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• W2074342828 abstract "PurposePosterolateral corner (PLC) injuries of the knee remain complex diagnostic and treatment challenges. Results of ACL reconstruction are adversely affected by failure to treat concomitant PLC injuries. However, the quantitative force on the ACL and altered knee kinematics after complete and especially partial PLC injuries remains unknown. The purpose of this study was to quantify changes in the force on the ACL in cadaveric knees subjected to external loading conditions after partial and complete PLC sectioning.Materials and methodsWe utilized a robotic testing system composed of a six degree-of-freedom robotic manipulator and universal force-moment sensor. The testing system offers the ability to operate with force and displacement controls and is capable of characterizing the in-vitro kinematics and in-situ forces in the ligaments of cadaveric knee specimens under a variety of external loading conditions. Twelve cadaveric knees were subjected to an external load of 134 N anterior force, a 9 Nm varus moment, and finally a combined load of 4 Nm internal and external tibial torque and a 9 Nm varus moment. The resulting knee kinematics and in-situ force in the ACL was determined using the testing system for several scenarios: intact knee, partial PLC sectioning, and complete PLC sectioning. The order of sectioning of the lateral collateral ligament (LCL), popliteofibular ligament (PFL), and popliteus tendon (PT) was varied.ResultsPartial or complete sectioning of the PLC did not significantly affect ACL load or translation with an applied anterior force at either 0 or 30 degrees. When a varus moment was applied, the varus opening significantly increased by 70 and 90% with the LCL and PLC sectioned respectively, but not with the PT or PFL sectioned alone. ACL load increased by 50% when the LCL was cut and nearly 100% with the entire PLC cut. Sectioning the PT alone did not affect ACL load when a varus moment was applied. A combined varus moment and external rotation torque decreased the ACL load with partial and complete PLC sectioning. Combining varus with an internal rotation torque when the LCL and PLC was sectioned increased ACL load by 30%. With the PT and PLC sectioned rotation increased at both 0 and 30 degrees. When the LCL alone was sectioned, there was no change in rotation at 30 degrees.Complete PLC sectioning at 30 and 60 degrees knee flexion resulted in 3.3 degrees of increased varus and 4.7 degrees of increased external rotation.ConclusionsLCL sectioning significantly increased ACL loads with either an applied varus moment or varus combined with internal rotation torque. The key structure in restraining varus opening is the LCL. Isolated sectioning of the PT or PFL had significantly less effect; however, complete PLC sectioning maximized ACL loads for every scenario. PurposePosterolateral corner (PLC) injuries of the knee remain complex diagnostic and treatment challenges. Results of ACL reconstruction are adversely affected by failure to treat concomitant PLC injuries. However, the quantitative force on the ACL and altered knee kinematics after complete and especially partial PLC injuries remains unknown. The purpose of this study was to quantify changes in the force on the ACL in cadaveric knees subjected to external loading conditions after partial and complete PLC sectioning. Posterolateral corner (PLC) injuries of the knee remain complex diagnostic and treatment challenges. Results of ACL reconstruction are adversely affected by failure to treat concomitant PLC injuries. However, the quantitative force on the ACL and altered knee kinematics after complete and especially partial PLC injuries remains unknown. The purpose of this study was to quantify changes in the force on the ACL in cadaveric knees subjected to external loading conditions after partial and complete PLC sectioning. Materials and methodsWe utilized a robotic testing system composed of a six degree-of-freedom robotic manipulator and universal force-moment sensor. The testing system offers the ability to operate with force and displacement controls and is capable of characterizing the in-vitro kinematics and in-situ forces in the ligaments of cadaveric knee specimens under a variety of external loading conditions. Twelve cadaveric knees were subjected to an external load of 134 N anterior force, a 9 Nm varus moment, and finally a combined load of 4 Nm internal and external tibial torque and a 9 Nm varus moment. The resulting knee kinematics and in-situ force in the ACL was determined using the testing system for several scenarios: intact knee, partial PLC sectioning, and complete PLC sectioning. The order of sectioning of the lateral collateral ligament (LCL), popliteofibular ligament (PFL), and popliteus tendon (PT) was varied. We utilized a robotic testing system composed of a six degree-of-freedom robotic manipulator and universal force-moment sensor. The testing system offers the ability to operate with force and displacement controls and is capable of characterizing the in-vitro kinematics and in-situ forces in the ligaments of cadaveric knee specimens under a variety of external loading conditions. Twelve cadaveric knees were subjected to an external load of 134 N anterior force, a 9 Nm varus moment, and finally a combined load of 4 Nm internal and external tibial torque and a 9 Nm varus moment. The resulting knee kinematics and in-situ force in the ACL was determined using the testing system for several scenarios: intact knee, partial PLC sectioning, and complete PLC sectioning. The order of sectioning of the lateral collateral ligament (LCL), popliteofibular ligament (PFL), and popliteus tendon (PT) was varied. ResultsPartial or complete sectioning of the PLC did not significantly affect ACL load or translation with an applied anterior force at either 0 or 30 degrees. When a varus moment was applied, the varus opening significantly increased by 70 and 90% with the LCL and PLC sectioned respectively, but not with the PT or PFL sectioned alone. ACL load increased by 50% when the LCL was cut and nearly 100% with the entire PLC cut. Sectioning the PT alone did not affect ACL load when a varus moment was applied. A combined varus moment and external rotation torque decreased the ACL load with partial and complete PLC sectioning. Combining varus with an internal rotation torque when the LCL and PLC was sectioned increased ACL load by 30%. With the PT and PLC sectioned rotation increased at both 0 and 30 degrees. When the LCL alone was sectioned, there was no change in rotation at 30 degrees.Complete PLC sectioning at 30 and 60 degrees knee flexion resulted in 3.3 degrees of increased varus and 4.7 degrees of increased external rotation. Partial or complete sectioning of the PLC did not significantly affect ACL load or translation with an applied anterior force at either 0 or 30 degrees. When a varus moment was applied, the varus opening significantly increased by 70 and 90% with the LCL and PLC sectioned respectively, but not with the PT or PFL sectioned alone. ACL load increased by 50% when the LCL was cut and nearly 100% with the entire PLC cut. Sectioning the PT alone did not affect ACL load when a varus moment was applied. A combined varus moment and external rotation torque decreased the ACL load with partial and complete PLC sectioning. Combining varus with an internal rotation torque when the LCL and PLC was sectioned increased ACL load by 30%. With the PT and PLC sectioned rotation increased at both 0 and 30 degrees. When the LCL alone was sectioned, there was no change in rotation at 30 degrees. Complete PLC sectioning at 30 and 60 degrees knee flexion resulted in 3.3 degrees of increased varus and 4.7 degrees of increased external rotation. ConclusionsLCL sectioning significantly increased ACL loads with either an applied varus moment or varus combined with internal rotation torque. The key structure in restraining varus opening is the LCL. Isolated sectioning of the PT or PFL had significantly less effect; however, complete PLC sectioning maximized ACL loads for every scenario. LCL sectioning significantly increased ACL loads with either an applied varus moment or varus combined with internal rotation torque. The key structure in restraining varus opening is the LCL. Isolated sectioning of the PT or PFL had significantly less effect; however, complete PLC sectioning maximized ACL loads for every scenario." @default.
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• W2074342828 title "In Situ Force in the Anterior Cruciate Ligament and Knee Kinematics in the Partially and Completely Posterolateral Corner Deficient Knee (SS-11)" @default.
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