Biomechanical Modeling For Prediction Of Laxity And Failure After Anterior Crucitate Ligament Reconstruction

The role of meniscal lesions and their removal or repair in combination with Anterior Cruciate Ligament reconstruction has been studied, but mostly in cadaveric setting; thus, the in-vivo role remains unexplored. Another emerging topic is the role of anatomy -and in particular the role of posterior tibial slope- as risk factor for ACL failure. Moreover, the role of anatomy has been investigated also regarding the genesis of joint laxity, but only in cadaveric models or with static radiographic studies. The present PhD thesis has 4 main aims developed within 11 original studies, which investigate the role of meniscus and joint anatomy in the genesis of laxity before and after ACL reconstruction (Aim 1 and 2), and their role on the outcomes of ACL reconstruction (Aim 3 and 4). To answer the Aim 1 and Aim 2, a systematic review and in-vivo experimental studies with surgical navigation were performed, while to answer the Aim 3 and Aim 4, prospective and retrospective cohorts of patients undergoing ACL reconstruction were investigated. The results of literature search and in-vivo navigations studies highlighted the biomechanical importance of medial and lateral meniscus integrity in pre-and post-operative laxity, and a novel insight regarding the ability of Lateral Notch Sign -among all anatomical parameters- to detect “high grade” laxity is provided (Aim 1 and 2). In the clinical setting, medial and lateral meniscal removal or repair demonstrated to affect outcomes and reoperations, either at short and long-term follow-up. Finally, anatomical parameter -in particular Tibial Plateau Slope- were identified as possible risk-factors for failure of ACL reconstruction and contralateral ACL injuries (Aim 3 and 4).