In-Situ Force in the Anterior Cruciate Ligament, the Lateral Collateral Ligament, and the Anterolateral Capsule Complex During a Simulated Pivot Shift Test.

The role of the anterolateral capsule complex in knee rotatory stability remains controversial. Therefore, the objective of this study was to determine the in situ forces in the anterior cruciate ligament (ACL), the anterolateral capsule, the lateral collateral ligament (LCL), and the forces transmitted between each region of the anterolateral capsule in response to a simulated pivot shift test. A robotic testing system applied a simulated pivot shift test continuously from full extension to 90 degrees of flexion to intact cadaveric knees (n=7). To determine the magnitude of the in situ forces, kinematics of the intact knee were replayed in position control mode after the following procedures were performed: (i) ACL transection; (ii) capsule separation; (iii) anterolateral capsule transection; and (iii) LCL transection. A repeated measures ANOVA was performed to compare in situ forces between each knee state (*p<0.05). The in situ force in the ACL was significantly greater than the forces transmitted between each region of the anterolateral capsule at 5 degrees and 15 degrees of flexion but significantly lower at 60 degrees, 75 degrees, and 90 degrees of flexion. This study demonstrated that the ACL is the primary rotatory stabilizer at low flexion angles during a simulated pivot shift test in the intact knee, but the anterolateral capsule plays an important secondary role at flexion angles greater than 60 degrees. Furthermore, the contribution of the anterolateral ligament to rotatory knee stability in this study was negligible during a simulated pivot shift test. (c) 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:847-853, 2018.