The effect of an iliotibial tenodesis on intraarticular graft forces and knee joint motion

Abstract

Lateral extraarticular reconstructions are used as iso lated procedures in knees with moderate rotatory insta bility and as "backups" in knees requiring primary repair or intraarticular reconstruction for major rotatory insta bility. We used an experimental knee testing system to analyze the immediate postoperative mechanical effect of an iliotibial band tenodesis on an intraarticular recon struction of the ACL in fresh cadaver knees using a composite graft consisting of a bone-patellar tendon- bone segment augmented with the Kennedy Ligament Augmentation Device (LAD, 3M Co., St. Paul, MN). The intraarticular graft was standardized by using a force- setting technique. Ligament and graft forces were measured using buckle transducers, and joint motion was measured using an instrumented spatial linkage as 90 N anteriorly directed tibial loads were applied to seven fresh knee specimens at 0°, 30°, 60°, and 90° of flexion. The following knee states were tested in each specimen: intact ACL, excised ACL, intraarticular reconstruction, intraarticular reconstruction with the tenodesis added, and tenodesis with the intraarticular reconstruction added.

Adding the iliotibial band tenodesis to an existing standardized intraarticular reconstruction significantly decreased the force in the ACL composite graft by an average of 43%. When the standardized intraarticular reconstruction was added to an existing tenodesis, the graft forces were an average of 15% below the level of when the reconstruction was performed alone. The force in the tenodesis was significantly less than the composite graft force at extension; however, the differ ences between the tenodesis and total graft force were not significant from 30° to 90° of flexion. Load sharing appeared to occur between the tenodesis and intraar ticular graft. The tenodesis caused the tibia to be in an externally rotated configuration relative to normal, po tentially interfering with the "screw home mechanism."

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References

Andrews JR, Sanders RA, Morin B. Surgical treatment of anterolateral rotatory instability A follow-up study Am J Sports Med 13 112-119, 1985

Benum P. Anterolateral rotatory instability of the knee joint Results after stabilization by transposition of the lateral part of the patellar ligament A preliminary report Acta Orthop Scand 53 613-617, 1982

Butler DL, Grood ES, Noyes FR, et al On the interpretation of our anterior cruciate ligament data Clin Orthop 196 26-34, 1985

Clancy WG, Nelson DA, Reider B., et al Anterior cruciate ligament reconstruction using one-third of the patellar ligament, augmented by extraarticular tendon transfers J Bone Joint Surg 64A 352-359, 1982

Ellison AE Distal iliotibial-band transfer for anterolateral rotatory instability of the knee J Bone Joint Surg 61A 330-337, 1979

Galway RD, Beaupré A., Maclntosh DL Pivot shift A clinical sign of symptomatic anterior cruciate ligament insufficiency J Bone Joint Surg 54B 763-764, 1972

Gallehon DL, Warren RF, Wickiewicz TL Acute repair of the anterior cruciate ligament—Past and present . Orthop Clin North Am 16 111-125, 1985

Hanley P., Lew WD, Lewis JL, et al: Load sharing and graft forces in anterior cruciate ligament reconstruction with the Ligament Augmentation Device Am J Sports Med 17 414-422, 1989

Kapandji IA The Physiology of the Joints Vol II New York, Churchill-Livingstone , 1970, p 134

10.

Kennedy JC, Stewart R., Walker DM Anterolateral rotatory instability of the knee joint An early analysis of the Ellison procedure J Bone Joint Surg 60A 1031-1039, 1978

11.

Kennedy JC, Roth JH, Mendenhall HV, et al Presidential address Intraarticular replacement in the anterior cruciate ligament-deficient knee Am J Sports Med 8 1-8, 1980

12.

Krackow KA, Brooks RL Optimization of knee ligament position for lateral extraarticular reconstruction Am J Sports Med 11 293-302, 1983

13.

Lewis JL, Lew WD, Hill JA, et al Knee joint motion and ligament forces before and after ACL reconstruction J Biomech Eng 111 97-106, 1989

14.

Lewis JL, Lew WD, Schmidt J. Description and accuracy evaluation of an in vitro knee joint testing system J Biomech Eng 110 238-248, 1988

15.

Lewis JL, Lew WD, Shybut GT, et al Biomechanical function of knee ligaments, (Ch 12) in Finerman G (ed) AAOS Symposium of Sports Medicine The Knee, St Louis, CV Mosby Co , 1985, pp 152-168

16.

Losee RE, Johnson TR, Southwick WO Anterior subluxation of the lateral tibial plateau A diagnostic test and operative repair J Bone Joint Surg 60A 1015-1030, 1978

17.

Noyes FR, Butler DL, Paulos LE, et al Intra-articular cruciate reconstruction I Perspectives on graft strength, vascularization, and immediate motion after replacement Clin Orthop 172 71-77, 1983

18.

O'Brien SJ, Warren RF, Wickiewicz TL, et al The iliotibial band lateral sling procedure and its effect on the results of ACL reconstruction Am J Sports Med, in press, 1990

19.

Sidles JA, Larson RV, Garbini JL, et al Ligament length relationships in the moving knee J Orthop Res 6 593-610, 1988

20.

Sydney SV, Haynes DW, Hungerford DS, et al The altered kinematic effect of an iliotibial band tenodesis on the anterior cruciate deficient knee Trans Orthop Res Soc 12 266, 1987

21.

Zarins B., Rowe CR ACL reconstruction Combined method using semitendinosus tendon and iliotibial band Orthop Trans 4 291-292, 1980