A Review on Finite Element Modeling and Simulation of the Anterior Cruciate Ligament Reconstruction.

The anterior cruciate ligament (ACL) constitutes one of the most important stabilizing tissues of the knee joint whose rapture is very prevalent. ACL reconstruction (ACLR) from a graft is a surgery which yields the best outcome. Taking into account the complicated nature of this operation and the high cost of experiments, finite element (FE) simulations can become a valuable tool for evaluating the surgery in a pre-clinical setting. The present study summarizes, for the first time, the current advancement in ACLR in both clinical and computational level. It also emphasizes on the material modeling and properties of the most popular grafts as well as modeling of different surgery techniques. It can be concluded that more effort is needed to be put toward more realistic simulation of the surgery, including also the use of two bundles for graft representation, graft pretension and artificial grafts. Furthermore, muscles and synovial fluid need to be included, while patellofemoral joint is an important bone that is rarely used. More realistic models are also required for soft tissues, as most articles used isotropic linear elastic models and springs. In summary, accurate and realistic FE analysis in conjunction with multidisciplinary collaboration could contribute to ACLR improvement provided that several important aspects are carefully considered.