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From the Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, and the Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts
* Address correspondence to Guoan Li, PhD, Massachusetts General Hospital, 55 Fruit Street, GRJ 1215, Boston, MA 02114 (e-mail: gli1{at}partners.org).
Background: Most knowledge regarding cruciate ligament function is based on in vitro experiments.
Purpose: To investigate the in vivo elongation of the functional bundles of the anterior cruciate ligament and posterior cruciate ligament during weightbearing flexion.
Hypothesis: The biomechanical role of functional bundles of the anterior cruciate ligament and posterior cruciate ligament under in vivo loading is different from that measured in cadavers.
Study Design: In vivo biomechanical study.
Methods: Elongation of the anterior cruciate ligament and posterior cruciate ligament was measured during a quasi-static lunge using imaging and 3-dimensional computer-modeling techniques.
Results: The anterior-medial bundle of the anterior cruciate ligament had a relatively constant length from full extension to 90°of flexion. The posterior-lateral bundle of the anterior cruciate ligament decreased in length with flexion. Both bundles of the posterior cruciate ligament had increased lengths with flexion.
Conclusion: The data did not demonstrate the reciprocal function of the 2 bundles of the anterior cruciate ligament or the posterior cruciate ligament with flexion observed in previous studies. Instead, the data suggest that there is a reciprocal function between the anterior cruciate ligament and posterior cruciate ligament with flexion. The anterior cruciate ligament plays a more important role in low-flexion angles, whereas the posterior cruciate ligament plays a more important role in high flexion.
Clinical Relevance: Understanding the biomechanical role of the knee ligaments in vivo is essential to reproduce the structural behavior of the ligament after injury (especially for 2-bundle reconstructions) and thus improve surgical outcomes.
Key Words: in vivo knee kinematics • anterior cruciate ligament (ACL) • posterior cruciate ligament (PCL) • soft tissue biomechanics
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