding

This work was supported by Italian Ministry of Health, Progetto RF Ministero Salute [grant number 2010-2312173].

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Provided by the Institutional Review Board.

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Informed consent was obtained from all the participants included in the study.

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Zaffagnini, S., Signorelli, C., Bonanzinga, T. et al. Technical variables of ACL surgical reconstruction: effect on post-operative static laxity and clinical implication. Knee Surg Sports Traumatol Arthrosc 24, 3496–3506 (2016). https://doi.org/10.1007/s00167-016-4320-x

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