{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T10:24:08Z","timestamp":1792751048512,"version":"4.5.0"},"reference-count":46,"publisher":"SAGE Publications","issue":"9","license":[{"start":{"date-parts":[[2021,6,11]],"date-time":"2021-06-11T00:00:00Z","timestamp":1623369600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100009026","name":"smith and nephew","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100009026","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Am J Sports Med"],"published-print":{"date-parts":[[2021,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Biomechanical studies on anterior cruciate ligament (ACL) injuries and reconstructions are based on ACL transection instead of realistic injury trauma.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>To replicate an ACL injury in vitro and compare the laxity that occurs with that after an isolated ACL transection injury before and after ACL reconstruction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design:<\/jats:title>\n                    <jats:p>Controlled laboratory study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Nine paired knees were ACL injured or ACL transected. For ACL injury, knees were mounted in a rig that imposed tibial anterior translation at 1000 mm\/min to rupture the ACL at 22.5\u00b0 of flexion, 5\u00b0 of internal rotation, and 710 N of joint compressive force, replicating data published on clinical bone bruise locations. In contralateral knees, the ACL was transected arthroscopically at midsubstance. Both groups had ACL reconstruction with bone\u2013patellar tendon\u2013bone graft. Native, ACL-deficient, and reconstructed knee laxities were measured in a kinematics rig from 0\u00b0 to 100\u00b0 of flexion with optical tracking: anterior tibial translation (ATT), internal rotation (IR), anterolateral (ATT + IR), and pivot shift (IR + valgus).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      The ACL ruptured at 26 \u00b1 5 mm of ATT and 1550 \u00b1 620 N of force (mean \u00b1 SD) with an audible spring-back tibiofemoral impact with 5\n                      <jats:sup>o<\/jats:sup>\n                      of valgus. ACL injury and transection increased ATT ( P &lt; .001). ACL injury caused greater ATT than ACL transection by 1.4 mm (range, 0.4-2.2 mm; P = .033). IR increased significantly in ACL-injured knees between 0\u00b0 and 30\u00b0 of flexion and in ACL transection knees from 0\u00b0 to 20\u00b0 of flexion. ATT during the ATT + IR maneuver was increased by ACL injury between 0\u00b0 and 80\u00b0 and after ACL transection between 0\u00b0 and 60\u00b0. Residual laxity persisted after ACL reconstruction from 0\u00b0 to 40\u00b0 after ACL injury and from 0\u00b0 to 20\u00b0 in the ACL transection knees. ACL deficiency increased ATT and IR in the pivot-shift test ( P &lt; .001). The ATT in the pivot-shift increased significantly at 0\u00b0 to 20\u00b0 after ACL transection and 0\u00b0 to 50\u00b0 after ACL injury, and this persisted across 0\u00b0 to 20\u00b0 and 0\u00b0 to 40\u00b0 after ACL reconstruction.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>This study developed an ACL injury model in vitro that replicated clinical ACL injury as evidenced by bone bruise patterns. ACL injury caused larger increases of laxity than ACL transection, likely because of damage to adjacent tissues; these differences often persisted after ACL reconstruction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Relevance:<\/jats:title>\n                    <jats:p>This in vitro model created more realistic ACL injuries than surgical transection, facilitating future evaluation of ACL reconstruction techniques.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/03635465211017145","type":"journal-article","created":{"date-parts":[[2021,6,11]],"date-time":"2021-06-11T13:35:02Z","timestamp":1623418502000},"page":"2387-2395","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":15,"title":["An Anterior Cruciate Ligament In Vitro Rupture Model Based on Clinical Imaging"],"prefix":"10.1177","volume":"49","author":[{"given":"Lukas","family":"Willinger","sequence":"first","affiliation":[{"name":"Biomechanics Group, Mechanical Engineering Department, Imperial College London, London, UK"},{"name":"Orthopaedic Surgery Department, Technical University of Munich, Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kiron K.","family":"Athwal","sequence":"additional","affiliation":[{"name":"Biomechanics Group, Mechanical Engineering Department, Imperial College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andy","family":"Williams","sequence":"additional","affiliation":[{"name":"Biomechanics Group, Mechanical Engineering Department, Imperial College London, London, UK"},{"name":"Fortius Clinic, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew A.","family":"Amis","sequence":"additional","affiliation":[{"name":"Biomechanics Group, Mechanical Engineering 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