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  4. Can lateral tenodesis improve the rotational stability of the ACL reconstruction? A finite element analysis
 
research article

Can lateral tenodesis improve the rotational stability of the ACL reconstruction? A finite element analysis

Risvas, Konstantinos
•
Stanev, Dimitar  
•
Moustakas, Konstantinos
February 27, 2024
Plos One

One of the most common knee injuries is the Anterior Cruciate Ligament (ACL) rupture with severe implications on knee stability. The usual treatment is the ACL Reconstruction (ACLR) surgery where the surgeon replaces the torn ligament with a graft in an effort to restore knee kinematics. In case of excessive rotatory instability, Lateral Extra-Articular Tenodesis (LET) can be performed in combination with ACLR. Additionally, LET appears to reduce ACLR graft forces minimizing graft failure chances. However, there are concerns about overconstraining physiological rotation. To gain insight in this controversial topic, we developed an automatic, open-source tool to create a series of Finite Element (FE) models attempting to investigate the interactions of ACLR and LET through simulation. We started by creating a validated model of the healthy knee joint that served as reference for subsequent FE simulations. Then, we created FE models of standalone ACLR and combined ACLR-LET. Each model was assessed by applying a loading profile that resembles the reduction phase of the Pivot-Shift clinical exam. We measured the External Tibia Rotation (ETR), the Posterior Tibia Translation (PTT) of the lateral tibial compartment, and the ACLR graft stress developed around the femoral tunnel insertion site. We observed the following: a) LET reduces ETR and PTT compared to isolated ACLR, b) combined ACLR-LET is more sensitive to LET graft pretension with lower values showcasing performance closer to the healthy joint, c) LET reduces ACLR graft forces for the same pretension values, d) LET exhibits significant overconstraint for higher pretension values. In general, these findings are in agreement with relevant clinical studies and accentuate the potential of the developed framework as a tool that can assist orthopaedists during surgery planning. We provide open access for the FE models of this study to enhance research transparency, reproducibility and extensibility.

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Type
research article
DOI
10.1371/journal.pone.0293161
Web of Science ID

WOS:001196523000032

Author(s)
Risvas, Konstantinos
Stanev, Dimitar  
Moustakas, Konstantinos
Date Issued

2024-02-27

Publisher

Public Library Science

Published in
Plos One
Volume

19

Issue

2

Article Number

e0293161

Subjects

Anterior Cruciate Ligament

•

Extraarticular Tenodesis

•

Shift

•

Forces

•

Injuries

•

Surgery

•

Grafts

•

Stress

•

Strain

•

Angle

Editorial or Peer reviewed

REVIEWED

Written at

EPFL

EPFL units
BIOROB  
FunderGrant Number

EACEA - Erasmus

101082688

Available on Infoscience
May 1, 2024
Use this identifier to reference this record
https://infoscience.epfl.ch/handle/20.500.14299/207639
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