ArticleAnnals of biomedical engineering2026
Effect of Internal Tibial Torque on ACL Tear at the Femoral Enthesis.
Article in Annals of biomedical engineering, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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3 authors.
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Abstract
purposeThis study aims to investigate the relationship between increasing internal tibial torque (ITT) and the distribution of stress on the anterior cruciate ligament (ACL), with a focus on identifying the location of tear initiation and propagation. In particular, the study emphasizes the femoral enthesis as a potential site of geometric vulnerability during pivot landing.
methodsA three-dimensional finite element model of the ACL was developed and combined with an extended finite element method framework to simulate tear initiation and propagation. The model was driven by torque-indexed, three-dimensional knee kinematics obtained from previous in silico knee simulations that were validated against in vitro cadaveric knee tests (15 specimens). ITT was applied in graded steps to reproduce pivot landing-relevant internal rotation loading. Stress/strain fields were evaluated, and tear initiation/propagation were tracked to quantify damage evolution.
resultsMaximum von Mises stress increased proportionally with ITT and localized near the femoral enthesis, with a mean increase of 26.56% for each 5Nm increase in torque. Stress concentration consistently occurred at the posterolateral bundle attachment on the femoral side, where tear initiation was predicted. With further ITT increases, the tear propagated from the femoral enthesis, indicating a torque-dependent damage progression mechanism.
conclusionIncreased ITT produced reproducible stress/strain concentration at the femoral enthesis, supporting structural vulnerability during pivot landing. This approach extends stress-only analyses by predicting rupture initiation and tear progression. These findings may inform prevention and rehabilitation by highlighting the roles of ITT and femoral insertion morphology in ACL tear initiation and propagation.
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