Abstract
For years, bioengineers and orthopaedic surgeons have applied the principles of mechanics to gain valuable information about the complex function of the anterior cruciate ligament (ACL). The results of these investigations have provided scientific data for surgeons to improve methods of ACL reconstruction and postoperative rehabilitation. This review paper will present specific examples of how the field of biomechanics has impacted the evolution of ACL research. The anatomy and biomechanics of the ACL as well as the discovery of new tools in ACL-related biomechanical study are first introduced. Some important factors affecting the surgical outcome of ACL reconstruction, including graft selection, tunnel placement, initial graft tension, graft fixation, graft tunnel motion and healing, are then discussed. The scientific basis for the new surgical procedure, i.e., anatomic double bundle ACL reconstruction, designed to regain rotatory stability of the knee, is presented. To conclude, the future role of biomechanics in gaining valuable in-vivo data that can further advance the understanding of the ACL and ACL graft function in order to improve the patient outcome following ACL reconstruction is suggested.
Highlights
An anterior cruciate ligament (ACL) rupture is one of the most common knee injuries in sports
It is estimated that the annual incidence is about 1 in 3,000 within the general population in the United States, which translates into more than 150,000 new ACL tears every year [1,2]
Over the past three decades, clinically relevant biomechanical studies have provided us with important data on the ACL, on its complex anatomy and functions in stabilizing the knee joint in multiple degrees of freedom (DOF)
Summary
An anterior cruciate ligament (ACL) rupture is one of the most common knee injuries in sports. It is estimated that approximately 100,000 primary ACL reconstruction surgeries are performed annually in the United States [1,3]. Over the past three decades, clinically relevant biomechanical studies have provided us with important data on the ACL, on its complex anatomy and functions in stabilizing the knee joint in multiple degrees of freedom (DOF). Surgical reconstruction of the ACL has not been able to reproduce its complex function. Both short and long term clinical outcome studies reveal an 11–32% less than satis-. The contributions of biomechanics in determining some key factors that affect the surgical outcomes of ACL reconstruction are discussed. We have pioneered the use of a robotic manipulator together with a 6-DOF universal force-moment sensor (UFS), as illustrated in Figure 1[22]
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