{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T15:04:48Z","timestamp":1777388688430,"version":"3.51.4"},"reference-count":21,"publisher":"SAGE Publications","issue":"12","license":[{"start":{"date-parts":[[2011,9,9]],"date-time":"2011-09-09T00:00:00Z","timestamp":1315526400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Am J Sports Med"],"published-print":{"date-parts":[[2011,12]]},"abstract":"<jats:p>Background: Recently, anatomic anterior cruciate ligament (ACL) reconstruction is emphasized to improve joint laxity and to potentially avert initiation of cartilage degeneration. There is a paucity of information on the efficacy of ACL reconstructions by currently practiced tunnel creation techniques in restoring normal joint laxity.<\/jats:p>\n                  <jats:p>Study Design: Controlled laboratory study.<\/jats:p>\n                  <jats:p>Hypothesis: Anterior cruciate ligament reconstruction by the anteromedial (AM) portal technique, outside-in (OI) technique, and modified transtibial (TT) technique can equally restore the normal knee joint laxity and ACL forces.<\/jats:p>\n                  <jats:p>Methods: Eight fresh-frozen human cadaveric knee specimens were tested using a robotic testing system under an anterior tibial load (134 N) at 0\u00b0, 30\u00b0, 60\u00b0, and 90\u00b0 of flexion and combined torques (10-N\u00b7m valgus and 5-N\u00b7m internal tibial torques) at 0\u00b0 and 30\u00b0 of flexion. Knee joint kinematics, ACL, and ACL graft forces were measured in each knee specimen under 5 different conditions (ACL-intact knee, ACL-deficient knee, ACL-reconstructed knee by AM portal technique, ACL-reconstructed knee by OI technique, and ACL-reconstructed knee by TT technique).<\/jats:p>\n                  <jats:p>Results: Under anterior tibial load, no significant difference was observed between the 3 reconstructions in terms of restoring anterior tibial translation ( P &gt; .05). However, none of the 3 ACL reconstruction techniques could completely restore the normal anterior tibial translations ( P &lt; .05). Under combined tibial torques, both AM portal and OI techniques closely restored the normal knee anterior tibial translation ( P &gt; .05) at 0\u00b0 of flexion but could not do so at 30\u00b0 of flexion ( P &lt; .05). The ACL reconstruction by the TT technique was unable to restore normal anterior tibial translations at both 0\u00b0 and 30\u00b0 of flexion under combined tibial torques ( P &lt; .05). Forces experienced by the ACL grafts in the 3 reconstruction techniques were lower than those experienced by normal ACL under both the loading conditions.<\/jats:p>\n                  <jats:p>Conclusion: Anterior cruciate ligament reconstructions by AM portal, OI, and modified TT techniques are biomechanically comparable with each other in restoring normal knee joint laxity and in situ ACL forces.<\/jats:p>\n                  <jats:p>Clinical Relevance: Anterior cruciate ligament reconstructions by AM portal, OI, and modified TT techniques result in similar knee joint laxities. Technical perils and pearls should be carefully considered before choosing a tunnel creating technique.<\/jats:p>","DOI":"10.1177\/0363546511420810","type":"journal-article","created":{"date-parts":[[2011,9,9]],"date-time":"2011-09-09T23:40:51Z","timestamp":1315611651000},"page":"2604-2610","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":54,"title":["Biomechanical Evaluation of Knee Joint Laxities and Graft Forces After Anterior Cruciate Ligament Reconstruction by Anteromedial Portal, Outside-In, and Transtibial Techniques"],"prefix":"10.1177","volume":"39","author":[{"given":"Jae Ang","family":"Sim","sequence":"first","affiliation":[{"name":"Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts"},{"name":"Department of Orthopaedics, Gachon University Gil Hospital, Incheon, South Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hemanth R.","family":"Gadikota","sequence":"additional","affiliation":[{"name":"Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jing-Sheng","family":"Li","sequence":"additional","affiliation":[{"name":"Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guoan","family":"Li","sequence":"additional","affiliation":[{"name":"Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas J.","family":"Gill","sequence":"additional","affiliation":[{"name":"Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2011,9,9]]},"reference":[{"key":"bibr1-0363546511420810","doi-asserted-by":"publisher","DOI":"10.1177\/0363546509340768"},{"key":"bibr2-0363546511420810","doi-asserted-by":"publisher","DOI":"10.1007\/s00264-010-1000-1"},{"key":"bibr3-0363546511420810","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2010.07.018"},{"key":"bibr4-0363546511420810","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2003.11.034"},{"key":"bibr5-0363546511420810","doi-asserted-by":"publisher","DOI":"10.1177\/0363546508314428"},{"key":"bibr6-0363546511420810","doi-asserted-by":"publisher","DOI":"10.1115\/1.2895477"},{"key":"bibr7-0363546511420810","doi-asserted-by":"publisher","DOI":"10.1097\/BLO.0b013e31802eb45f"},{"key":"bibr8-0363546511420810","doi-asserted-by":"publisher","DOI":"10.1016\/S0030-5898(02)00030-5"},{"key":"bibr9-0363546511420810","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2007.06.013"},{"issue":"3","key":"bibr10-0363546511420810","first-page":"135","volume":"16","author":"Hardin 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