J Knee Surg 2019; 32(10): 960-965
DOI: 10.1055/s-0038-1672198
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Effect of Femoral Antetorsion on Tibiofemoral Translation and Rotation in the Anterior Cruciate Ligament Deficient Knee

Mohamed Omar
1   Department of Trauma, Hannover Medical School, Hannover, Germany
,
Yousif Al Saiegh
1   Department of Trauma, Hannover Medical School, Hannover, Germany
,
Emmanouil Liodakis
1   Department of Trauma, Hannover Medical School, Hannover, Germany
,
Timo Stuebig
1   Department of Trauma, Hannover Medical School, Hannover, Germany
,
Daniel Guenther
1   Department of Trauma, Hannover Medical School, Hannover, Germany
,
David Steimer
1   Department of Trauma, Hannover Medical School, Hannover, Germany
,
Nael Hawi
1   Department of Trauma, Hannover Medical School, Hannover, Germany
,
Christian Krettek
1   Department of Trauma, Hannover Medical School, Hannover, Germany
,
Eduardo M. Suero
1   Department of Trauma, Hannover Medical School, Hannover, Germany
› Author Affiliations
Funding None.
Further Information

Publication History

16 November 2017

17 August 2018

Publication Date:
03 October 2018 (online)

Abstract

We aimed to investigate how increased or decreased femoral antetorsion would affect the biomechanics of the knee in an anterior cruciate ligament (ACL)-deficient cadaveric model. We hypothesized that external or internal rotation of the distal femur, achieved through a femoral osteotomy, would affect the magnitude of tibiofemoral translation and rotation. Navigated measurements of tibiofemoral translation and rotation during the anterior drawer, Lachman, and pivot shift tests were performed on six whole-body cadaveric specimens in each of the following four conditions: native, ACL-deficient knee, ACL-deficient knee and 20-degree internal distal femur rotation, and ACL-deficient knee and 20-degree external distal femur rotation. Increased femoral antetorsion significantly reduced anterior tibial translation in the ACL-deficient knee during the anterior drawer, Lachman, and pivot shift tests (p < 0.05). Conversely, decreasing femoral antetorsion resulted in an increase in anterior tibial translation in the anterior drawer (nonsignificant), Lachman (p < 0.05), and pivot shift (p < 0.05) tests. Internally rotating the distal femur significantly reduced the magnitude of tibial rotation during the pivot shift test in the ACL-deficient knee (p < 0.05), whereas external rotation of the distal femur significantly increased tibial rotation (p < 0.05). The magnitude of femoral antetorsion affects tibiofemoral translation in an ACL-deficient cadaveric mode. Internally rotating the distal femur 20 degrees reduced the magnitude of tibial translation and rotation similar to that of the native knee, whereas externally rotating the distal femur aggravated translational and rotational instability.

Ethical Approval

This article does not contain any studies with human participants or animals performed by any of the authors.


 
  • References

  • 1 Smith HC, Vacek P, Johnson RJ. , et al. Risk factors for anterior cruciate ligament injury: a review of the literature - part 1: neuromuscular and anatomic risk. Sports Health 2012; 4 (01) 69-78
  • 2 Nguyen A-D, Boling MC, Levine B, Shultz SJ. Relationships between lower extremity alignment and the quadriceps angle. Clin J Sport Med 2009; 19 (03) 201-206
  • 3 Kaneko M, Sakuraba K. Association between femoral anteversion and lower extremity posture upon single-leg landing: implications for anterior cruciate ligament injury. J Phys Ther Sci 2013; 25 (10) 1213-1217
  • 4 Mostafa AA, Griffon DJ, Thomas MW, Constable PD. Morphometric characteristics of the pelvic limbs of Labrador Retrievers with and without cranial cruciate ligament deficiency. Am J Vet Res 2009; 70 (04) 498-507
  • 5 Ragetly CA, Evans R, Mostafa AA, Griffon DJ. Multivariate analysis of morphometric characteristics to evaluate risk factors for cranial cruciate ligament deficiency in Labrador retrievers. Vet Surg 2011; 40 (03) 327-333
  • 6 Ragetly CA, Griffon DJ, Klump LM, Hsiao-Wecksler ET. Pelvic limb kinetic and kinematic analysis in Labrador Retrievers predisposed or at a low risk for cranial cruciate ligament disease. Vet Surg 2012; 41 (08) 973-982
  • 7 Griffon DJ, Cunningham D, Gordon-Evans WJ, Tanaka R, Bruecker KA, Boudrieau RJ. Evaluation of a scoring system based on conformation factors to predict cranial cruciate ligament disease in Labrador Retrievers. Vet Surg 2017; 46 (02) 206-212
  • 8 Mostafa AA, Griffon DJ, Thomas MW, Constable PD. Radiographic evaluation of femoral torsion and correlation with computed tomographic techniques in labrador retrievers with and without cranial cruciate ligament disease. Vet Surg 2014; 43 (05) 534-541
  • 9 Ragetly CA, Griffon DJ, Hsu MKI, Klump LM, Hsiao-Wecksler ET. Kinetic and kinematic analysis of the right hind limb during trotting on a treadmill in Labrador Retrievers presumed predisposed or not predisposed to cranial cruciate ligament disease. Am J Vet Res 2012; 73 (08) 1171-1177
  • 10 Bretin P, O'Loughlin PF, Suero EM. , et al. Influence of femoral malrotation on knee joint alignment and intra-articular contract pressures. Arch Orthop Trauma Surg 2011; 131 (08) 1115-1120
  • 11 Lee TQ, Morris G, Csintalan RP. The influence of tibial and femoral rotation on patellofemoral contact area and pressure. J Orthop Sports Phys Ther 2003; 33 (11) 686-693
  • 12 Harner CD, Paulos LE, Greenwald AE, Rosenberg TD, Cooley VC. Detailed analysis of patients with bilateral anterior cruciate ligament injuries. Am J Sports Med 1994; 22 (01) 37-43
  • 13 Sobczak S, Dugailly P-M, Baillon B. , et al. In vitro biomechanical study of femoral torsion disorders: effect on femoro-tibial kinematics. Clin Biomech (Bristol, Avon) 2012; 27 (10) 1011-1016
  • 14 Markolf KL, Jackson SR, McAllister DR. Relationship between the pivot shift and Lachman tests: a cadaver study. J Bone Joint Surg Am 2010; 92 (11) 2067-2075
  • 15 Citak M, Suero EM, Rozell JC, Bosscher MR, Kuestermeyer J, Pearle AD. A mechanized and standardized pivot shifter: technical description and first evaluation. Knee Surg Sports Traumatol Arthrosc 2011; 19 (05) 707-711
  • 16 Musahl V, Voos J, O'Loughlin PF, Stueber V, Kendoff D, Pearle AD. Mechanized pivot shift test achieves greater accuracy than manual pivot shift test. Knee Surg Sports Traumatol Arthrosc 2010; 18 (09) 1208-1213
  • 17 Saiegh YA, Suero EM, Guenther D. , et al. Sectioning the anterolateral ligament did not increase tibiofemoral translation or rotation in an ACL-deficient cadaveric model. Knee Surg Sports Traumatol Arthrosc 2017; 25 (04) 1086-1092
  • 18 Hoshino Y, Araujo P, Ahlden M. , et al. Standardized pivot shift test improves measurement accuracy. Knee Surg Sports Traumatol Arthrosc 2012; 20 (04) 732-736
  • 19 Shultz SJ, Nguyen AD, Levine BJ. The relationship between lower extremity alignment characteristics and anterior knee joint laxity. Sports Health 2009; 1 (01) 54-60
  • 20 Suero EM, Njoku IU, Voigt MR, Lin J, Koenig D, Pearle AD. The role of the iliotibial band during the pivot shift test. Knee Surg Sports Traumatol Arthrosc 2013; 21 (09) 2096-2100
  • 21 Giffin JR, Vogrin TM, Zantop T, Woo SL, Harner CD. Effects of increasing tibial slope on the biomechanics of the knee. Am J Sports Med 2004; 32 (02) 376-382
  • 22 Giffin JR, Stabile KJ, Zantop T, Vogrin TM, Woo SL, Harner CD. Importance of tibial slope for stability of the posterior cruciate ligament deficient knee. Am J Sports Med 2007; 35 (09) 1443-1449
  • 23 Voos JE, Suero EM, Citak M. , et al. Effect of tibial slope on the stability of the anterior cruciate ligament-deficient knee. Knee Surg Sports Traumatol Arthrosc 2012; 20 (08) 1626-1631
  • 24 Petrigliano FA, Suero EM, Voos JE, Pearle AD, Allen AA. The effect of proximal tibial slope on dynamic stability testing of the posterior cruciate ligament- and posterolateral corner-deficient knee. Am J Sports Med 2012; 40 (06) 1322-1328
  • 25 Suero EM, Citak M, Cross MB, Bosscher MR, Ranawat AS, Pearle AD. Effects of tibial slope changes in the stability of fixed bearing medial unicompartmental arthroplasty in anterior cruciate ligament deficient knees. Knee 2012; 19 (04) 365-369
  • 26 Shin CS, Chaudhari AM, Andriacchi TP. Valgus plus internal rotation moments increase anterior cruciate ligament strain more than either alone. Med Sci Sports Exerc 2011; 43 (08) 1484-1491
  • 27 Ejnisman L, Philippon MJ, Lertwanich P. , et al. Relationship between femoral anteversion and findings in hips with femoroacetabular impingement. Orthopedics 2013; 36 (03) e293-e300
  • 28 Beaulieu ML, Oh YK, Bedi A, Ashton-Miller JA, Wojtys EM. Does limited internal femoral rotation increase peak anterior cruciate ligament strain during a simulated pivot landing?. Am J Sports Med 2014; 42 (12) 2955-2963
  • 29 Beaulieu ML, Wojtys EM, Ashton-Miller JA. Risk of anterior cruciate ligament fatigue failure is increased by limited internal femoral rotation during in vitro repeated pivot landings. Am J Sports Med 2015; 43 (09) 2233-2241