Biomechanics of Double Bundle Anterior Cruciate Ligament Reconstruction
Author(s)
Cuomo, Pierluigi
Type
Thesis
Abstract
The scope of this thesis was to verify whether anatomic reconstruction of the
anterior cruciate ligament (ACL) with close replication of its two main bundles
ensures better knee kinematics and improved clinical outcomes.
The thesis articulates into three parts. In the first part the current anatomic
knowledge is reviewed with regard to the double bundle ACL structure and an
anatomic study is presented: its results will serve as a basis for the following
kinematics and clinical studies.
In the second part, a method to investigate cadaveric knee laxities is presented
and employed to test intact and ACL deficient knees and to explore the function
of the anteromedial and posterolateral ACL bundles. The ACL was found to be a
primary restrain to anterior tibial translation mainly because of the action of the
anteromedial bundle, with the posterolateral acting as a secondary restrain. Both
bundles then were found to equally contribute to control the limit of internal
rotation. Finally the reconstruction of both ACL bundles was demonstrated to be
superior to traditional single bundle reconstruction in restoring intact knee anterior
and rotational laxity.
The third part focused on double bundle surgical technique with the development
of surgical instruments that were validated on cadaver knees and found to be
extremely accurate on the tibial side, less on the femur. Surgical technique was
then improved and introduced into clinical practice. Two clinical studies were
conducted and demonstrated the superiority of double bundle anatomic
reconstruction in improving subjective and objective results as well as
instrumented knee laxity measurements. In conclusion the main finding of this thesis was that, after a deep understanding
of ACL anatomy and biomechanics, the replication at surgery of its native
structure improves knee stability and patients’ satisfaction.
anterior cruciate ligament (ACL) with close replication of its two main bundles
ensures better knee kinematics and improved clinical outcomes.
The thesis articulates into three parts. In the first part the current anatomic
knowledge is reviewed with regard to the double bundle ACL structure and an
anatomic study is presented: its results will serve as a basis for the following
kinematics and clinical studies.
In the second part, a method to investigate cadaveric knee laxities is presented
and employed to test intact and ACL deficient knees and to explore the function
of the anteromedial and posterolateral ACL bundles. The ACL was found to be a
primary restrain to anterior tibial translation mainly because of the action of the
anteromedial bundle, with the posterolateral acting as a secondary restrain. Both
bundles then were found to equally contribute to control the limit of internal
rotation. Finally the reconstruction of both ACL bundles was demonstrated to be
superior to traditional single bundle reconstruction in restoring intact knee anterior
and rotational laxity.
The third part focused on double bundle surgical technique with the development
of surgical instruments that were validated on cadaver knees and found to be
extremely accurate on the tibial side, less on the femur. Surgical technique was
then improved and introduced into clinical practice. Two clinical studies were
conducted and demonstrated the superiority of double bundle anatomic
reconstruction in improving subjective and objective results as well as
instrumented knee laxity measurements. In conclusion the main finding of this thesis was that, after a deep understanding
of ACL anatomy and biomechanics, the replication at surgery of its native
structure improves knee stability and patients’ satisfaction.
Editor(s)
Amis, Andrew
Date Issued
2012
Date Awarded
2012-03
Citation
2012
Copyright Statement
Attribution NoDerivatives 4.0 International Licence (CC BY-ND)
Advisor
Amis, Andrew
Bull, Anthony
Creator
Cuomo, Pierluigi
Publisher Department
Mechanical Engineering
Publisher Institution
Imperial College London
Qualification Level
Doctoral
Qualification Name
Doctor of Philosophy (PhD)