Elsevier

Clinical Biomechanics

Volume 19, Issue 7, August 2004, Pages 719-725
Clinical Biomechanics

Influence of a mono-centric knee brace on the tension of the collateral ligaments in knee joints after sectioning of the anterior cruciate ligament––an in vitro study

https://doi.org/10.1016/j.clinbiomech.2004.04.008Get rights and content

Abstract

Objective. To analyze the influence of knee bracing on the tension of the medial and lateral collateral ligaments in anterior cruciate ligament deficiency.

Design. The tension of the collateral ligaments in anterior cruciate ligament deficient knees was measured with and without knee bracing using an in vitro model.

Background. Anterior cruciate ligament deficiency increases the tension in both collateral ligaments at the knee joint. Therefore knee braces should reduce that tension increase. However, that effect has never been proven quantitatively.

Methods. After anterior cruciate ligament-transection, the forces of the medial (anterior/posterior part) and lateral collateral ligament were measured in ten fresh human cadaver knees at 0°, 20°, 40°, 60°, 80° and 100° of flexion, with and without application of a mono-centric knee brace. To quantify the ligament forces, strain gauges were fixed at the bony origins of the ligaments.

Results. Bracing led to a significant decrease of ligament forces (20–100°: P<0.0001) in the anterior part of the medial collateral ligament in all joint positions. In the posterior aspect, this effect was observed only at 40° (P<0.0001) and 80° (P=0.001) of flexion. In the lateral collateral ligament, bracing caused a strain reduction from 60° to 100° of flexion (P<0.0001). Therefore a flexion angle dependent effect of knee bracing on the strain was seen in the posterior aspect of the medial and in the lateral collateral ligament in anterior cruciate ligament deficient knee joints.

Conclusions. Application of a mono-centric knee brace leads to a significant position dependent reduction of collateral ligament tension after anterior cruciate ligament-rupture.
Relevance

The over-all force reducing effect of applying a mono-centric knee brace may contribute to counteract the increasing knee laxity seen in some conservatively treated anterior cruciate ligament-patients over time.

Section snippets

Objective

Anterior cruciate ligament (ACL) deficiency changes the mechanical characteristics of the knee joint. Sectioning the anterior cruciate ligament has been shown both in vitro (Markolf et al., 1976) and in vivo (von Eisenhart-Rothe et al., 2004) to increase anterior–posterior motion at the tibiofemoral joint. This increase in anterior–posterior motion may lead to a shift in load to other static stabilizers of the knee. For example, an increase in tension in both the medial collateral ligament

Specimens

Ten fresh adult right cadaver knees without signs of knee injury or surgery were used for this study. The knee specimens, including all muscular structures, were extracted 20 cm proximal and distal of the joint interface, then deep-frozen at −30 °C immediately afterwards. Before preparation and testing, the knees were thawed in a water bath at room temperature for about 10 h.

During preparation, the tendons of the quadriceps, semimembranosus, biceps femoris and gastrocnemius muscles were

Results

For better understanding of the results the tensions of the ligaments in the intact knee are included into the figures.

Discussion

In this in vitro study we answered the specific questions following our introduction:

  • 1.

    Knee bracing has a knee flexion angle dependent effect on the strain of the collateral ligaments in ACL-deficient knee joints.

    By applying a knee brace, a highly significant reduction of tension was found at the anterior part of the medial collateral ligament in all joint positions. At the posterior part of the medial collateral ligament a significant tension reduction could be observed only at 40° and 80° of

Conclusion

This study shows that the application of a mono-centric knee brace leads to a significant reduction of collateral ligament tension after ACL sectioning. This effect is dependent on the position of the knee joint and shows a different extent on the medial and lateral collateral ligament. However, the application of a knee brace does not change the strain pattern of each ligament. Therefore a knee brace may add mechanical protection to the collateral ligaments in ACL-deficient knee joints and may

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