The medial ligaments and the ACL restrain anteromedial laxity of the knee.

PURPOSE: The purpose of this study was to determine the contribution of each of the ACL and medial ligament structures in resisting anteromedial rotatory instability (AMRI) loads applied in vitro. METHODS: Twelve knees were tested using a robotic system. It imposed loads simulating clinical laxity tests at 0° to 90° flexion: ±90 N anterior-posterior force, ±8 Nm varus-valgus moment, and ±5 Nm internal-external rotation, and the tibial displacements were measured in the intact knee. The ACL and individual medial structures-retinaculum, superficial and deep medial collateral ligament (sMCL and dMCL), and posteromedial capsule with oblique ligament (POL + PMC)-were sectioned sequentially. The tibial displacements were reapplied after each cut and the reduced loads required allowed the contribution of each structure to be calculated. RESULTS: For anterior translation, the ACL was the primary restraint, resisting 63-77% of the drawer force across 0° to 90°, the sMCL contributing 4-7%. For posterior translation, the POL + PMC contributed 10% of the restraint in extension; other structures were not significant. For valgus load, the sMCL was the primary restraint (40-54%) across 0° to 90°, the dMCL 12%, and POL + PMC 16% in extension. For external rotation, the dMCL resisted 23-13% across 0° to 90°, the sMCL 13-22%, and the ACL 6-9%. CONCLUSION: The dMCL is the largest medial restraint to tibial external rotation in extension. Therefore, following a combined ACL + MCL injury, AMRI may persist if there is inadequate healing of both the sMCL and dMCL, and MCL deficiency increases the risk of ACL graft failure.

Assessment of pose repeatability and specimen repositioning of a robotic joint testing platform.

This paper describes the quantitative assessment of a robotic testing platform, consisting of an industrial robot and a universal force-moment sensor, via the design of fixtures used to hold the tibia and femur of cadaveric knees. This platform was used to study the contributions of different soft tissues and the ability of implants and reconstruction surgeries to restore normal joint functions, in previously published literature. To compare different conditions of human joints, it is essential to reposition specimens with high precision after they have been removed for a surgical procedure. Methods and experiments carried out to determine the pose repeatability and measure errors in repositioning specimens are presented. This was achieved using an optical tracking system (fusion Track 500, Atracsys Switzerland) to measure the position and orientation of bespoke rigid body markers attached to the tibial and femoral pots after removing and reinstalling them inside the rigs. The pose repeatability was then evaluated by controlling the robotic platform to move a knee joint repeatedly to/from a given pose while tracking the position and orientation of a rigid body marker attached to the tibial fixture. The results showed that the proposed design ensured a high repeatability in repositioning the pots with standard deviations for the computed distance and angle between the pots at both ends of the joint equal to 0.1mm, 0.01mm, 0.13° and 0.03° for the tibial and femoral fixtures respectively. Therefore, it is possible to remove and re-setup a joint with high precision. The results also showed that the errors in repositioning the robotic platform (that is: specimen path repeatability) were 0.11mm and 0.12°, respectively.