Anatomy and Biomechanics of the Cruciate Ligaments and Their Surgical Implications
2.5 Conclusion
Knee dislocations are severe injuries because they may result in disruption of multiple ligaments, surrounding musculature, and neurovascular structures [ 53 ] . Diagnosis and acute treatment can be dif fi cult, and the varying techniques that are utilized to reconstruct the anterior and PCLs can be controversial. These injuries, owing to ligamentous disruption and surrounding soft-tissue damage, may lead to a biomechanical disadvantage of the knee joint prior to or after reconstruction attempts are made.
Table 2.1 Tensile strength comparison
Material Maximum load (N)
Anterior cruciate ligament 2,000
Posterior cruciate ligament 4,000
Bone-patellar tendon-bone (10 mm) 2,900 Semitendinosus and gracilis (2-strand) 1,900 Semitendinosus and gracilis (4-strand) 2,800
Table comparing tensile strength of the native ACL, PCL, patella ten- don autograft, doubled hamstring and quadrupled hamstring autografts
To prevent abnormal translations and angulations in the reconstructed knee, surgeons performing reconstructions in patients with multiple ligament injuries must have a complete understanding of the normal anatomy and biomechanics of the entire knee as well as the anterior and PCLs. This knowledge should help optimize the timing of surgery, the order of ligamentous reconstruction, the anatomic placement of grafts, and the rehabilitation of the surrounding musculature.
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DOI 10.1007/978-0-387-49289-6_3, © Springer Science+Business Media New York 2013