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Knee Surg Sports Traumatol Arthrosc. 2014 May;22(5):972-8. doi: 10.1007/s00167-013-2499-7. Epub 2013 Apr 9.

A comparison of dynamic rotational knee instability between anatomic single-bundle and over-the-top anterior cruciate ligament reconstruction using triaxial accelerometry.

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Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA.



Recently, single-bundle (SB) anterior cruciate ligament (ACL) reconstruction has been advanced by the anatomic concept, but the biomechanical outcome of the anatomic method has not been fully investigated, especially for rotational instability. Anatomic SB and the single over-the-top procedures are the treatment of choice for primary cases and revision or skeletally immature cases, respectively. The purpose of this study was to investigate the dynamic rotational instability of anatomic SB and over-the-top reconstruction during a pivot shift test using triaxial accelerometry.


Eight fresh frozen human cadaveric knees were used in this study. Rotational instability measurement was conducted during a pivot shift test by the use of a triaxial accelerometer attached to the tibia. The tests were performed in the ACL-intact, ACL-deficient and ACL-reconstructed knees with two different procedures (anatomic SB and over-the-top). The acceleration in three directions and the magnitude of acceleration were measured to evaluate rotational instability and compare between four different knee states.


The overall magnitude of acceleration was significantly different (P < 0.01) between the ACL-intact knees and the ACL-deficient knees. Both anatomic SB and over-the-top ACL reconstruction significantly reduced the overall magnitude of acceleration compared to the ACL-deficient knees, but still had larger accelerations compared to the ACL-intact knees. There was no significant difference for the overall magnitude of acceleration between anatomic SB and over-the-top reconstruction procedure.


Over-the-top reconstruction provides comparable result to anatomic SB reconstruction in terms of controlling the dynamic rotational stability. Over-the-top reconstruction might be one of the options for revision cases and in skeletally immature patients.

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