Effect of Fatigue on Tibial Rotation After Single- and Double-Bundle Anterior Cruciate Ligament Reconstruction

Abstract

Background: Fatigue is an extrinsic factor adversely affecting joint proprioception and neuromuscular response, thereby increasing anterior cruciate ligament (ACL) strain and injury risk. The effectiveness of the single- and double-bundle techniques for ACL reconstruction to control residual rotational knee laxity under fatigue has not been examined. Hypothesis: Fatigue results in a significant increase in tibial rotation angles and moments in both ACL-intact and single- and double-bundle ACL-reconstructed knees. The 2 groups with ACL-reconstructed knees will show no significant differences in tibial rotation angles and moments either pre- or postfatigue. Study Design: Controlled laboratory study. Methods: Twenty-four male patients who underwent successful single-bundle (n = 12) or double-bundle (n = 12) ACL reconstructions and 10 matched healthy controls were subjected to a standard lower limb muscle fatigue protocol using an isokinetic dynamometer. Three-dimensional motion analysis was used to measure tibial rotation and rotational knee moments in the pre- and postfatigue states, during a swinging maneuver on the weightbearing leg from a standing position with the knee in extension. Results: Tibial rotation of the single-bundle group significantly increased postfatigue (prefatigue 22° ± 10° vs 29° ± 15° postfatigue, P = .015). In contrast, the double-bundle group showed similar tibial rotation values pre- and postfatigue (16° ± 6° vs 18° ± 4°, P = .22). The double-bundle group showed a trend toward decreased tibial rotation values pre- and post-fatigue compared with controls (22 ± 4 and 23 ± 4) ( P = .065 and .08, respectively). In the prefatigue state, rotational moments (N·mm/Kg) of the single-bundle (339 ± 148) and double-bundle (317 ± 97) groups were significantly lower than that of controls (465 ± 134) ( P = .05 and .03, respectively). In the postfatigue state, an increase was observed in rotational moments of the single-bundle (388 ± 131) and double-bundle (408 ± 187) groups compared with prefatigue values, whereas a decrease was noted in the control group (411 ± 117). Conclusion: Single-bundle ACL-reconstructed knees demonstrate a reduced ability to resist rotational loads under fatigue. Double-bundle reconstructed knees had significantly better control of tibial rotation when fatigued. However, they demonstrate an excessive, yet not significant, reduction in tibial rotation compared with the intact knee, suggesting a possible overcorrection in rotational laxity.