We applied specific forces and moments to the knees of fifteen whole
lower limbs of cadavera and measured, with a six degrees-of-freedom
electrogoniometer, the position of the tibia at which the ligaments and the
geometry of the joint limited motion. The limits were determined for
anterior and posterior tibial translation, internal and external rotation,
and varus and valgus angulation from zero to 90 degrees of flexion. The
limits were measured in the intact knee and then the changes that occurred
with removal of the posterior cruciate ligament, the lateral collateral
ligament, the popliteus tendon at its femoral attachment, and the arcuate
complex were measured. The cutting order was varied, allowing us to
determine the changes in the limits that occurred when each structure was
cut alone and the amount of motion of the joint that was required for each
structure to become taut and to limit additional motion when the other
supporting structures had been removed. Removal of only the posterior
cruciate ligament increased the limit for posterior tibial translation,
with no change in the limits for tibial rotation or varus and valgus
angulation. The additional posterior translation was least at full
extension and increased progressively, reaching 11.4 millimeters at 90
degrees of flexion. The progressive increase in posterior translation with
flexion was apparently due to slackening of the posterior portion of the
capsule, as the translation nearly doubled when the posterolateral
structures subsequently were removed. Removal of only the posterolateral
extra-articular restraints increased the amount of external rotation and
varus angulation. The average increase in external rotation depended on the
angle of flexion; it was greatest at 30 degrees of flexion and decreased
with additional flexion. At 90 degrees of flexion, the intact posterior
cruciate ligament limited the increase in external rotation to only 5.3
degrees, less than one-half of the 13.0-degree increase that occurred at 30
degrees of flexion. Subsequent removal of the posterior cruciate ligament
markedly increased external rotation at 90 degrees of flexion, resulting in
a total increase of 20.9 degrees. The limit for varus angulation was normal
as long as the lateral collateral ligament was intact. When the lateral
collateral ligament was cut, the limit increased 4.5 degrees (approximately
4.5 millimeters of additional joint opening) when the knee was partially
flexed (to 15 degrees).(ABSTRACT TRUNCATED AT 400 WORDS)