Dynamic Radiostereometry Evaluation of 2 Different Anterior Cruciate Ligament Reconstruction Techniques During a Single-Leg Squat

Stefano Di Paolo, Piero Agostinone, Alberto Grassi, Gian Andrea Lucidi, Erika Pinelli, Marco Bontempi, Gregorio Marchiori, Laura Bragonzoni, Stefano Zaffagnini, Stefano Di Paolo, Piero Agostinone, Alberto Grassi, Gian Andrea Lucidi, Erika Pinelli, Marco Bontempi, Gregorio Marchiori, Laura Bragonzoni, Stefano Zaffagnini

Abstract

Background: Lateral extra-articular tenodesis in the context of anterior cruciate ligament (ACL) reconstruction (ACLR) is performed to better control anterolateral knee instability in patients with high-grade preoperative pivot shift. However, some authors believe these procedures may cause lateral compartment overconstraint, affecting knee motion in daily life.

Purpose/hypothesis: The primary aim of the present study was to identify kinematic differences during the execution of an activity under weightbearing conditions between knees having undergone ACLR using anatomic single-bundle (SB) versus single-bundle plus lateral plasty (SBLP) techniques. The secondary aim was to compare the postoperative kinematic data with those from the same knees before ACLR and from the healthy contralateral knees in order to investigate if ACLR was able to restore physiologic knee biomechanics during squat execution. The hypotheses were that (1) the SBLP technique would allow a better restoration of internal-external (IE) knee rotation than would SB and (2) regardless of the technique, ACLR would not fully restore physiologic knee biomechanics.

Study design: Randomized controlled trial; Level of evidence, 2.

Methods: In total, 32 patients (42 knees) were included in the study. Patients were asked to perform a single-leg squat before surgery (ACL-injured group, n = 32; healthy contralateral group, n = 10) and at minimum 18-month follow-up after ACLR (SB group, n = 9; SBLP group, n = 18). Knee motion was determined using a validated model-based tracking process that matched patient-specific magnetic resonance imaging bone models to dynamic biplane radiographic images under the principles of roentgen stereophotogrammetric analysis. Data processing was performed using specific software. The authors compared IE and varus-valgus rotations and anterior-posterior and medial-lateral translations among the groups.

Results: The mean follow-up period was 21.7 ± 4.5 months. No kinematic differences were found between the SB and SBLP groups (P > .05). A more medial tibial position (P < .05) of the ACL-injured group was reported during the entire motor task and persisted after ACLR in both the SB and the SBLP groups. Differences in IE and varus-valgus rotations were found between the ACL-injured and healthy groups.

Conclusion: There were no relevant kinematic differences between SBLP and anatomic SB ACLR during the execution of a single-leg squat. Regardless of the surgical technique, ACLR failed in restoring knee biomechanics.

Registration: NCT02323386 (ClinicalTrials.gov identifier).

Keywords: anterior cruciate ligament; biplane radiography; in vivo knee kinematics; lateral extra-articular tenodesis; single-leg squat.

Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: The authors received funding for this study from the Italian National Health Service. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

© The Author(s) 2021.

Figures

Figure 1.
Figure 1.
CONSORT (Consolidated Standards of Reporting Trials) flow diagram describing the design of the study. ACL, anterior cruciate ligament; DB, double-bundle; SB, single bundle; SBLP, single-bundle plus lateral plasty.
Figure 2.
Figure 2.
Anterior cruciate ligament reconstructive surgery using (A) single-bundle and (B) single-bundle plus lateral plasty.
Figure 3.
Figure 3.
Roentgen stereophotogrammetric analysis data elaboration: 3-dimensional models of bones were obtained from magnetic resonance imaging and used in specific software to reproduce the joint movement through a validated tracking system that matched models and dynamic radiographs. Also see Supplemental Figure S1 (available online).
Figure 4.
Figure 4.
Comparison of knee internal-external rotation among the 4 groups. The asterisk indicates a statistically significant difference (P < .05). ACL, anterior cruciate ligament; SB, single-bundle; SBLP, single-bundle plus lateral plasty.
Figure 5.
Figure 5.
Comparison of knee varus-valgus rotation among the 4 groups. The asterisk indicates a statistically significant difference (P< .05). ACL, anterior cruciate ligament; SB, single-bundle; SBLP, single-bundle plus lateral plasty.
Figure 6.
Figure 6.
Comparison of tibial anterior-posterior translation among the 4 groups. The asterisk indicates a statistically significant difference (P < .05). ACL, anterior cruciate ligament; SB, single-bundle; SBLP, single-bundle plus lateral plasty.
Figure 7.
Figure 7.
Comparison of tibial medial-lateral translation among the 4 groups. The asterisk indicates a statistically significant difference (P < .05).   ACL, anterior cruciate ligament; SB, single-bundle; SBLP, single-bundle plus lateral plasty.

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