Anterolateral rotatory instability of the knee. Cadaver study of extraarticular patellar-tendon transposition

A cadaver knee-testing system was used to analyze the effect of an extraarticular reconstruction for anterolateral rotatory instability in which the lateral one third of the patellar tendon with a patellar bone block was transposed to the lateral femoral condyle. Ligament and reconstruction tendon forces were measured using buckle transducers, and joint motion was measured using an instrumented spatial linkage as 90 N anteriorly directed tibial loads were applied to seven knee specimens at 0 degree, 30 degrees, 60 degrees, and 90 degrees of flexion by a pneumatic load apparatus. This was done for each knee with first an intact, then an excised anterior cruciate ligament, and finally the extraarticular reconstruction. Forces in the transposed graft exhibited an isotonic pattern over the flexion range, unlike the intact anterior cruciate ligament, which was more highly loaded in extension than in flexion. The transposition of the patellar tendon led to external rotation of the tibia in both unloaded and anterior load conditions throughout flexion. Collateral ligament forces increased with anterior cruciate ligament excision, with the force in the medial ligament remaining higher than normal with the reconstruction, while the lateral forces became lower than normal.