In Vivo Kinematics of the Knee after Anterior Cruciate Ligament Reconstruction: A Clinical and Functional Evaluation

Background Recent follow-up studies have reported a high incidence of joint degeneration in patients with anterior cruciate ligament reconstruction. Abnormal kinematics after anterior cruciate ligament reconstruction have been thought to contribute to the degeneration. Hypothesis Anterior cruciate ligament reconstruction, which was designed to restore anterior knee laxity under anterior tibial loads, does not reproduce knee kinematics under in vivo physiological loading conditions. Study Design Controlled laboratory study. Methods Both knees of 7 patients with complete unilateral rupture of the anterior cruciate ligament were magnetic resonance imaged, and 3D models were constructed from these images. The anterior cruciate ligament of the injured knee was arthroscopically reconstructed using a bone–patellar tendon–bone autograft. Three months after surgery, the kinematics of the intact contralateral and reconstructed knees were measured using a dual-orthogonal fluoroscopic system while the subjects performed a single-legged weightbearing lunge. The anterior laxity of both knees was measured using a KT-1000 arthrometer. Results The anterior laxity of the reconstructed knee as measured with the arthrometer was similar to that of the intact contralateral knee. However, under weightbearing conditions, there was a statistically significant increase in anterior translation of the reconstructed knee compared with the intact knee at full extension (approximately 2.9 mm) and 15° (approximately 2.2 mm) of flexion. In addition, there was a mean increase in external tibial rotation of the anterior cruciate ligament–reconstructed knee beyond 30° of flexion (approximately 2° at 30° of flexion), although no statistical significance was detected. Conclusion The data demonstrate that although anterior laxity was restored during KT-1000 arthrometer testing, anterior cruciate ligament reconstruction did not restore normal knee kinematics under weightbearing loading conditions. Clinical Relevance Future reconstruction techniques should aim to restore function of the knee under physiological loading conditions.