A method for quantifying the anterior load–displacement behavior of the human knee in both the low and high stiffness regions

The anterior load–displacement behavior of the human knee with an intact ACL is characterized by a very low stiffness region initially and a high stiffness region that develops as anterior load is increased. Although this behavior has been well recognized for some time, a method for quantitatively describing the behavior in these two regions based on limits of motion at specific values of anterior/posterior force has not yet been developed. Thus, the purposes of this study were to describe and justify such a method for measuring the laxity and stiffness in both of these regions in the intact knee. Unique to this study, low stiffness and high stiffness laxities were computed based on three limits of motion for seven cadaveric knees tested at flexion angles ranging from 0° to 90°. Defining the reference position of the tibia relative to the femur, one limit was the 0 N posterior limit which was determined using a specially designed load cycle to reduce uncertainty in establishing a reference position. Defining the upper bound of the load–displacement curve, a second limit was the 225 N anterior limit. A third intermediate limit was the 45 N anterior limit, which was the load that represented the transition from the low stiffness to the high stiffness region. Stiffnesses corresponding to each of the two regions were computed using regression analysis and also estimated based on the laxities. Comparison between the computed and estimated stiffnesses demonstrated that the stiffnesses in both the low and high stiffness regions can be estimated reasonably accurately based on the laxities. Therefore, the 0 N posterior limit and the two laxities are the three quantities needed to describe the load–displacement behavior of the normal knee.