Effect of axial loading during knee flexion on ACL end-to-end distance in healthy and ACL-deficient knees

Purpose: The purpose of this study was to determine the effect of physiological axial loading during knee flexion on changes in anterior cruciate ligament (ACL) end-to-end distance for normal and ACL-deficient knees. Methods: Biomechanical tests were conducted on ten cadaveric knees using an Instron machine. We gathered positional data of the tibia and femur at low to middle flexion angles (0°, 15°, 30°, 45° and 60°) with/without axial loading. First, no external load was applied to the specimens at each angle, and then, a 1000-N axial load was applied to the knees. The same test protocols were repeated after transection of the ACL. Using computer software (Geomagic Studio 10), we regenerated positional data and calculated the end-to-end distances of the anteromedial, posterolateral and the entire ACL bundle at each angle. Results: Compared with ACL-intact knees without axial loading, knees under axial loading did not show significant increases in end-to-end distance. Under axial loading, we found no significant differences in end-to-end distances between bundles in ACL-intact knees according to the increase in knee flexion angle. After ACL transection, axial loading significantly increased end-to-end distances of all three bundles (P < 0.001), and the distances increased significantly with flexion angle (P < 0.05 at all angles in all bundles). Conclusion: The changing patterns of the ACL end-to-end distance in ACL-deficient knees were different from those in healthy knees after applying physiological axial loading, and the ACL end-to-end distances in ACL-deficient knees increased remarkably as knee flexion angles increased.