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Microstructural and Mechanical Properties of the Posterior Cruciate Ligament: A Comparison of the Anterolateral and Posteromedial Bundles

Wright, Jon O. MD; Skelley, Nathan W. MD; Schur, Reid P. BS; Castile, Ryan M. BS; Lake, Spencer P. PhD; Brophy, Robert H. MD

Journal of Bone & Joint Surgery - American Volume: 5 October 2016 - Volume 98 - Issue 19 - p 1656–1664
doi: 10.2106/JBJS.16.00032
Scientific Articles

Background: The microstructural organization (collagen fiber alignment) of the posterior cruciate ligament (PCL), which likely corresponds with its functional properties, has only been described qualitatively in the literature, to our knowledge. The goal of this study was to quantify the tensile mechanical and microstructural properties of the PCL and compare these qualities between the anterolateral and posteromedial bundles.

Methods: Twenty-two knee specimens from 13 donors (8 male and 5 female; mean age [and standard deviation] at the time of death, 43.0 ± 4.1 years; mean body mass index, 30.0 ± 6.7 kg/m2) were dissected to isolate the PCL, and each bundle was split into 3 regions. Mechanical testing of each regional sample consisted of preconditioning followed by a ramp-and-hold stress-relaxation test and a quasi-static ramp-to-failure test. Microstructural analysis was performed with use of a high-resolution, division-of-focal-plane polarization camera to evaluate the average direction of collagen orientation and the degree to which the collagen fibers were aligned in that direction. Results were compared between the anterolateral and posteromedial bundles and across the regions of each bundle.

Results: The anterolateral and posteromedial bundles demonstrated largely equivalent mechanical and microstructural properties. Elastic moduli in the toe and linear regions were not different; however, the posteromedial bundle did show significantly more stress relaxation (p = 0.004). There were also few differences in microstructural properties between bundles, which again were seen only in stress relaxation. Comparing regions within each bundle, several mechanical and microstructural parameters showed significant relationships across the posteromedial bundle, following a gradient of decreasing strength and alignment from anterior to posterior.

Conclusions: The PCL has relatively homogenous microstructural and mechanical properties, with few differences between the anterolateral and posteromedial bundles. This finding suggests that distinct functions of the PCL bundles result primarily from size and anatomical location rather than from differences in these properties.

Clinical Relevance: These properties of the PCL can be used to assess the utility of graft choices and operative techniques for PCL reconstruction and may partly explain limited differences in the outcomes of single-bundle compared with double-bundle reconstruction techniques for the PCL.

1Departments of Orthopaedic Surgery (J.O.W., N.W.S., S.P.L, and R.H.B.), Mechanical Engineering and Materials Science (R.P.S., R.M.C., and S.P.L.), and Biomedical Engineering (S.P.L.), Washington University in St. Louis, St. Louis, Missouri

2Department of Orthopaedic Surgery, Beaumont Health, Royal Oak, Michigan

E-mail address for R.H. Brophy: brophyr@wudosis.wustl.edu

Copyright 2016 by The Journal of Bone and Joint Surgery, Incorporated
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