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The Position of the Tibia during Graft Fixation Affects Knee Kinematics and Graft Forces for Anterior Cruciate Ligament Reconstruction

Jürgen Höher, MD, Akihiro Kanamori, MD, Jennifer Zeminski, MS, Freddie H. Fu, MD and Savio L-Y. Woo, PhD

Musculoskeletal Research Center, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania

Presented at the 24th annual meeting of the AOSSM, Vancouver, British Columbia, Canada, July 1998.

Address correspondence and reprint requests to Savio L-Y. Woo, PhD, University of Pittsburgh, E1641 Biomedical Science Tower, 210 Lothrop Street, POB 71199, Pittsburgh, PA 15213

Ten cadaveric knees (donor ages, 36 to 66 years) were tested at full extension, 15°, 30°, and 90° of flexion under a 134-N anterior tibial load. In each knee, the kinematics as well as in situ force in the graft were compared when the graft was fixed with the tibia in four different positions: full knee extension while the surgeon applied a posterior tibial load (Position 1), 30° of flexion with the tibia at the neutral position of the intact knee (Position 2), 30° of flexion with a 67-N posterior tibial load (Position 3), and 30° of flexion with a 134-N posterior tibial load (Position 4). For Positions 1 and 2, the anterior tibial translation and the in situ forces were up to 60% greater and 36% smaller, respectively, than that of the intact knee. For Position 3, knee kinematics and in situ forces were closest to those observed in the intact knee. For Position 4, anterior tibial translation was significantly decreased by up to 2 mm and the in situ force increased up to 31 N. These results suggest that the position of the tibia during graft fixation is an important consideration for the biomechanical performance of an anterior cruciate ligament-reconstructed knee.

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