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Articles by A Hosseini
Total Records ( 3 ) for A Hosseini
  T. J Gill , S. K Van de Velde , D. W Wing , L. S Oh , A Hosseini and G. Li
  Background

The actual in vivo tibiofemoral and patellofemoral kinematics of the posterior cruciate ligament (PCL)-reconstructed knee joint are unknown.

Hypothesis

Current single-bundle PCL reconstruction is unable to correct the abnormal tibiofemoral and patellofemoral kinematics caused by rupture of the ligament.

Study Design

Controlled laboratory study/case series; Level of evidence, 4.

Methods

Seven patients with an isolated PCL injury in 1 knee and the contralateral side intact were included in the study. Magnetic resonance and dual fluoroscopic imaging techniques were used to compare the tibiofemoral and patellofemoral kinematics between the intact contralateral (control group), PCL-deficient, and PCL-reconstructed knee during physiologic loading with a single-legged lunge. Data were collected preoperatively and 2 years after single-bundle reconstruction.

Results

The PCL reconstruction reduced the abnormal posterior tibial translation in PCL-deficient knees to levels not significantly different from those of the intact knee. Posterior cruciate ligament deficiency resulted in an increased lateral tibial translation between 75° and 120° of flexion, and reconstruction was unable to restore these values to normal. No differences were detected among the groups in varus-valgus and internal-external rotation. The PCL reconstruction reduced the increased patellar flexion of PCL-deficient knees between 90° and 120° of knee flexion and the lateral shift at 120°. The abnormal patellar rotation and tilt seen in PCL deficiency at flexion angles of 75° and greater persisted after reconstruction.

Conclusion

Single-bundle PCL reconstruction was successful in restoring normal anteroposterior translation of the tibia, as well as the patellar flexion and shift. However, single-bundle PCL reconstruction was unable to achieve the same success in mediolateral translation of the tibia or in the patellar rotation and tilt.

Clinical Relevance

The persistent abnormal mediolateral translation of the tibia, as well as decreased patellar rotation and tilt, provide a possible explanation for the development of cartilage degeneration after reconstruction of an isolated PCL injury.

  J. L Wu , J. K Seon , H. R Gadikota , A Hosseini , K. M Sutton , T. J Gill and G. Li
  Background

The in situ forces of the anteromedial (AM) and posterolateral bundles (PL) of the anterior cruciate ligament (ACL) under simulated functional loads such as simulated muscle loads have not been reported. These data are instrumental for improvement of the anatomical double-bundle ACL reconstruction.

Hypothesis

The load-sharing patterns of the 2 bundles are complementary under simulated muscle loads.

Study Design

Descriptive laboratory study.

Methods

Eight cadaveric knees in this study were sequentially studied using a robotic testing system. Each knee was tested under 3 external loading conditions including (1) a 134-N anterior tibial load; (2) combined rotational loads of 10 N·m of valgus and 5 N·m internal tibial torques; and (3) a 400-N quadriceps muscle load with the knee at 0°, 15°, 30°, 60°, and 90° of flexion. The in situ forces of the 2 bundles of ACL were determined using the principle of superposition.

Results

Under the anterior tibial load, the PL bundle carried peak loads at full extension and concurrently had significantly lower force than the AM bundle throughout the range of flexion (P <.05). Under the combined rotational loads, the PL bundle contributed to carrying the load between 0° and 30°, although less than the AM bundle. Under simulated muscle loads, both bundles carried loads between 0° and 30°. There was no significant difference between the 2 bundle forces at all flexion angles (P > .05).

Conclusion

Under externally applied loads, in general, the AM bundle carried a greater portion of the load at all flexion angles, whereas the PL bundle only shared the load at low flexion angles. The bundles functioned in a complementary rather than a reciprocal manner to each other.

Clinical Relevance

The data appear to support the concept that both bundles function in a complementary manner. Thus, how to re-create the 2 bundle functions in an ACL reconstruction should be further investigated.

  J. L Wu , A Hosseini , M Kozanek , H. R Gadikota , T. J Gill and G. Li
 

Background: The function of the anteromedial (AM) and posterolateral (PL) bundles of the anterior cruciate ligament (ACL) during gait has not been reported.

Hypothesis: The AM and PL bundles have distinct functional behavior during the stance phase of treadmill gait.

Study Design: Descriptive laboratory study.

Methods: Three-dimensional models of the knee were created by magnetic resonance images from 8 healthy subjects. The contour of the 2 bundle attachments were constructed on each model. Each bundle was represented by a straight line connecting its tibial and femoral attachment centroids. Next, the knee kinematics during the stance phase of gait was determined with a dual fluoroscopic imaging system. The relative elongation, sagittal plane elevation, coronal plane elevation, and transverse plane deviation of the 2 bundles were measured directly from heel strike to toe-off.

Results: At heel strike, the AM and PL bundles had first peak elongation of 9% ± 7% and 9% ± 13%, respectively. At 50% progress of the stance phase, both bundles were maximally elongated, 12% ± 7% for the AM bundle and 13% ± 15% for the PL bundle. No significant difference was found for each bundle between 40% and 60% of the stance phase (P > .05). With increasing knee flexion, the sagittal plane and coronal plane elevations of the 2 bundles decreased, whereas the deviation angles increased.

Conclusion: Both bundles are anisometric and function in a similar manner during the stance phase of gait. They were maximally elongated throughout the midstance where they were stretched maximally to resist anterior tibial translation.

Clinical relevance: This information can be useful for further improving anatomical ACL reconstructions to better reproduce the 2 bundle functions. It may also be useful for designing postoperative rehabilitation regimens to prevent overstretch of the grafts.

 
 
 
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