Abstract
Surgical reconstruction is generally recommended for posterior cruciate ligament (PCL) injuries; however, the use of grafts is still a controversial problem. In this study, a three-dimensional finite element model of the human tibiofemoral joint with articular cartilage layers, menisci, and four main ligaments was constructed to investigate the effects of graft strengths on knee kinematics and in-situ forces of PCL grafts. Nine different graft strengths with stiffness ranging from 0% (PCL rupture) to 200%, in increments of 25%, of an intact PCL’s strength were used to simulate the PCL reconstruction. A 100 N posterior tibial drawer load was applied to the knee joint at full extension. Results revealed that the maximum posterior translation of the PCL rupture model (0% stiffness) was 6.77 mm in the medial compartment, which resulted in tibial internal rotation of about 3.01°. After PCL reconstruction with any graft strength, the laxity of the medial tibial compartment was noticeably improved. Tibial translation and rotation were similar to the intact knee after PCL reconstruction with graft strengths ranging from 75% to 125% of an intact PCL. When the graft’s strength surpassed 150%, the medial tibia moved forward and external tibial rotation greatly increased. The in-situ forces generated in the PCL grafts ranged from 13.15 N to 75.82 N, depending on the stiffness. In conclusion, the strength of PCL grafts have has a noticeable effect on anterior-posterior translation of the medial tibial compartment and its in-situ force. Similar kinematic response may happen in the models when the PCL graft’s strength lies between 75% and 125% of an intact PCL.
Highlights
Surgical reconstruction of damaged ligaments is a relatively new but rapidly developing option for the treatment of knee conditions
When the knee was at full extension and sustained a 100 N posterior drawer force, Fox et al [24] used robotic technology to determine the forces in a human posterior cruciate ligament (PCL) and found that an intact PCL has a mean in-situ force of 35.6 N
This study found that the strength of PCL grafts should lie between 75% and 125% of an intact PCL, which could decrease the risks of abnormal tibial rotation and early failure after PCL reconstruction
Summary
Surgical reconstruction of damaged ligaments is a relatively new but rapidly developing option for the treatment of knee conditions. Most of these surgical treatments were originally developed for anterior cricuate ligament (ACL) reconstruction and adapted to the posterior cruciate ligament (PCL). This is primarily due to the far greater incidence of injury to the ACL, but this does not withdraw from the severity of damage to the PCL. Despite treatment of the PCL being a controversial issue, surgical reconstruction is recommended for patients with PCL-deficient knees [6,7]. Information regarding graft strength and in-situ forces is important for a successful postoperative rehabilitation
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