The Biomechanical Interdependence between the Anterior Cruciate Ligament Replacement Graft and the Medial Meniscus

To establish a quantitative biomechanical relationship between the anterior cruciate ligament graft and the medial meniscus, 10 human cadaveric knees were examined using the robotic/universal force-moment sensor testing system. In response to a combined 134-N anterior and 200-N axial compressive tibial load, the resulting kinematics of the knee and the in situ forces in the anterior cruciate ligament, the anterior cruciate ligament graft, and the medial meniscus were measured. Anterior tibial translation significantly increased after anterior cruciate ligament transection, between 6.8 +/- 2.3 mm at full extension and 12.6 +/- 3.3 mm at 30 degrees of flexion. Consequently, the resultant forces on the medial meniscus, ranging from 52 +/- 30 N to 63 +/- 51 N between full extension and 90 degrees of knee flexion in the intact knee, were doubled as a result of anterior cruciate ligament deficiency. However, after anterior cruciate ligament reconstruction, anterior tibial translations were restored to the levels of the intact knee, and thus the forces on the medial meniscus were restored as well. Likewise, the in situ forces in the anterior cruciate ligament replacement graft increased between 33% and 50% after medial meniscectomy.