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Deterioration of Stress Distribution Due to Tunnel Creation in Single-Bundle and Double-Bundle Anterior Cruciate Ligament Reconstructions

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Abstract

Bone tunnel enlargement is a common effect associated with knee laxity after anterior cruciate ligament (ACL) reconstruction. Nevertheless, its exact pathomechanism remains controversial. One of the possible reasons could be bone remodeling due to tunnel creation, which changes the stress environment in the joint. The present study aims to characterize the deteriorated stress distribution on the articular surface, which is due to tunnel creation after single-bundle or double-bundle ACL reconstruction. The stress distributions in the knee following ACL reconstruction under the compression, rotation, and valgus torques were calculated using a validated three-dimensional finite element (FE) model. The results indicate that, (a) under compression, von Mises stress is decreased at lateral and posteromedial regions of single/anteromedial (AM) tunnel, whereas it is increased at anterior region of single/AM tunnel in tibial subchondral bone; (b) the concentration of tensile stress is transferred from the articular surface to the location of graft fixation, and tensile stress in subchondral plate is decreased after ACL reconstruction; (c) severe stress concentration occurs between AM and posterolateral tunnels following the double-bundle reconstruction, which may contribute to the tunnel communication after surgery. In summary, the present study affirms that the deterioration of stress distribution occurs near the articular surface, which may cause the collapse of the tunnel wall, and lead to tunnel enlargement. The present study provides an insight into the effect of tunnel creation on articular stress deterioration after single-bundle or double-bundle ACL reconstruction. These findings provide knowledge on the effect of tunnel enlargement after ACL reconstruction in the long term.

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Acknowledgment

We thank Dr. Gong He for her very kind suggestions of the study design and results analysis, Dr. Kuang Guanming for advice on the surgery process, Dr. Wang Ting for advice on model development, and MR Henry Fong for editing manuscript. The present study was supported by grants from the National Natural Science Foundation of China (NSFC Grants 10925208 and 11120101001) and the National Key Lab of Virtual Reality Technology. The sponsors had no role in any aspect of the study, including data collection and analysis, manuscript preparation, or the authorization for publication.

Conflict of interest

We declare that the authors are not in any financial or personal relationship with people or organizations that may influence the present work; there is no professional or personal interest of any kind in any product, service, and/or company that may construe to influence the position presented in or the review of, the present manuscript.

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Authors and Affiliations

  1. Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, 37 Xueyuan Road, Haidian District, Beijing, 100191, China

    Jie Yao & Yubo Fan

  2. National Key Laboratory of Virtual Reality Technology, Beihang University, Beijing, 100191, China

    Jie Yao & Yubo Fan

  3. Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong

    Jie Yao & Ming Zhang

  4. Li Ning Sports Science Research Center, Beijing, China

    Jason Tak-Man Cheung

  5. Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong

    ChunYi Wen, Yong Hu, Chunhoi Yan, Kwong-Yuen Peter Chiu & William Weijia Lu

  6. Research Center for Human Tissues and Organs Degeneration, Shenzhen Institute of Advanced Technology, Chinese Academy of Science, Shenzhen, China

    ChunYi Wen & William Weijia Lu

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  1. Jie Yao
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Corresponding authors

Correspondence to William Weijia Lu or Yubo Fan.

Additional information

Associate Editor Michael R. Torry oversaw the review of this article.

J. Yao and C. Wen equally contributed to this work.

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Yao, J., Wen, C., Cheung, J.TM. et al. Deterioration of Stress Distribution Due to Tunnel Creation in Single-Bundle and Double-Bundle Anterior Cruciate Ligament Reconstructions. Ann Biomed Eng 40, 1554–1567 (2012). https://doi.org/10.1007/s10439-012-0517-4

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  • DOI: https://doi.org/10.1007/s10439-012-0517-4

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