ArticleKnee surgery, sports traumatology, arthroscopy : official journal of the ESSKA2022
ACL graft with extra-cortical fixation rotates around the femoral tunnel aperture during knee flexion.
Article in Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers.
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Who cites it
17 citing papers in PubMed, 24 citations in OpenAlex.
- Which technique provides more benefits in return to sports and clinical outcomes after anterior cruciate ligament reconstruction: Double-bundle or single-bundle? A randomized controlled study.Chinese medical journal · 2025Trial
- Radiologic maturation and tunnel changes after all-inside versus standard hamstring ACL reconstruction: a prospective comparative study.La Radiologia medica · 2026Article
- Primary versus rerupture of the anterior cruciate ligament: rupture site patterns and graft elongation-a systematic review and meta-analysis.Knee surgery & related research · 2026Review
- Anterior Cruciate Ligament Reconstruction: Common Intraoperative Mistakes and Techniques for Error Recovery.Current reviews in musculoskeletal medicine · 2025Review
- A simplified algorithm to work up graft re-rupture following anterior cruciate ligament reconstruction.Bulletin of the Hospital for Joint Disease (2013) · 2025Review
- Biomechanical Comparison of ACL-R Using an Iliotibial Band Autograft Reinforcement and Bone-Patellar Tendon-Bone Graft With and Without Lateral Extra-articular Tenodesis.Orthopaedic journal of sports medicine · 2025Article
- Surgical Robots Improve Tunnel Angle and Graft Bending Angle in Anatomic ACL Reconstruction: A Multicenter Study.Bioengineering (Basel, Switzerland) · 2025Article
- Tendon Groove Technique: A Double-Bundle Footprint Technique for Anterior Cruciate Ligament Reconstruction.Arthroscopy techniques · 2024Article
- Transversal calcaneal anchored Achilles tendon reconstruction with free semitendinosus tendon autograft for acute rupture of Achilles tendon: clinical evaluation.Scientific reports · 2024Article
- Periosteal wrapping of the hamstring tendon autograft improves graft healing and prevents tunnel widening after anterior cruciate ligament anatomic reconstruction.Archives of orthopaedic and trauma surgery · 2024Article
- Outcomes of RigidFix Cross Pin Fixation in Femoral and Tibial Tunnel for Anterior Cruciate Ligament Reconstruction.Orthopaedic surgery · 2024Article
- A Modified Technique for All-Inside Anterior Cruciate Ligament Reconstruction (ACLR): True Femoral Socket.Arthroscopy techniques · 2023Article
- A comparison of stress, contact pressure, and contact area on menisci in re-injury mechanisms after reconstruction of the anterior cruciate ligament with autograft and synthetic graft: a finite element study.International orthopaedics · 2023Article
- The optimal tibial tunnel placement to maximize the graft bending angle in the transtibial posterior cruciate ligament reconstruction: a quantitative assessment in three-dimensional computed tomography model.Quantitative imaging in medicine and surgery · 2023Article
- Failure Rates and Complications After Multiple-Revision ACL Reconstruction: Comparison of the Over-the-Top and Transportal Drilling Techniques.Orthopaedic journal of sports medicine · 2023Article
- Minimizing risk of iatrogenic nerve injury during peroneus longus tendon autograft harvest: a cadaveric study at different ankle or knee positions.Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2023Article
- Anterior Screw Insertion Results in Greater Tibial Tunnel Enlargement Rates after Single-Bundle Anterior Cruciate Ligament Reconstruction than Posterior Insertion: A Retrospective Study.Medicina (Kaunas, Lithuania) · 2023Article
Corrections and comments
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Authors and funding
6 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeAn understanding of the behavior of a new ACL graft in the femoral tunnel during knee motion and external loading can provide information pertinent to graft healing, tunnel enlargement, and graft failure. The purpose of the study was to measure the percentage of the tunnel filled by the graft and determine the amount and location of the graft-tunnel contact with knee motion and under external knee loads.
methodsSingle bundle anatomical ACL reconstruction was performed on six cadaveric knees. Specimens were positioned with a robotic testing system under: (1) passive flexion-extension, (2) 89-N anterior and posterior tibial loads, (3) 5-N m internal and external torques, and (4) 7-N m valgus moment. The knees were then dissected, repositioned by the robot and the geometry of the femoral tunnel and graft were digitized by laser scanning. The percentage of tunnel filled and the contact region between graft and tunnel at the femoral tunnel aperture were calculated.
resultsThe graft occupies approximately 70% of the femoral tunnel aperture and anterior tibial loading tended to reduce this value. The graft contacted about 60% of the tunnel circumference and the location of the graft-tunnel contact changed significantly with knee flexion.
conclusionThis study found that the graft tends to rotate around the tunnel circumference during knee flexion-extension and contract under knee loading. The "windshield-wiper" and "bungee cord" effect may contribute to femoral tunnel enlargement, affect graft healing, and lead to graft failure. There can be a considerable motion of the graft in the tunnel after surgery and appropriate rehabilitation time should be allowed for graft-tunnel healing to occur. To reduce graft motion, consideration should be given to interference screw fixation or a graft with bone blocks, which may allow an earlier return to activity.
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