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Lima LHPD, Gomes JLE. Must a Knee with Anterior Cruciate Ligament Deficiency and High-grade Pivot Shift Test Present an Increase in Internal Rotation? Rev Bras Ortop 2024; 59:e82-e87. [PMID: 38524720 PMCID: PMC10957268 DOI: 10.1055/s-0044-1779316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 05/29/2023] [Indexed: 03/26/2024] Open
Abstract
Objective: Rupture of the anterior cruciate ligament (ACL) is one of the most common injuries in athletes and is often associated with damage to anterolateral structures. This combination of injuries presents itself clinically as a high-grade pivot shift test. The hypothesis of this study is that patients with ACL deficiency and high-grade pivot shift test should have an increased internal knee rotation. Methods: Twenty-two patients were tested. After effective spinal anesthesia, two tests were performed with the patient in supine position. First, the bilateral pivot shift test was performed manually, and its grade was recorded. Then, with the knee flexed to 90 degrees, the examiner drew the projection of the foot in a neutral position and in maximum internal rotation, and the angle of internal rotation was measured from the axes built between the central point of the heel and the hallux. Results: In the ACL-deficient knee, it was observed that there is a statistically significant average internal rotation (IR) delta of 10.5 degrees between the groups when not adjusted for age, and 10.6 degrees when adjusted for age. Conclusions: Knees with ACL deficiency and with pivot shift test grade I do not show increased internal rotation in relation to knees with intact ACL. Knees with ACL deficiency and with pivot shift test grades II and III show increased internal rotation in comparison to healthy knees.
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Shatrov J, Freychet B, Hopper GP, Coulin B, El Helou A, An JS, Vieira TD, Sonnery-Cottet B. Radiographic Incidence of Knee Osteoarthritis After Isolated ACL Reconstruction Versus Combined ACL and ALL Reconstruction: A Prospective Matched Study From the SANTI Study Group. Am J Sports Med 2023:3635465231168899. [PMID: 37154412 DOI: 10.1177/03635465231168899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
BACKGROUND Combined anterior cruciate ligament (ACL) reconstruction (ACLR) and anterolateral ligament reconstruction (ALLR) have demonstrated reduced risk of graft rerupture as compared with isolated ACLR. However, concerns remain that the risk of osteoarthritis (OA) may be increased by the addition of ALLR. PURPOSE/HYPOTHESIS The aim of this study was to evaluate the incidence of OA with isolated ACLR in comparison with ACLR + ALLR at medium-term follow-up. We hypothesized that there would be no differences between the groups. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Patients who underwent ACLR + ALLR with hamstring tendon autograft between January 2011 and March 2012 were propensity matched to patients who underwent isolated ACLR with bone-patellar tendon-bone (BPTB) or hamstring tendon autograft in the same period. Medium-term radiographic evaluation was performed using the International Knee Documentation Committee (IKDC) radiographic OA grading scale, modified Kellgren-Lawrence grade, and the surface fit method to assess percentage of joint space narrowing. Clinical outcomes were assessed with the following measures: IKDC, Knee injury and Osteoarthritis Outcome Score (KOOS), Lysholm, Tegner, and ACL Return to Sport after Injury. RESULTS A total of 80 patients (42 ACLR + ALLR and 38 isolated ACLR) were analyzed with a mean follow-up of 104 months. There was no significant difference between groups for joint space narrowing in the medial or lateral tibiofemoral or lateral patellofemoral (PF) compartment. However, 36.8% in the isolated ACLR group versus 11.9% in the ACLR + ALLR group had narrowing of the medial PF compartment (P = .0118). A lateral meniscal tear increased the risk of lateral tibiofemoral narrowing by nearly 5 times (odds ratio, 4.9; 95% CI, 1.547-19.367; P = .0123). The risk of medial PF narrowing was >4-fold with an isolated ACLR (odds ratio, 4.8; 95% CI, 1.44-19.05; P = .0179). Between the isolated ACLR group and the ACLR + ALLR group, the secondary meniscectomy rate was 13.2% versus 11.9% (not significantly different). There was no difference between groups in KOOS, Tegner, or IKDC scores. There was also no difference between groups for grades of osteoarthritic change for any classification system. Patients who received a BPTB graft had medial PF joint narrowing in 66.7% of cases as compared with 11.9% in those who received ACLR + ALLR (P = 0.118). CONCLUSION ACLR + ALLR did not increase the risk of OA in the lateral tibiofemoral compartment when compared with an isolated ACLR at medium-term follow-up. Isolated ACLR using BPTB was associated with a significantly increased risk of medial PF joint space narrowing. REGISTRATION NCT05123456 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Jobe Shatrov
- Centre Orthopedique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, Lyon, France
| | - Benjamin Freychet
- Centre Orthopedique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, Lyon, France
| | - Graeme P Hopper
- Centre Orthopedique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, Lyon, France
- NHS Lanarkshire University Hospitals, Glasgow, UK
| | - Benoit Coulin
- Centre Orthopedique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, Lyon, France
| | - Abdo El Helou
- Centre Orthopedique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, Lyon, France
| | - Jae-Sung An
- Centre Orthopedique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, Lyon, France
| | - Thais Dutra Vieira
- Centre Orthopedique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, Lyon, France
| | - Bertrand Sonnery-Cottet
- Centre Orthopedique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, Lyon, France
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Suh DK, Cho IY, Noh S, Yoon DJ, Jang KM. Anatomical and Biomechanical Characteristics of the Anterolateral Ligament: A Descriptive Korean Cadaveric Study Using a Triaxial Accelerometer. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020419. [PMID: 36837620 PMCID: PMC9964873 DOI: 10.3390/medicina59020419] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 02/11/2023] [Accepted: 02/17/2023] [Indexed: 02/25/2023]
Abstract
Background and Objectives: The anterolateral ligament (ALL) could be the potential anatomical structure responsible for rotational instability after anterior cruciate ligament (ACL) reconstruction. The purpose of this study was to investigate the anatomical and biomechanical characteristics of the ALL in Korean cadaveric knee joints. Materials and Methods: Twenty fresh-frozen cadaveric knees were dissected and tested. Femoral and tibial footprints of the ALL were recorded. Pivot shift and Lachman tests were measured with KiRA. Results: The prevalence of ALL was 100%. The average distance of the tibial footprint to the tip of the fibular head was 19.85 ± 3.41 mm; from the tibial footprint to Gerdy's tubercle (GT) was 18.3 ± 4.19 mm; from the femoral footprint to the lateral femoral epicondyle was 10.25 ± 2.97 mm. ALL's footprint distance was the longest at 30° of flexion (47.83 ± 8.05 mm, p < 0.01) in a knee with intact ALL-ACL and neutral rotation. During internal rotation, the footprint distance was the longest at 30° of flexion (50.05 ± 8.88 mm, p < 0.01). Internal rotation produced a significant increase at all three angles after ACL-ALL were transected (p = 0.022), where the footprint distance was the longest at 30° of flexion (52.05 ± 7.60 mm). No significant difference was observed in KiRA measurements between intact ALL-ACL and ALL-transected knees for pivot shift and Lachman tests. However, ACL-ALL-transected knees showed significant differences compared to the intact ALL-ACL and ALL-transected knees (p < 0.01). Conclusions: The ALL was identified as a distinct ligament structure with a 100% prevalence in this cadaveric study. The ALL plays a protective role in internal rotational stability. An isolated ALL transection did not significantly affect the ALL footprint distances or functional stability tests. Therefore, the ALL is thought to act as a secondary supportive stabilizer for rotational stability of the knee joint in conjunction with the ACL.
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Affiliation(s)
- Dae Keun Suh
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Il-Yup Cho
- Joint Center, Seoul Barunsesang Hospital, Seoul 08523, Republic of Korea
| | - Sehyun Noh
- College of Medicine, Korea University, Seoul 02841, Republic of Korea
| | - Dong Joo Yoon
- College of Medicine, Korea University, Seoul 02841, Republic of Korea
| | - Ki-Mo Jang
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul 02841, Republic of Korea
- Correspondence: ; Tel.: +82-920-6406
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Devitt BM, Neri T, Fritsch BA. Combined anterolateral complex and anterior cruciate ligament injury: Anatomy, biomechanics, and management-State-of-the-art. J ISAKOS 2023; 8:37-46. [PMID: 36368633 DOI: 10.1016/j.jisako.2022.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 10/06/2022] [Accepted: 10/25/2022] [Indexed: 11/11/2022]
Abstract
Anterior cruciate ligament (ACL) rupture typically occurs because of sudden axial loading of the knee in conjunction with a coupled valgus and rotational moment about the tibia. However, the ACL is not the only structure damaged during this mechanism of injury, and studies have shown that the anterolateral complex (ALC) of the knee is also commonly involved. Biomechanical studies have established that the ALC plays an important role as a secondary stabiliser to control anterolateral rotatory laxity (ALRL). Indeed, it has been suggested that failure to address injury to the ALC at the time of ACL reconstruction (ACLR) may increase the risk of graft failure owing to persistent ALRL. The concept of combining a lateral extra-articular procedure to augment ACLR for the treatment of ACL injury emerged with a view to decrease the failure rate of either procedure in isolation. This state-of-the-art review discusses the history of the anatomy of the ALC, the biomechanics of a variety of lateral extra-articular augmentation procedures, and provides clinical guidelines for their use in primary ACLR.
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Affiliation(s)
- Brian M Devitt
- Dublin City University, School of Health and Human Performance & Sports Surgery Clinic, Dublin, D09 C523, Ireland.
| | - Thomas Neri
- Department of Orthopaedic Surgery, University Hospital of Saint-Etienne, University of Lyon - Jean Monnet, 42000, France
| | - Brett A Fritsch
- Sydney Orthopaedic Research Institute, Level 1, The Gallery, 445 Victoria Avenue, Chatswood, NSW 2067, Australia
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Di Paolo S, Grassi A, Pizza N, Lucidi GA, Dal Fabbro G, Macchiarola L, Zaffagnini S. Anterior cruciate ligament reconstruction with lateral plasty restores anterior-posterior laxity in the case of concurrent partial medial meniscectomy. Knee Surg Sports Traumatol Arthrosc 2022; 30:1646-1653. [PMID: 34379166 DOI: 10.1007/s00167-021-06689-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 07/29/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the in vivo knee laxity in the presence of a partial medial meniscectomy before and after a single-bundle ACL reconstruction with a lateral plasty (SBLP) and to compare it with the knee laxity after a single-bundle ACL reconstruction (SB). METHODS One-hundred and one patients with ACL tear were enrolled in the study and grouped according to the surgical technique and the meniscus treatment: regarding the SBLP technique (n = 55), 31 patients underwent isolated ACL reconstruction ("SBLP Isolated ACL Group"), while 24 patients underwent combined ACL reconstruction and partial medial meniscectomy ("SBLP ACL + MM Group"); regarding the SB technique (n = 46), 33 patients underwent isolated ACL reconstruction ("SB Isolated ACL Group"), while 13 patients underwent combined ACL reconstruction and partial medial meniscectomy ("SB ACL + MM Group"). Anterior-posterior clinical laxity at 30° (AP30) and 90° (AP90) of knee flexion was quantified before and after surgery through a surgical navigation system dedicated to kinematic assessment. RESULTS In the ACL-deficient status, the antero-posterior laxity was significantly higher in the presence of a combined MM in both the AP30 and the AP90, with no differences between the two surgical techniques. After the ACL reconstruction, both AP30 and AP90 translations decreased significantly (p < 0.0001) compared to the ACL-deficient status. No differences were found for AP30 and AP90 between SBLP Isolated ACL and SBLP + MM groups, while a significantly higher AP90 translation was found for the SB + MM group compared to the SB Isolated ACL group. Moreover, the AP90 translation in the SB ACL + MM group was significantly higher than the one of the other three groups, i.e., SBLP ACL + MM, SB, and SBLP Isolated ACL group. CONCLUSION The ACL reconstruction with lateral plasty reduced the AP knee laxity caused by the medial meniscectomy in the context of an ACL surgery. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Stefano Di Paolo
- Dipartimento di Scienze per la Qualità della Vita QUVI, Università di Bologna, Bologna, Italy
| | - Alberto Grassi
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, via Pupilli 1, 40136, Bologna, Italy
| | - Nicola Pizza
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, via Pupilli 1, 40136, Bologna, Italy.
| | - Gian Andrea Lucidi
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, via Pupilli 1, 40136, Bologna, Italy
| | - Giacomo Dal Fabbro
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, via Pupilli 1, 40136, Bologna, Italy
| | - Luca Macchiarola
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, via Pupilli 1, 40136, Bologna, Italy
| | - Stefano Zaffagnini
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, via Pupilli 1, 40136, Bologna, Italy.,Dipartimento di Scienze Biomediche e Neuromotorie DIBINEM, Università di Bologna, Bologna, Italy
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6
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Novaes M, Carvalho A, Sauer JF, Brech GC, Helito CP, João SMA. Postural control during single leg stance in individuals with clinical indication for combined reconstruction of the anterior cruciate and the anterolateral ligaments of the knee: a cross-sectional study. BMC Musculoskelet Disord 2022; 23:383. [PMID: 35468775 PMCID: PMC9040202 DOI: 10.1186/s12891-022-05347-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 04/19/2022] [Indexed: 11/30/2022] Open
Abstract
Background Several studies have shown persistent postural control deficits and rotatory instability in patients after isolated Anterior Cruciate Ligament (ACL) reconstruction. There is evidence to support that the Anterolateral Ligament (ALL) plays an important role in the remaining anterolateral rotatory laxity of the knee. There are no further evidences in order to understand how patients with a combined ACL + ALL reconstruction surgery indication behave regarding postural control. The aim of this cross-sectional study was to assess if patients with a clinical indication for the combined ACL + ALL surgery showed a deficient postural control in single leg stance compared to subjects with a regular ACL reconstruction indication and to a control group. Methods An assessment of static postural control on single leg stance was performed on a force plate, with eyes open and closed, and the center of pressure (COP) displacement variables were analyzed: maximum and mean amplitude in anteroposterior (AP) and in mediolateral (ML) direction; mean velocity of displacement and area of displacement. Eighty-nine male individuals participated and were divided into 3 groups: ACL Group, ACL + ALL Group and Control Group. Results The ACL+ ALL Group showed significantly greater COP displacement in most variables in the injured leg for the eyes closed test, compared to the ACL Group, as detailed: Total ML displacement (9.8 ± 6.77 vs. 13.98 ± 6.64, p < 0.001); Mean ML displacement (2.58 ± 2.02 vs. 3.72 ± 1.99, p < 0.001); Total AP displacement (9.5 ± 3.97 vs. 11.7 ± 3.66, p = 0.001); Mean AP displacement (1.77 ± 0.87 vs. 2.27 ± 0.86, p = 0.001); Area of displacement (111.44 ± 127.3 vs. 183.69 ± 131.48, p < 0.001). Conclusion Subjects with a clinical indication for ACL + ALL combined reconstruction surgery showed increased COP displacement compared to patients with indication for an ACL isolated reconstruction surgery.
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Affiliation(s)
- Marilia Novaes
- Physical Therapy Service, Instituto de Ortopedia e Traumatologia, Hospital das clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, 333 Ovidio Pires de Campos St, São Paulo, SP, Zip Code: 05403-010, Brazil. .,Department of Physical Therapy, Speech and Occupational Therapy, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Adriana Carvalho
- Physical Therapy Service, Instituto de Ortopedia e Traumatologia, Hospital das clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, 333 Ovidio Pires de Campos St, São Paulo, SP, Zip Code: 05403-010, Brazil.,Department of Physical Therapy, Speech and Occupational Therapy, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Juliana F Sauer
- Physical Therapy Service, Instituto de Ortopedia e Traumatologia, Hospital das clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, 333 Ovidio Pires de Campos St, São Paulo, SP, Zip Code: 05403-010, Brazil.,Department of Physical Therapy, Speech and Occupational Therapy, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Guilherme C Brech
- Physical Therapy Service, Instituto de Ortopedia e Traumatologia, Hospital das clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, 333 Ovidio Pires de Campos St, São Paulo, SP, Zip Code: 05403-010, Brazil
| | - Camilo P Helito
- Knee Surgery Division, Instituto de Ortopedia e Traumatologia, Hospital das clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Silvia M A João
- Department of Physical Therapy, Speech and Occupational Therapy, Universidade de São Paulo, São Paulo, SP, Brazil
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Moreno Mateo F, Perea SH, Green DW. Lateral-extra articular tenodesis vs. anterolateral ligament reconstruction in skeletally immature patients undergoing anterior cruciate ligament reconstruction. Curr Opin Pediatr 2022; 34:71-75. [PMID: 34845153 DOI: 10.1097/mop.0000000000001084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The aim of this study was to review the most recent available evidence about lateral-extra articular tenodesis (LET) and anterolateral ligament (ALL) reconstruction in young patients treated for anterior cruciate ligament (ACL) injury. RECENT FINDINGS The ALL of the knee acts as a secondary stabilizer of the knee preventing anterior translation and internal rotation. In vitro and in vivo biomechanical studies as well as prospective clinical trials have shown the importance of the ALL in knee biomechanics. The ALL injury has a synergetic impact on the knee stability in patients with acute ACL injury. ALL augmentation of ACL provides reduction of knee instability and graft failure and higher return to sport rates in high-risk patients. It has not been demonstrated that extra-articular procedures increase the risk of knee osteoarthritis secondary to knee over-constriction. Both Iliotibial band (ITB) ALL reconstruction and modified Lemaire LET have been shown safe and effective. Minimal biomechanical or clinical differences have been found between the two reconstruction methods. SUMMARY Young patients with ACL tears and risk factors such as laxity or pivot shift willing to return to sports may benefit from ALL augmentation. Therefore, it is essential to identify these high-risk patients to individualize treatment.
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Affiliation(s)
- Fernando Moreno Mateo
- Division of Pediatric Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
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The Cadaveric Studies and the Definition of the Antero-Lateral Ligament of the Knee: From the Anatomical Features to the Patient-Specific Reconstruction Surgical Techniques. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312852. [PMID: 34886585 PMCID: PMC8657304 DOI: 10.3390/ijerph182312852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/23/2021] [Accepted: 11/30/2021] [Indexed: 11/16/2022]
Abstract
Cadaver studies represented a milestone in surgical orthopaedic research, and still today they play a crucial role in the achievement of new knowledge about joint disease behaviour and treatment. In this review, an overview of the cadaver studies available in the literature about the anatomy, role, and treatment of the antero-lateral ligament (ALL) of the knee was performed. The aim of the review was to describe and gain more insight into the part of in vitro study in understanding knee joint anatomy and biomechanics, and in developing surgical reconstruction techniques. The findings of the review showed that cadaver studies had, and will continue to have, a key role in the research of knee joint biomechanics and surgical reconstruction. Moreover, they represent a powerful tool to develop and test new devices which could be useful in clinical and surgical practice.
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9
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Gunaydin B, Kurtoglu Ozcaglayan TI, Cetin MU, Sari A, Dincel YM, Tekin C. Does anterolateral ligament injury change the treatment option in patients with partial ACL tears? Acta Orthop Belg 2021. [DOI: 10.52628/87.2.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Patients with ACL tears with ALL injury have more clinical complaints (instability, feeling of the pop on the knee or knee sliding). patients have ALL injury with partial ACL tears, It is unclear whether the choice of treatment will be conservative or surgical.
This study aimed to determine the effect of anterolateral ligament (ALL) status, whether intact or ruptured, on the choice of conservative or surgical treatment in patients with partial anterior cruciate ligament (ACL) tears.
Between 2015 and 2019, patients with suspected partial ACL tears were identified on both physical examination and MR imaging. 122 patients who had partial ACL tears and also status of patient’s ALL could be evaluated by radiologist were included in the study, retrospectively.
Sixty-two patients who underwent ACL reconstruction were determined as group 1, and 60 patients who did not undergo ACL reconstruction were defined as group 2. In patients with partial ACL rupture with or without ACL reconstruction, it was evaluated whether a ruptured or non- ruptured ALL was effective in this decision of conservative or surgically.
The MRIs of patients with partial ACL tears were evaluated by a radiologist and it was concluded that the ALLs of 50 patients were ruptured, and 72 were intact. The ALLs of 36 patients in group 1 were ruptured, and 26 patients were intact. Fourteen patients in group 2 had ruptured ALLs, 46 patient’s ALLs were intact. Seventy-two percent of the patients with partial ACL tears who had ruptured ALLs in MRI underwent ACL reconstruction.
It was found that ACL reconstruction was performed more frequently in patients with partial ACL tears with ALL rupture. Therefore, we believe that preoperative evaluations of ALLs using MRI in patients with partial ACL tears are essential for surgical planning.
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He Q, Chen S, Li L. Image Enhancement Technology Based on Deep Trust Network Model in Clinical Treatment of Traumatology and Orthopedics. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:1717512. [PMID: 34336150 PMCID: PMC8289591 DOI: 10.1155/2021/1717512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/10/2021] [Accepted: 06/29/2021] [Indexed: 11/23/2022]
Abstract
Fractures have brought great pain to patients, and treatment requires a lot of time and yield slow results, which seriously affect the production and life of people. Fractures are mostly treated with traditional conservative treatment methods. For orthopedic trauma, image enhancement technology has gradually played an important role in the clinical treatment of orthopedic trauma and has become a kind of suffering. It has become a new treatment method that attracts people's attention. In order to study the application of image enhancement technology based on the deep trust network model in the clinical treatment of trauma and orthopedics, this paper conducted a related survey of fracture patients in the city's first hospital, reviewed relevant literature, and interviewed professionals, and we collected relevant material, constructed case templates, and created clinical research models using comprehensive quantitative and qualitative analytical techniques. Studies have shown that the use of image enhancement techniques in the treatment of fractures has been successful, with healing efficiency approximately 20% faster than conservative treatment. In the clinical treatment of trauma and orthopedics, image enhancement technology can effectively reduce the incidence of complications in the prognosis of patients. Symptom Drop. This shows that the image enhancement technology of the deep trust network model can play an important role in the clinical treatment of trauma and orthopedics.
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Affiliation(s)
- Qiaomu He
- Suizhou Hospital, Hubei University of Medicine, Department of Orthopedics, Hubei, Suizhou 441300, China
| | - Shenghao Chen
- Suizhou Hospital, Hubei University of Medicine, Department of Orthopedics, Hubei, Suizhou 441300, China
| | - Lei Li
- Suizhou Hospital, Hubei University of Medicine, Department of Orthopedics, Hubei, Suizhou 441300, China
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Berthold DP, Willinger L, LeVasseur MR, Marrero DE, Bell R, Muench LN, Kane Z, Imhoff AB, Herbst E, Cote MP, Arciero RA, Edgar CM. High Rate of Initially Overlooked Kaplan Fiber Complex Injuries in Patients With Isolated Anterior Cruciate Ligament Injury. Am J Sports Med 2021; 49:2117-2124. [PMID: 34086492 PMCID: PMC8246408 DOI: 10.1177/03635465211015682] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Injuries to the Kaplan fiber complex (KFC) are not routinely assessed for in the anterior cruciate ligament (ACL)-deficient knee during preoperative magnetic resonance imaging (MRI). As injuries to the KFC lead to anterolateral rotatory instability (ALRI) in the ACL-deficient knee, preoperative detection of these injuries on MRI scans may help surgeons to individualize treatment and improve outcomes, as well as to reduce failure rates. PURPOSE To retrospectively determine the rate of initially overlooked KFC injuries on routine MRI in knees with isolated primary ACL deficiency. STUDY DESIGN Case series; Level of evidence, 4. METHODS Patients who underwent isolated ACL reconstruction between August 2013 and December 2019 were identified. No patient had had Kaplan fiber (KF) injury identified on the initial reading of the MRI scan or at the time of surgery. Preoperative knee MRI scans (minimum 1.5 T) were reviewed and injuries to the proximal and distal KFs were recorded by 3 independent reviewers. KF length and distance to nearby anatomic landmarks (the lateral joint line and the lateral femoral epicondyle) were measured. Additional radiological findings, including bleeding, lateral femoral notch sign, and bone marrow edema (BME), were identified to detect correlations with KFC injury. RESULTS The intact KFC could reliably be identified by all 3 reviewers (85.9% agreement; Kappa, 0.716). Also, 53% to 56% of the patients with initially diagnosed isolated ACL ruptures showed initially overlooked injuries to the KFC. Injuries to the distal KFs were more frequent (48.1%, 53.8%, and 43.3% by the first, second, and third reviewers, respectively) than injuries to the proximal KFs (35.6%, 47.1%, and 45.2% by the first, second, and third reviewers, respectively). Bleeding in the lateral supracondylar region was associated with KFC injuries (P = .023). Additionally, there was a positive correlation between distal KF injuries and lateral tibial plateau BME (P = .035), but no associations were found with the lateral femoral notch sign or other patterns of BME, including pivot-shift BME. CONCLUSION KF integrity and injury can be reliably detected on routine knee MRI scans. Also, 53% to 56% of the patients presenting with initially diagnosed isolated ACL ruptures had concomitant injuries to the KFC. This is of clinical relevance, as ACL injuries diagnosed by current routine MRI examination protocols may come with a high number of occult or hidden KFC injuries. As injuries to the KFC contribute to persistent ALRI, which may influence ACL graft failure or reoperation rates, significant improvements in preoperative diagnostic imaging are required to determine the exact injury pattern and to assist in surgical decision making.
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Affiliation(s)
- Daniel P. Berthold
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA,Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany,Daniel P. Berthold, MD, Ismaninger Str. 22, 81675 Munich, Germany ()
| | - Lukas Willinger
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Matthew R. LeVasseur
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - Daniel E. Marrero
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - Ryan Bell
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - Lukas N. Muench
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - Zenon Kane
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Andreas B. Imhoff
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Elmar Herbst
- Department of Trauma, Hand and Reconstructive Surgery University Hospital, Münster, Germany
| | - Mark P. Cote
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Robert A. Arciero
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - Cory M. Edgar
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
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12
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Lee YS. Editorial Commentary: Timing of the Combined Anterior Cruciate Ligament and Anterolateral Ligament Reconstruction: Still a Debatable Issue. Arthroscopy 2021; 37:1918-1919. [PMID: 34090574 DOI: 10.1016/j.arthro.2021.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 02/11/2021] [Indexed: 02/02/2023]
Abstract
Anterior cruciate ligament (ACL) injuries frequently occur as the results of twisting injury of the knee. Accompanying damages to other structures at the time of injury determine the severity of the injury, subsequent surgical procedures, and hence, clinical outcomes. Anterolateral ligament (ALL) seems to act as a side-bar of the ACL rather than a major ligament that should be reconstructed separately. We should also consider the pros and cons of the adding ALL reconstruction procedures. There is insufficient evidence that can either support or refute that ALL plays an important role for knee stability. Determining the timing of the combined reconstruction is still a debatable issue, just like the efficacy of combined ACL and ALL reconstruction.
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Affiliation(s)
- Yong Seuk Lee
- Seoul National University College of Medicine, Seoul National University Bundang Hospital
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13
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Littlefield CP, Belk JW, Houck DA, Kraeutler MJ, LaPrade RF, Chahla J, McCarty EC. The Anterolateral Ligament of the Knee: An Updated Systematic Review of Anatomy, Biomechanics, and Clinical Outcomes. Arthroscopy 2021; 37:1654-1666. [PMID: 33340678 DOI: 10.1016/j.arthro.2020.12.190] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 11/29/2020] [Accepted: 12/03/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To perform an updated systematic review of the anatomy, biomechanics, function of the anterolateral ligament (ALL), and the clinical outcomes of anterolateral ligament reconstruction (ALLR) when performed in conjunction with anterior cruciate ligament reconstruction (ACLR). METHODS A systematic search of the literature was performed by searching PubMed, the Cochrane Library, and Embase with the search phrase anterolateral ligament for articles published from February 2017 to May 2020. Inclusion criteria included studies that evaluated the anatomy, function, or biomechanics of the ALL; surgical technique articles on ALLR; clinical articles reporting outcomes of ALLR; studies published in English; and full-text articles. Exclusion criteria included studies published before February 2017. A subjective synthesis was performed, in which ranges were reported, and individual study data were presented in forest plots. RESULTS Overall, 40 articles were included in this systematic review, with 11 articles describing ALL anatomy, 14 articles analyzing ALL function and biomechanics, 7 articles discussing the surgical technique of combined ACLR and ALLR (ACLR/ALLR), and 8 articles describing the clinical outcomes of ACLR/ALLR. The addition of ALLR in combination with ACLR (ACLR+) results in lower graft failure rates for ACLR/ALLR (0.0%-15.7%) when compared with isolated ACLR (I-ACLR) patients (7.4%-21.7%). Three of 5 studies using the Subjective International Knee Documentation Committee score, 2 of 5 studies using the Lysholm score, and 1 of 2 studies using the Tegner score reported significantly better scores at latest follow-up among ACLR+ patients compared with I-ACLR (P < .05). CONCLUSIONS The ALL acts as a secondary stabilizer to the anterior cruciate ligament and helps resist internal knee rotation and anterior tibial translation. Based on the current literature, combined ACLR with ALLR may result in lower graft failure rates and improved patient-reported outcomes when compared with I-ACLR in patients with specific indications, although several studies have shown equivalent outcomes between these 2 cohorts. CLINICAL RELEVANCE The contents of this review provide great insight for orthopaedic surgeons who are performing ACLR and considering additional procedures to increase overall knee stability and decrease likeliness for re-rupture. The postoperative functional and clinical outcomes shown in patients undergoing ACLR+ compared with I-ACLR should be given proper consideration when evaluating available treatment courses.
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Affiliation(s)
- Connor P Littlefield
- University of Colorado School of Medicine, Department of Orthopaedics, University of Colorado, Aurora, Colorado, U.S.A
| | - John W Belk
- University of Colorado School of Medicine, Department of Orthopaedics, University of Colorado, Aurora, Colorado, U.S.A..
| | - Darby A Houck
- University of Colorado School of Medicine, Department of Orthopaedics, University of Colorado, Aurora, Colorado, U.S.A
| | - Matthew J Kraeutler
- St. Joseph's University Medical Center, Department of Orthopaedic Surgery, Paterson, New Jersey, U.S.A
| | | | - Jorge Chahla
- Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Eric C McCarty
- University of Colorado School of Medicine, Department of Orthopaedics, University of Colorado, Aurora, Colorado, U.S.A
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14
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Mitchell BC, Siow MY, Bastrom T, Bomar JD, Pennock AT, Parvaresh K, Edmonds EW. Predictive Value of the Magnetic Resonance Imaging-Based Coronal Lateral Collateral Ligament Sign on Adolescent Anterior Cruciate Ligament Reconstruction Graft Failure. Am J Sports Med 2021; 49:935-940. [PMID: 33617286 DOI: 10.1177/0363546521988939] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The coronal lateral collateral ligament (LCL) sign is the presence of the full length of the LCL visualized on a single coronal magnetic resonance imaging (MRI) slice at the posterolateral corner of the knee. The coronal LCL sign has been shown to be associated with elevated measures of anterior tibial translation and internal rotation in the setting of anterior cruciate ligament (ACL) tear. HYPOTHESIS The coronal LCL sign (with greater anterior translation, internal rotation, and posterior slope of the tibia) will indicate a greater risk for graft failure after ACL reconstructive surgery. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Retrospective review was performed of adolescent patients with ACL reconstruction: a cohort without graft failure and a cohort with graft failure. MRI was utilized to measure tibial translation and femorotibial rotation and to identify the coronal LCL sign. The posterior tibial slope was measured on lateral radiographs. Patient-reported outcomes were collected. RESULTS We identified 114 patients with no graft failure and 39 patients with graft failure who met all criteria, with a mean follow-up time of 3.5 years (range, 2-9.4 years). Anterior tibial translation was associated with anterolateral complex injury (P < .001) but not graft failure (P = .06). Internal tibial rotation was associated with anterolateral complex injury (P < .001) and graft failure (P = .042). Posterior tibial slope was associated with graft failure (P = .044). The coronal LCL sign was associated with anterolateral complex injury (P < .001) and graft failure (P = .013), with an odds ratio of 4.3 for graft failure (95% CI, 1.6-11.6; P = .003). Subjective patient-reported outcomes and return to previous level of sport were not associated with failure. Comparison of MRI before and after ACL reconstruction in the graft failure cohort demonstrated a reduced value in internal rotation (P = .003) but no change in coronal LCL sign (P = .922). CONCLUSION Our study demonstrates that tibial internal rotation and posterior slope are independent predictors of ACL graft failure in adolescents. Although the value of internal rotation could be improved with ACL reconstruction, the presence of the coronal LCL sign persisted over time and was predictive of graft rupture (without the need to make measurements or memorize values of significant risk). Together, these factors indicate that greater initial knee deformity after initial ACL tear predicts greater risk for future graft failure.
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Affiliation(s)
- Brendon C Mitchell
- Department of Orthopaedic Surgery, University of California-San Diego, San Diego, California, USA
| | - Matthew Y Siow
- Department of Orthopaedic Surgery, University of California-San Diego, San Diego, California, USA
| | - Tracey Bastrom
- Division of Orthopaedic Surgery, Rady Children's Hospital, San Diego, California, USA
| | - James D Bomar
- Division of Orthopaedic Surgery, Rady Children's Hospital, San Diego, California, USA
| | - Andrew T Pennock
- Division of Orthopaedic Surgery, Rady Children's Hospital, San Diego, California, USA
| | - Kevin Parvaresh
- Department of Orthopaedic Surgery, Rush Medical Center, Chicago, Illinois, USA
| | - Eric W Edmonds
- Division of Orthopaedic Surgery, Rady Children's Hospital, San Diego, California, USA
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15
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Plantaris tendon: a novel graft for anterolateral ligament reconstruction and additional reinforcement for anterior cruciate ligament autografts in combined reconstructive procedures. Knee Surg Sports Traumatol Arthrosc 2020; 28:2604-2608. [PMID: 32047996 DOI: 10.1007/s00167-020-05885-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 01/23/2020] [Indexed: 02/06/2023]
Abstract
The anterolateral ligament is recently recognized as an important structure in restoring rotational stability of the anterior cruciate ligament-deficient knee. Biomechanical and clinical studies confirmed the benefits of concurrent anterior cruciate ligament and anterolateral ligament reconstruction. However, present techniques mostly use hamstring tendons autografts and therefore additionally disrupt the knee biomechanics. The plantaris tendon is a well known and accessible graft and has excellent biomechanical properties for anterolateral ligament reconstruction. The present paper describes a new combined anterior cruciate ligament and anterolateral ligament reconstruction technique using plantaris tendon and semitendinosus tendon.Level of evidence V (Case report).
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16
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Sonnery-Cottet B, Pioger C, Vieira TD, Franck F, Kajetanek C, Fayard JM, Thaunat M, Saithna A. Combined ACL and Anterolateral Reconstruction Is Not Associated With a Higher Risk of Adverse Outcomes: Preliminary Results From the SANTI Randomized Controlled Trial. Orthop J Sports Med 2020; 8:2325967120918490. [PMID: 32490026 PMCID: PMC7238835 DOI: 10.1177/2325967120918490] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background The widespread historical abandonment of lateral extra-articular procedures in anterior cruciate ligament (ACL) injuries occurred as a result of concerns about high rates of adverse events. Recently, the popularity of lateral extra-articular procedures has resurged, warranting an urgent evaluation of their safety profile. Purpose/Hypothesis The aim of this study was to perform an interim analysis of the ongoing SANTI randomized controlled trial to determine whether combined ACL and anterolateral ligament reconstruction (ACL + ALLR) is associated with an increased rate of adverse outcomes when compared with isolated ACL reconstruction (ACLR). The hypothesis was that there would be no significant difference between groups at a minimum follow-up of 1 year. Study Design Randomized controlled trial; Level of evidence, 1. Methods Recruitment commenced in November 2016. Patients scheduled for ACLR were randomized to either isolated ACLR (with bone-patellar tendon-bone [BPTB] autograft) or combined ACL + ALLR (with hamstring tendon autograft). All patients with a minimum follow-up of 1 year by March 2019 were included. The evaluated parameters included complications and reoperations, knee laxity parameters, range of motion, and scores on the Tegner, Lysholm, International Knee Documentation Committee (IKDC), and Knee injury and Osteoarthritis Outcome Score (KOOS) instruments. Results A total of 224 patients (112 in each group) with a mean ± SD follow-up of 12.3 ± 1.9 months (range, 12-19 months) formed the study population. A significantly higher rate of reoperation for cyclops syndrome was noted in the isolated ACLR group compared with the combined ACL + ALLR group (8.9% vs 0%, respectively; P = .0012). No significant differences were found in frequency of graft rupture (ACLR, 5.4%; ACL + ALLR, 0.9%; P = .1191), range of motion deficits, pain, or reoperation for meniscectomy between groups. No cases of postoperative infection, venous thromboembolism, or arthrofibrosis were seen. Subjective IKDC (81.2 vs 86.8; P = .0048), Lysholm (88 vs 92; P = .0131), and some components of the KOOS were significantly better in the combined ACL + ALLR group. Conclusion This study demonstrates no evidence of an increased risk of short-term adverse events after combined ACL + ALLR compared with isolated ACLR with BPTB graft. Registration NCT03740022 (ClinicalTrials.gov Identifier).
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Affiliation(s)
- Bertrand Sonnery-Cottet
- Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, FIFA Medical Centre of Excellence, Groupe Ramsay GDS, Lyon, France
| | - Charles Pioger
- Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, FIFA Medical Centre of Excellence, Groupe Ramsay GDS, Lyon, France
| | - Thais Dutra Vieira
- Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, FIFA Medical Centre of Excellence, Groupe Ramsay GDS, Lyon, France
| | - Florent Franck
- Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, FIFA Medical Centre of Excellence, Groupe Ramsay GDS, Lyon, France
| | - Charles Kajetanek
- Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, FIFA Medical Centre of Excellence, Groupe Ramsay GDS, Lyon, France
| | - Jean-Marie Fayard
- Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, FIFA Medical Centre of Excellence, Groupe Ramsay GDS, Lyon, France
| | - Mathieu Thaunat
- Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, FIFA Medical Centre of Excellence, Groupe Ramsay GDS, Lyon, France
| | - Adnan Saithna
- Sano Orthopedics, Advanced Orthopedics and Sports Medicine, Kansas City, Missouri, USA
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Knee laxity in anterolateral complex injuries versus lateral meniscus posterior horn injuries in anterior cruciate ligament deficient knees: A cadaveric study. Knee 2020; 27:363-374. [PMID: 31874819 DOI: 10.1016/j.knee.2019.11.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 11/08/2019] [Accepted: 11/26/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND In the anterior cruciate ligament (ACL) injured knee, additional injury of the anterolateral ligament (ALL) and capsule may increase the pathologic laxity. The purpose of this study was to compare the effects of the anterolateral complex (ALC) injury in ACL injured knee with the effects of lateral meniscus posterior horn (LMPH) meniscectomy. METHODS Ten fresh-frozen cadaveric knees were used. After testing the (1) intact knees and (2) ACL sectioned knees (ACL-), two groups were established: an (3) ALC sectioning group (n = 5), which underwent additional ALC sectioning (ACL-/ALC-) after ACL sectioning, and a separate (3) LMPH meniscectomy group (n = 5) that underwent LMPH meniscectomy (ACL-/LMPH-) after ACL sectioning. Knee laxity was measured in terms of internal-external rotation, anterior-posterior translation, and varus-valgus angulation for each condition at knee flexion angles of 0°, 30°, 60° and 90°. RESULTS After additional sectioning of the ALC (ACL-/ALC-), the mean internal rotation at 0, 30, 60 and 90° of knee flexion was 11.9 ± 1.3°, 18.1 ± 1.6°, 18.3 ± 1.8°, and 17.8 ± 2.4°, respectively, showing significant internal rotation laxity when compared to the intact knee (P = .031, .020, .001 and .033). Anterior translation also significantly increased compared to the ACL- knee at 30° (12.7 ± 1.4 to 16.8 ± 1.7 mm: P = .039). In contrast, additional meniscectomy of the LMPH (ACL-/LMPH-) significantly increased valgus laxity compared to the intact knee at 30, 60 and 90° (P = .021, .018 and .024). CONCLUSION These findings suggest that the anterolateral complex, which include the ALL and anterolateral capsule, may play an important role in stabilizing the knee against internal rotation and anterior translation.
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18
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Anterolateral ligament reconstruction as an augmented procedure for double-bundle anterior cruciate ligament reconstruction restores rotational stability: Quantitative evaluation of the pivot shift test using an inertial sensor. Knee 2020; 27:397-405. [PMID: 32178972 DOI: 10.1016/j.knee.2020.02.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 02/01/2020] [Accepted: 02/09/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to investigate the biomechanical function of the anterolateral structures (ALS) of the knee regarding rotational stability, and to attempt to verify the effectiveness of anterolateral ligament (ALL) reconstruction concomitant with double-bundle anterior cruciate ligament (ACL) reconstruction by quantifying the pivot shift test (PST) using an inertial sensor. METHODS Six knees of the fresh-frozen cadavers were evaluated during the following phases: (1) [Intact]; (2) ACL-deficient [ACL-D]; (3) ACL-reconstructed [ACL-R]; (4) ACL-reconstructed + ALS-deficient [ACL-R + ALS-D]; and (5) combined ACL and ALL reconstructed [ACL-R + ALL-R]. We evaluated knee rotational instability during each phase using the PST. We used an inertial sensor to calculate tibial external rotational angular velocity (ERAV) and tibial acceleration. Data were analyzed using repeated-measures analysis of variance; statistical significance was accepted as P < 0.05. RESULTS Relative to [Intact], [ACL-D] caused a significant increase in ERAV and acceleration. However, there was no difference in these parameters between [ACL-R] and [Intact]. [ACL-R + ALS-D] increased ERAV significantly compared with [ACL-R], and there was a significant difference between ERAV during [ACL-R + ALS-D] and [Intact]. However, ERAV was significantly reduced during [ACL-R + ALL-R] compared with [ACL-R + ALS-D], and there was no significant difference in ERAV or acceleration between [ACL-R + ALL-R] and [Intact]. CONCLUSIONS ALS controlled rotational instability in cooperation with the ACL in a cadaveric model. In cases of combined injury of ACL and ALS, concomitant ACL and ALL reconstruction may restore knee stability comparable with the intact state.
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Lee JK, Seo YJ, Jeong SY, Yang JH. Biomechanical function of the anterolateral ligament of the knee: a systematic review. Knee Surg Relat Res 2020; 32:6. [PMID: 32660580 PMCID: PMC7219217 DOI: 10.1186/s43019-019-0021-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 11/21/2019] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND It has been suggested that the anterolateral ligament (ALL) is an important anterolateral stabilizer of the knee joint which functions to prevent anterolateral subluxation and anterior subluxation at certain flexion angles in the knee. PURPOSE To analyze and systematically interpret the biomechanical function of the ALL. METHODS An online search was conducted for human cadaveric biomechanical studies that tested function of the ALL in resisting anterolateral subluxation and anterior subluxation of the knee. Two reviewers independently searched Medline, Embase, and the Cochrane Database of Systematic Reviews for studies up to 25 September 2018. Biomechanical studies not reporting the magnitude of anterior tibial translation or tibial internal rotation in relation to the function of the ALL were excluded. RESULTS Twelve biomechanical studies using human cadavers evaluating parameters including anterior tibial translation and/or internal tibial rotation in anterior cruciate ligament (ACL)-sectioned and ALL-sectioned knees were included in the review. Five studies reported a minor increase or no significant increase in anterior tibial translation and internal tibial rotation with further sectioning of the ALL in ACL-deficient knees. Five studies reported a significant increase in knee laxity in tibial internal rotation or pivot shift with addition of sectioning the ALL in ACL-deficient knees. Two studies reported a significant increase in both anterior tibial translation and internal tibial rotation during application of the anterior-drawer and pivot-shift tests after ALL sectioning. CONCLUSION There was inconsistency in the biomechanical characteristics of the ALL of the knee in resisting anterolateral and anterior subluxation of the tibia.
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Affiliation(s)
- Jin Kyu Lee
- Department of Orthopaedic Surgery, Hanyang University Hospital, Seoul, South Korea
| | - Young Jin Seo
- Department of Orthopaedic Surgery, Dongtan Sacred Heart Hospital, Dongtan, Gyeonggi-do, South Korea
| | - Soo-Young Jeong
- Department of Orthopaedic Surgery, Hanyang University Hospital, Seoul, South Korea
| | - Jae-Hyuk Yang
- Department of Orthopedic Surgery, Guri Hospital, Hanyang University Medical Center, 153, Gyeongchunro, Guri, Gyeonggi-Do, 11923, South Korea.
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Katakura M, Koga H, Nakamura T, Araki D, Nagai K, Nishida K, Kuroda R, Muneta T. Biomechanical Effects of Additional Anterolateral Structure Reconstruction With Different Femoral Attachment Sites on Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2019; 47:3373-3380. [PMID: 31657943 DOI: 10.1177/0363546519880192] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Recently reported anterolateral structure reconstructions (ALSRs) to augment intra-articular anterior cruciate ligament reconstruction (ACLR) use various femoral attachment sites, and their biomechanical effects are still unknown. HYPOTHESIS ALSR concomitant with ACLR would control anterolateral rotational instability better than ACLR alone, and if ALSR had different femoral attachment sites, there would be different effects on its control of anterolateral rotational instability. STUDY DESIGN Controlled laboratory study. METHODS Twelve fresh-frozen hemipelvis lower limbs were included. Anterior tibial translation during the Lachman test and tibial acceleration during the pivot-shift test were measured with a 3-dimensional electromagnetic measurement system in situations with the (1) ACL and ALS intact, (2) ACL and ALS cut, (3) ALSR without ACLR (ALSR alone), (4) ACLR without ALSR (ACLR alone), and (5) ALSR with ACLR. Three femoral attachment sites were used for ALSR: F1, 2 mm anterior and 2 mm distal to the lateral epicondyle; F2, 4 mm posterior and 8 mm proximal to the lateral epicondyle; and F3, over-the-top position for the lateral extra-articular tenodesis. The Steel test and Wilcoxon signed rank test were used for statistical analysis. RESULTS Anterior tibial translation during the Lachman test in the ACL and ALS-cut state was significantly larger than it was in the ACL and ALS-intact state, while its difference disappeared after ACLR. As for the pivot-shift test, additional ALSR with F2 to ACLR significantly decreased the acceleration (P = .046), although additional ALSR with F1 and F3 showed no significant effect. CONCLUSION ALSR with the femoral attachment site 4 mm posterior and 8 mm proximal to the lateral epicondyle in addition to ACLR played a role in reducing anterolateral rotational instability the most effectively among the measured attachment sites. CLINICAL RELEVANCE The present data will contribute to determine the appropriate femoral attachment site for ALSR to better control anterolateral rotational instability after ACL reconstruction.
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Affiliation(s)
- Mai Katakura
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.,Department of Orthopaedic Surgery, Hospital of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hideyuki Koga
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.,Department of Orthopaedic Surgery, Hospital of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tomomasa Nakamura
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Daisuke Araki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Kanto Nagai
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Kyohei Nishida
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Takeshi Muneta
- National Hospital Organization Disaster Medical Center, Tachikawa-shi, Japan
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Grassi A, Di Paolo S, Lucidi GA, Macchiarola L, Raggi F, Zaffagnini S. The Contribution of Partial Meniscectomy to Preoperative Laxity and Laxity After Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction: In Vivo Kinematics With Navigation. Am J Sports Med 2019; 47:3203-3211. [PMID: 31613650 DOI: 10.1177/0363546519876648] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Limited in vivo kinematic information exists on the effect of clinical-based partial medial and lateral meniscectomy in the context of anterior cruciate ligament (ACL) reconstruction. HYPOTHESIS In patients with ACL deficiency, partial medial meniscus removal increases the anteroposterior (AP) laxity with compared with those with intact menisci, while partial lateral meniscus removal increases dynamic laxity. In addition, greater postoperative laxity would be identified in patients with partial medial meniscectomy. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS A total of 164 patients with ACL tears were included in the present study and divided into 4 groups according to the meniscus treatment they underwent: patients with partial lateral meniscectomy (LM group), patients with partial medial meniscectomy (MM group), patients with partial medial and lateral meniscectomy (MLM group), and patients with intact menisci who did not undergo any meniscus treatment (IM group). A further division in 2 new homogeneous groups was made based on the surgical technique: 46 had an isolated single-bundle anatomic ACL reconstruction (ACL group), while 13 underwent a combined single-bundle anatomic ACL reconstruction and partial medial meniscectomy (MM-ACL group). Standard clinical laxities (AP translation at 30° of knee flexion, AP translation at 90° of knee flexion) and pivot-shift (PS) tests were quantified before and after surgery by means of a surgical navigation system dedicated to kinematic assessment. The PS test was quantified through 3 different parameters: the anterior displacement of the lateral tibial compartment (lateral AP); the posterior acceleration of the lateral AP during tibial reduction (posterior acceleration); and finally, the area included by the lateral AP translation with respect to the flexion/extension angle (area). RESULTS In the ACL-deficient status, the MM group showed a significantly greater tibial translation compared with the IM group (P < .0001 for AP displacement at 30° [AP30] and 90° [AP90] of flexion) and the LM group (P = .002 for AP30 and P < .0001 for AP90). In the PS test, the area of LM group was significantly larger (57%; P = .0175) than the one of the IM group. After ACL reconstruction, AP translation at 30° was restored, while the AP90 remained significantly greater at 1.3 mm (P = .0262) in the MM-ACL group compared with those with intact menisci. CONCLUSION Before ACL reconstruction, partial medial meniscectomy increased AP laxity at 30° and 90° and lateral meniscectomy increased dynamic PS laxity with respect to intact menisci. Anatomic single-bundle ACL reconstruction decreased laxities, but a residual anterior translation of 1.3 mm at 90° remained in patients with partial medial meniscectomy, with respect to those with intact menisci.
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Affiliation(s)
- Alberto Grassi
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Di Paolo
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Gian Andrea Lucidi
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Luca Macchiarola
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Federico Raggi
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Zaffagnini
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.,Dipartimento di Scienze Biomediche e Neuromotorie DIBINEM, Università di Bologna, Italy
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Park YB, Lee HJ, Ro DH, Lee GY, Kim S, Kim SH. Anterolateral ligament injury has a synergic impact on the anterolateral rotatory laxity in acute anterior cruciate ligament-injured knees. Knee Surg Sports Traumatol Arthrosc 2019; 27:3334-3344. [PMID: 30631908 DOI: 10.1007/s00167-019-05347-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 01/04/2019] [Indexed: 01/24/2023]
Abstract
PURPOSE To investigate the prevalence of the anterolateral ligament (ALL) injuries and its role in rotatory laxity in acute anterior cruciate ligament (ACL)-injured knees. METHODS Two-hundred and ninety-six consecutive patients with acute ACL injuries were evaluated retrospectively, excluding those with other ligament injury and undetectable path of ALL in MRI. Patients were divided into two groups based on the degree of ACL injury in arthroscopy (complete versus partial group). Logistic regression and discriminant analysis were performed to assess the risk of pivot shift test. RESULTS A total of 169 patients were included (128 with complete and 41 with partial ACL rupture). Overall, 106/169 (62.7%) of ALL injuries were characterized, 87/128 (67.9%) in complete group, and 19/41 (46.3%) in partial group. The incidence of pivot shift was 120/128 (93.8%) and 14/41 (34.1%) in the complete and partial groups, respectively. The odds ratio in the pivot shift of combined ALL injury was found as 3.8 (95% CI 1.8-8.4) with the overall ACL injury, but higher as 17.1 (95% CI 3.1-96.4) with partial group. Higher grade of pivot shift showed a greater incidence of injury of ALL. Degree of ACL injury and ALL injury allowed 87.0% of correct classification of subsequent anterolateral rotatory laxity. CONCLUSION Injury to the ALL could have a synergetic effect on anterolateral rotatory laxity in acute ACL-injured knee, however, its effect might be minor in case of complete tear. Careful assessment about combined ALL injury should be considered, especially in knees with high-grade pivot shift in acute ACL-injured knees. LEVEL OF EVIDENCE Retrospective prognostic study, Level IV.
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Affiliation(s)
- Yong-Beom Park
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, South Korea
| | - Han-Jun Lee
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, South Korea
| | - Du-Hyun Ro
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-Gu, Seoul, 03080, South Korea
| | - Geun Young Lee
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, South Korea
| | - Sujin Kim
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, South Korea
| | - Seong Hwan Kim
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, South Korea. .,Orthopedic Department, Centre Hospitalier de Versailles, Le Chesnay, France.
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23
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Gunaydin B, Turgut A, Sari A, Tekin C, Kilinc BE, Kusak I, Sahin GG, Kalenderer O, Kabukcuoglu YS. Does anterolateral ligament rupture affect functional outcomes in patients who underwent an anterior cruciate ligament reconstruction? Int J Surg 2019; 65:25-31. [DOI: 10.1016/j.ijsu.2019.03.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 02/23/2019] [Accepted: 03/11/2019] [Indexed: 01/12/2023]
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24
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Grassi A, Signorelli C, Urrizola F, Macchiarola L, Raggi F, Mosca M, Samuelsson K, Zaffagnini S. Patients With Failed Anterior Cruciate Ligament Reconstruction Have an Increased Posterior Lateral Tibial Plateau Slope: A Case-Controlled Study. Arthroscopy 2019; 35:1172-1182. [PMID: 30878331 DOI: 10.1016/j.arthro.2018.11.049] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 11/13/2018] [Accepted: 11/16/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare knee anatomical parameters of patients with failed anterior cruciate ligament reconstruction (ACL-R) with those of a control group of sex-matched patients with successful ACL-R. METHODS Forty-three patients (34 male, 9 female) who experienced graft failure after ACL-R were enrolled in the failed group. These patients were matched to a control group of 43 patients who underwent primary ACL-R with a minimum follow-up of 24 months. On magnetic resonance imaging, the following parameters were evaluated: transepicondylar distance, lateral and medial femoral condyle widths, tibial plateau width, notch width index, and the ratio of width and height of the femoral notch, ratio between the height and depth of the lateral and medial femoral condyle, lateral and medial posterior tibial slopes, and anterior subluxation of the lateral and medial tibial plateau. Multivariate regression with backward elimination, including only the previously identified significant variables, defined the independent predictors for revision surgery. RESULTS The anatomical variables that were significantly different between the 2 study groups were lateral and medial posterior tibial slopes, anterior subluxation of the lateral and medial tibial plateau, medial tibial plateau width, lateral tibial plateau width, medial femoral condyle width, and transepicondylar distance; however, the multivariate regression analysis identified the lateral posterior tibial slope (LTPs), the anterior subluxation of the medial tibial plateau, and the medial femoral condyle width as significant independent predictors (P < .05). The LPTs had the highest coefficient and the highest sensitivity (88%) and specificity (84%) to identify failures when considering the optimal cutoff value of 7.4°. CONCLUSIONS Several anatomical parameters have been identified that differ significantly between patients with failed ACL-R and those without a documented failure. The most accurate predictor of ACL failure was an LTPs >7.4°, with a sensitivity of 88% and specificity of 84%. Surgeons should consider measuring LTPs during preoperative assessment of ACL-injured patients, and patients with values >7.4° should be considered at high risk of ACL-R failure. LEVEL OF EVIDENCE Level III retrospective prognostic trial.
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Affiliation(s)
- Alberto Grassi
- Laboratorio di Biomeccanica e Innovazione Tecnologica, IRCSS Istituto Ortopedico Rizzoli, Bologna, Italy; Clinica Ortopedica e Traumatologica II, IRCSS Istituto Ortopedico Rizzoli, Bologna, Italy; Dipartimento Scienze Biomediche e Neuromotorie-DIBINEM, Università di Bologna, Bologna, Italy
| | - Cecilia Signorelli
- Laboratorio di Biomeccanica e Innovazione Tecnologica, IRCSS Istituto Ortopedico Rizzoli, Bologna, Italy; Clinica Ortopedica e Traumatologica II, IRCSS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Francisco Urrizola
- Hospital Las Higueras, Talcahuano, Concepción, Región del Bío Bío, Chile
| | - Luca Macchiarola
- Laboratorio di Biomeccanica e Innovazione Tecnologica, IRCSS Istituto Ortopedico Rizzoli, Bologna, Italy; Clinica Ortopedica e Traumatologica II, IRCSS Istituto Ortopedico Rizzoli, Bologna, Italy; Dipartimento Scienze Biomediche e Neuromotorie-DIBINEM, Università di Bologna, Bologna, Italy.
| | - Federico Raggi
- Laboratorio di Biomeccanica e Innovazione Tecnologica, IRCSS Istituto Ortopedico Rizzoli, Bologna, Italy; Clinica Ortopedica e Traumatologica II, IRCSS Istituto Ortopedico Rizzoli, Bologna, Italy; Dipartimento Scienze Biomediche e Neuromotorie-DIBINEM, Università di Bologna, Bologna, Italy
| | - Massimiliano Mosca
- Laboratorio di Biomeccanica e Innovazione Tecnologica, IRCSS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Kristian Samuelsson
- Department of Orthopaedics, Sahlgrenska Universitetssjukhuset, Gothenburg, Sweden; Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Stefano Zaffagnini
- Laboratorio di Biomeccanica e Innovazione Tecnologica, IRCSS Istituto Ortopedico Rizzoli, Bologna, Italy; Clinica Ortopedica e Traumatologica II, IRCSS Istituto Ortopedico Rizzoli, Bologna, Italy; Dipartimento Scienze Biomediche e Neuromotorie-DIBINEM, Università di Bologna, Bologna, Italy
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25
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Weber AE, Zuke W, Mayer EN, Forsythe B, Getgood A, Verma NN, Bach BR, Bedi A, Cole BJ. Lateral Augmentation Procedures in Anterior Cruciate Ligament Reconstruction: Anatomic, Biomechanical, Imaging, and Clinical Evidence. Am J Sports Med 2019; 47:740-752. [PMID: 29401410 DOI: 10.1177/0363546517751140] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There has been an increasing interest in lateral-based soft tissue reconstructive techniques as augments to anterior cruciate ligament reconstruction (ACLR). The objective of these procedures is to minimize anterolateral rotational instability of the knee after surgery. Despite the relatively rapid increase in surgical application of these techniques, many clinical questions remain. PURPOSE To provide a comprehensive update on the current state of these lateral-based augmentation procedures by reviewing the origins of the surgical techniques, the biomechanical data to support their use, and the clinical results to date. STUDY DESIGN Systematic review. METHODS A systematic search of the literature was conducted via the Medline, EMBASE, Scopus, SportDiscus, and CINAHL databases. The search was designed to encompass the literature on lateral extra-articular tenodesis (LET) procedures and the anterolateral ligament (ALL) reconstruction. Titles and abstracts were reviewed for relevance and sorted into the following categories: anatomy, biomechanics, imaging/diagnostics, surgical techniques, and clinical outcomes. RESULTS The search identified 4016 articles. After review for relevance, 31, 53, 27, 35, 45, and 78 articles described the anatomy, biomechanics, imaging/diagnostics, surgical techniques, and clinical outcomes of either LET procedures or the ALL reconstruction, respectively. A multitude of investigations were available, revealing controversy in addition to consensus in several categories. The level of evidence obtained from this search was not adequate for systematic review or meta-analysis; thus, a current concepts review of the anatomy, biomechanics, imaging, surgical techniques, and clinical outcomes was performed. CONCLUSION Histologically, the ALL appears to be a distinct structure that can be identified with advanced imaging techniques. Biomechanical evidence suggests that the anterolateral structures of the knee, including the ALL, contribute to minimizing anterolateral rotational instability. Cadaveric studies of combined ACLR-LET procedures demonstrated overconstraint of the knee; however, these findings have yet to be reproduced in the clinical literature. The current indications for LET augmentation in the setting of ACLR and the effect on knee kinematic and joint preservation should be the subject of future research.
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Affiliation(s)
- Alexander E Weber
- Department of Orthopaedic Surgery, University of Southern California, Los Angeles, California, USA
| | - William Zuke
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Erik N Mayer
- Department of Orthopaedic Surgery, University of Southern California, Los Angeles, California, USA
| | - Brian Forsythe
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Alan Getgood
- Fowler Kennedy Sports Clinic, Western University, London, Ontario, Canada
| | - Nikhil N Verma
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Bernard R Bach
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
| | - Asheesh Bedi
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Brian J Cole
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, USA
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26
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Grassi A, Macchiarola L, Urrizola Barrientos F, Zicaro JP, Costa Paz M, Adravanti P, Dini F, Zaffagnini S. Steep Posterior Tibial Slope, Anterior Tibial Subluxation, Deep Posterior Lateral Femoral Condyle, and Meniscal Deficiency Are Common Findings in Multiple Anterior Cruciate Ligament Failures: An MRI Case-Control Study. Am J Sports Med 2019; 47:285-295. [PMID: 30657705 DOI: 10.1177/0363546518823544] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Tibiofemoral anatomic parameters, such as tibial slope, femoral condyle shape, and anterior tibial subluxation, have been suggested to increase the risk of anterior cruciate ligament (ACL) reconstruction failure. However, such features have never been assessed among patients experiencing multiple failures of ACL reconstruction. PURPOSE To compare the knee anatomic features of patients experiencing a single failure of ACL reconstruction with those experiencing multiple failures or with intact ACL reconstruction. STUDY Case-control study; Level of evidence, 3. METHODS Twenty-six patients who experienced failure of revision ACL reconstruction were included in the multiple-failure group. These patients were matched to a group of 25 patients with failure of primary ACL reconstruction and to a control group of 40 patients who underwent primary ACL reconstruction with no failure at a minimum follow-up of 24 months. On magnetic resonance imaging (MRI), the following parameters were evaluated: ratio between the height and depth of the lateral and medial femoral condyles, the lateral and medial tibial plateau slopes, and anterior subluxation of the lateral and medial tibial plateaus with respect to the femoral condyle. The presence of a meniscal lesion during each procedure was evaluated as well. Anatomic, demographic, and surgical characteristics were compared among the 3 groups. RESULTS The patients in the multiple-failure group had significantly higher values of lateral tibial plateau slope ( P < .001), medial tibial plateau slope ( P < .001), lateral tibial plateau subluxation ( P < .001), medial tibial plateau subluxation ( P < .001), and lateral femoral condyle height/depth ratio ( P = .038) as compared with the control group and the failed ACL reconstruction group. Moreover, a significant direct correlation was found between posterior tibial slope and anterior tibial subluxation for the lateral ( r = 0.325, P = .017) and medial ( r = 0.421, P < .001) compartments. An increased anterior tibial subluxation of 2 to 3 mm was present in patients with a meniscal defect at the time of the MRI as compared with patients who had an intact meniscus for both the lateral and the medial compartments. CONCLUSION A steep posterior tibial slope and an increased depth of the lateral femoral condyle represent a common finding among patients who experience multiple ACL failures. Moreover, higher values of anterior subluxation were found among patients with repeated failure and those with a medial or lateral meniscal defect.
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Affiliation(s)
- Alberto Grassi
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Luca Macchiarola
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Juan Pablo Zicaro
- Department of Orthopaedics, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Matias Costa Paz
- Department of Orthopaedics, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | | | | | - Stefano Zaffagnini
- II Clinica Ortopedica e Traumatologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.,Dipartimento di Scienze Biomediche e Neuromotorie DIBINEM, Università di Bologna, Bologna, Italy
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27
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Daggett M, Stephenson C, Dobson J, Whitaker A, Redler A, Monaco E, Wright B, Saithna A, Sonnery-Cottet B. Anatomic and Histological Study of the Anterolateral Aspect of the Knee: A SANTI Group Investigation. Orthop J Sports Med 2018; 6:2325967118799970. [PMID: 30345320 PMCID: PMC6187433 DOI: 10.1177/2325967118799970] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Background: The structure and function of the anterolateral aspect of the knee have been significantly debated, with renewed interest in this topic since the description of the anterolateral ligament (ALL). Purpose: To define and describe the distinct structures of the lateral knee and to correlate the macroscopic and histologic anatomic features. Study Design: Descriptive laboratory study. Methods: Twelve fresh-frozen human cadavers were used for anatomic analysis. In the left knee, a layer-by-layer dissection and macroscopic analysis were performed. In the right knee, an en bloc specimen was obtained encompassing an area from the Gerdy tubercle to the posterior fibular head and extending proximally from the anterior aspect to the posterior aspect of the lateral femoral epicondyle. The en bloc resection was then frozen, sliced at the level of the joint line, and reviewed by a musculoskeletal pathologist. Results: Macroscopically, the lateral knee has 4 main layers overlying the capsule of the knee: the aponeurotic layer, the superficial layer including the iliotibial band (ITB), the deep fascial layer, and the ALL. Histologically, 8 of 12 specimens demonstrated 4 consistent, distinct structures: the ITB, the ALL, the lateral collateral ligament, and the meniscus. Conclusion: The lateral knee has a complex orientation of layers and fibers. The ALL is a distinct structure from the ITB and is synonymous to the previously described capsulo-osseous layer of the ITB. Clinical Relevance: Increasingly, lateral extra-articular procedures are performed at the time of anterior cruciate ligament reconstruction. Understanding the anatomic features of the anterolateral aspect of the knee is necessary to understand the biomechanics and function of the structures present and allows surgeons to attempt to replicate those anatomic characteristics when performing extra-articular reconstruction.
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Affiliation(s)
- Matt Daggett
- Kansas City University of Medicine and Biosciences, Kansas City, Missouri, USA
- Matt Daggett, DO, Kansas City University of Medicine and Biosciences, 1750 Independence Ave, Kansas City, MO 64106, USA () (Twitter: @DrMattDaggett)
| | - Clark Stephenson
- Kansas City University of Medicine and Biosciences, Kansas City, Missouri, USA
| | - John Dobson
- Kansas City University of Medicine and Biosciences, Kansas City, Missouri, USA
| | - Amy Whitaker
- Kansas City University of Medicine and Biosciences, Kansas City, Missouri, USA
| | - Andrea Redler
- II School of Medicine, Sant’Andrea Hospital, Kirk Kilgour Sports Injury Center, University of Rome “La Sapienza,” Rome, Italy
| | - Edoardo Monaco
- II School of Medicine, Sant’Andrea Hospital, Kirk Kilgour Sports Injury Center, University of Rome “La Sapienza,” Rome, Italy
| | - Barth Wright
- Kansas City University of Medicine and Biosciences, Kansas City, Missouri, USA
| | - Adnan Saithna
- Renacres Ln, Ormskirk, Lancashire, Halsall, Ormskirk, UK
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28
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Editorial Commentary: When Biomechanics Apparently Conflicts With Clinical Practice: The Role of Translational Medicine Regarding Combined Anterior Cruciate Ligament and Lateral Knee Reconstruction. Arthroscopy 2018; 34:2696-2698. [PMID: 30173810 DOI: 10.1016/j.arthro.2018.06.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 06/22/2018] [Accepted: 06/25/2018] [Indexed: 02/02/2023]
Abstract
The role of the anterolateral ligament as a secondary restraint to the anterior cruciate ligament in controlling tibial internal rotation and pivot shift is greatly debated today because biomechanical studies lead to conflicting results. However, extra-articular reconstructions used along with intra-articular reconstructions seem to be able to improve knee stability and reduce the rate of failure, especially when a graft other than bone-patellar tendon-bone is used as an anterior cruciate ligament substitute. For translational medicine, the task is to fill the gap between laboratory studies and clinical practice.
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29
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Slichter ME, Wolterbeek N, Auw Yang KG, Zijl JAC, Piscaer TM. A novel test for assessment of anterolateral rotatory instability of the knee: the tibial internal rotation test (TIR test). J Exp Orthop 2018; 5:29. [PMID: 30094573 PMCID: PMC6085217 DOI: 10.1186/s40634-018-0141-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 06/22/2018] [Indexed: 01/26/2023] Open
Abstract
Background Rotational instability of the knee may persist after anterior cruciate ligament (ACL) reconstruction, which may be due to insufficiency of anterolateral stabilizing structures. However, no reliable diagnostic tool or physical examination test is available for identifying patients with anterolateral rotatory instability (ALRI). As shown in cadaveric studies, static internal rotation of the knee is increased in higher flexion angles of the knee after severing the anterolateral structures. This might also be the case in patients with an ACL-deficient knee and concomitant damage to the anterolateral structures. The objective of this study is to assess anterolateral rotatory instability of the knee during physical examination with a tibial internal rotation test. Methods ACL-injured knees of 52 patients were examined by two examiners and side-to-side differences were compared. Both lower legs were internally rotated by applying manual internal rotation torque to both feet in prone position with the knees in 30°, 60° and 90° of flexion. For quantification of the amount of rotation in degrees, a torque adapter on a booth was used. Intra-rater, inter-rater and rater-device agreement were determined by calculating kappa (κ) for the tibial internal rotation test. Results Tibial internal rotation is increased in 19.2% of the patients with ACL injury according to the tibial internal rotation test. Good intra-rater agreement was found for the tibial internal rotation test, κC = 0.63 (95%CI -0.02-1.28), p = 0.015. Fair inter-rater agreement was found, κF = 0.29 (95%CI 0.02–0.57), p = 0.038. Good rater-device agreement was found, κC = 0.62 (95%CI 0.15–1.10), p = 0.001. Conclusion The tibial internal rotation test shows increased tibial internal rotation in a small amount of patients with ACL injury. Even though no gold standard for assessment of increased tibial internal rotation of the knee is available yet, the test can be of additional value. It can be used for assessment of internal rotatory laxity of the knee as part of ALRI in addition to the pivot shift test. No clinical implications should yet be based on this test alone. Electronic supplementary material The online version of this article (10.1186/s40634-018-0141-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Malou E Slichter
- Department of Orthopaedic Surgery, St. Antonius hospital, P.O. Box 2500, 3430 EM, Nieuwegein, The Netherlands
| | - Nienke Wolterbeek
- Department of Orthopaedic Surgery, St. Antonius hospital, P.O. Box 2500, 3430 EM, Nieuwegein, The Netherlands
| | - K Gie Auw Yang
- Department of Orthopaedic Surgery, St. Antonius hospital, P.O. Box 2500, 3430 EM, Nieuwegein, The Netherlands
| | - Jacco A C Zijl
- Department of Orthopaedic Surgery, St. Antonius hospital, P.O. Box 2500, 3430 EM, Nieuwegein, The Netherlands
| | - Tom M Piscaer
- Department of Orthopaedic Surgery, St. Antonius hospital, P.O. Box 2500, 3430 EM, Nieuwegein, The Netherlands. .,Department of Orthopaedic Surgery, Erasmus Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands.
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30
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Kraeutler MJ, Welton KL, Chahla J, LaPrade RF, McCarty EC. Current Concepts of the Anterolateral Ligament of the Knee: Anatomy, Biomechanics, and Reconstruction. Am J Sports Med 2018; 46:1235-1242. [PMID: 28426251 DOI: 10.1177/0363546517701920] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
In 1879, Paul Segond described an avulsion fracture (now known as a Segond fracture) at the anterolateral proximal tibia with the presence of a fibrous band at the location of this fracture. Although references to this ligament were occasionally made in the anatomy literature after Segond's discovery, it was not until 2012 that Vincent et al named this ligament what we know it as today, the anterolateral ligament (ALL) of the knee. The ALL originates near the lateral epicondyle of the distal femur and inserts on the proximal tibia near Gerdy's tubercle. The ALL exists as a ligamentous structure that comes under tension during internal rotation at 30°. In the majority of specimens, the ALL can be visualized as a ligamentous structure, whereas in some cases it may only be palpated as bundles of more tense capsular tissue when internal rotation is applied. Biomechanical studies have shown that the ALL functions as a secondary stabilizer to the anterior cruciate ligament (ACL) in resisting anterior tibial translation and internal tibial rotation. These biomechanical studies indicate that concurrent reconstruction of the ACL and ALL results in significantly reduced internal rotation and axial plane tibial translation compared with isolated ACL reconstruction (ACLR) in the presence of ALL deficiency. Clinically, a variety of techniques are available for ALL reconstruction (ALLR). Current graft options include the iliotibial (IT) band, gracilis tendon autograft or allograft, and semitendinosus tendon autograft or allograft. Fixation angle also varies between studies from full knee extension to 60° to 90° of flexion. To date, only 1 modern study has described the clinical outcomes of concomitant ALLR and ACLR: a case series of 92 patients with a minimum 2-year follow-up. Further studies are necessary to define the ideal graft type, location of fixation, and fixation angle for ALLR. Future studies also must be designed in a prospective comparative manner to compare the clinical outcomes of patients undergoing ACLR with ALL reconstruction versus without ALL reconstruction. By discovering the true effect of the ALL, investigators can elucidate the importance of ALLR in the setting of an ACL tear.
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Affiliation(s)
- Matthew J Kraeutler
- University of Colorado School of Medicine, Department of Orthopedics, Aurora, Colorado, USA
| | - K Linnea Welton
- University of Colorado School of Medicine, Department of Orthopedics, Aurora, Colorado, USA
| | - Jorge Chahla
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Robert F LaPrade
- Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA
| | - Eric C McCarty
- University of Colorado School of Medicine, Department of Orthopedics, Aurora, Colorado, USA
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31
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Monaco E, Fabbri M, Mazza D, Daggett M, Redler A, Lanzetti RM, De Carli A, Ferretti A. The Effect of Sequential Tearing of the Anterior Cruciate and Anterolateral Ligament on Anterior Translation and the Pivot-Shift Phenomenon: A Cadaveric Study Using Navigation. Arthroscopy 2018; 34:1009-1014. [PMID: 29287952 DOI: 10.1016/j.arthro.2017.09.042] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Revised: 09/12/2017] [Accepted: 09/15/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the effect of progressive lesions of the anterior cruciate ligament (ACL) and anterolateral ligament (ALL) on anterior tibial translation (ATT) as evaluated through the Lachman test and internal tibial rotation (ITR) during a dynamic pivot-shift test in a cadaveric model. METHODS A total of 7 specimens were tested using a navigation system (2.2 OrthoPilot ACL navigation system). The anterior stability of the knee was measured through the Lachman test and dynamic rotational stability was measured through the pivot-shift test in 3 different conditions: intact knee; ACL-deficient knee; and finally, ACL- and ALL-deficient knee. The resulting measurements from the navigation system recorded the real-time changes in both translation and internal rotation during the Lachman and pivot-shift maneuvers. RESULTS Mean ATT was 7.57 ± 0.53 mm in the intact knee, 14 ± 2.44 mm in the ACL-deficient knee, and 14 ± 2.44 mm in the ACL- and ALL-deficient knee. Mean ITR during the pivot-shift test was 10.14° ± 2.26° in the intact knee, 12.14° ± 2.19° in the ACL-deficient knee, and 18.86° ± 2.73° in the ACL- and ALL-deficient knee. There was a statistically significant difference in static ATT between the intact and ACL-deficient knees (P = .039) but no difference through the addition of an ALL lesion (P = .068). For dynamic rotational control testing, there was no significant difference in ATT between groups but a significant difference in ITR was found (F = 25.17, P = .00034). CONCLUSIONS During the pivot-shift test, a combined lesion of the ACL and ALL has a significant effect on ITR whereas an isolated lesion of the ACL has no effect on either ATT or ITR. During the Lachman test, an isolated lesion of the ACL has a significant effect on ATT but an additional lesion of the ALL does not affect ATT. CLINICAL RELEVANCE Dynamic rotational control as tested by the pivot-shift test is greatly influenced by a combined lesion of the ACL and ALL. In clinical cases of a pivot shift, addressing the anterolateral structures may be considered.
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Affiliation(s)
- Edoardo Monaco
- University of Rome La Sapienza, Sant'Andrea Hospital, Rome, Italy
| | - Mattia Fabbri
- University of Rome La Sapienza, Sant'Andrea Hospital, Rome, Italy
| | - Daniele Mazza
- University of Rome La Sapienza, Sant'Andrea Hospital, Rome, Italy.
| | | | - Andrea Redler
- University of Rome La Sapienza, Sant'Andrea Hospital, Rome, Italy
| | | | - Angelo De Carli
- University of Rome La Sapienza, Sant'Andrea Hospital, Rome, Italy
| | - Andrea Ferretti
- University of Rome La Sapienza, Sant'Andrea Hospital, Rome, Italy
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Helito CP, Saithna A, Bonadio MB, Daggett M, Monaco E, Demange MK, Sonnery-Cottet B. Anterolateral Ligament Reconstruction: A Possible Option in the Therapeutic Arsenal for Persistent Rotatory Instability After ACL Reconstruction. Orthop J Sports Med 2018; 6:2325967117751348. [PMID: 29376085 PMCID: PMC5777553 DOI: 10.1177/2325967117751348] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- Camilo Partezani Helito
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.,Hospital Sírio Libanês, São Paulo, Brazil
| | - Adnan Saithna
- Medical Technologies and Advanced Materials, Clifton Campus, Nottingham Trent University, Nottingham, UK.,Renacres Hospital, Lancashire, UK
| | - Marcelo B Bonadio
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Matt Daggett
- Kansas City University, Kansas City, Missouri, USA
| | | | - Marco K Demange
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Bertrand Sonnery-Cottet
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Generale de Sante, Hospital Privé Jean Mermoz, Lyon, France
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Moroz PA, Quick EE, Horner NS, Duong A, Simunovic N, Ayeni OR. What Is the State of the Evidence in Anterolateral Ligament Research? Clin Sports Med 2018; 37:137-159. [DOI: 10.1016/j.csm.2017.07.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Abstract
The anterolateral ligament (ALL) of the knee has gained attention recently for its potential role in rotational stability of the knee, especially in association with anterior cruciate ligament (ACL) injuries. Anatomic studies have characterized the ALL as it runs in an anteroinferior and oblique direction from the lateral distal femur to the anterolateral proximal tibia, although the prevalence and variance of this ligament are not well understood. Magnetic resonance imaging and ultrasound have identified the ligament and linked it with the classically described Segond fracture. While the ALL likely plays a role in rotational stability of the knee, further studies investigating the significance of ALL injuries and the role of ALL reconstruction in combination with ACL reconstruction are warranted.
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Affiliation(s)
- Ronak M Patel
- Department of Orthopaedic Surgery, Washington University in St Louis, Chesterfield, Missouri, USA
| | - Robert H Brophy
- Department of Orthopaedic Surgery, Washington University in St Louis, Chesterfield, Missouri, USA
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Are there four tibial plateau columns? Yes there are, as illustrated by a postero-lateral apple-bite fracture. Response to a letter-to-the-editor. INTERNATIONAL ORTHOPAEDICS 2017; 42:443-446. [DOI: 10.1007/s00264-017-3686-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 10/30/2017] [Indexed: 01/12/2023]
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36
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Louis ML, D'ingrado P, Ehkirch FP, Bertiaux S, Colombet P, Sonnery-Cottet B, Schlatterer B, Pailhé R, Panisset JC, Steltzlen C, Lustig S, Lutz C, Dalmay F, Imbert P, Saragaglia D. Combined intra- and extra-articular grafting for revision ACL reconstruction: A multicentre study by the French Arthroscopy Society (SFA). Orthop Traumatol Surg Res 2017; 103:S223-S229. [PMID: 28889985 DOI: 10.1016/j.otsr.2017.08.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Accepted: 08/23/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND A careful analysis of the reasons for ACL reconstruction failure is essential to selection of the optimal surgical revision technique designed to ensure good rotational stability and to minimise the risk of re-rupture. OBJECTIVE To evaluate anterolateral ligament (ALL) stabilisation during revision ACL reconstruction. HYPOTHESIS ALL stabilisation during revision ACL reconstruction provides good rotational stability without increasing the risk of complications. MATERIAL AND METHODS This multicentre study included 349 patients, 151 retrospectively and 198 prospectively. There were 283 males and 66 females. Inclusion criteria were an indication for revision ACL reconstruction surgery with combined intra-articular reconstruction and ALL stabilisation after failed autograft ACL reconstruction, and intact PCL. Exclusion criteria were primary ACL reconstruction and concomitant peripheral medial and/or lateral lesions. Each patient underwent a clinical and radiographic evaluation before and after revision surgery. Before revision surgery, the mean IKDC score was 56.5±15.5 and 96% of patients were IKDC C or D. RESULTS Rates were 5.0% for early and 10.5% for late postoperative complications. Lachmann's test had a hard stop at last follow-up in 97% of patients. The pivot-shift test was positive in 1% of patients. The mean subjective IKDC score was 84.5±13.0 and 86.5% of patients were IKDC A or B. The proportions of patients with radiographic knee osteoarthritis at last follow-up was unchanged for the lateral tibio-femoral and patello-femoral compartments but increased by 9.7% to 21.2% for the medial tibio-femoral compartment. The re-rupture rate was 1.2% and the further surgical revision rate was 5.4%. CONCLUSION Anterior laxity at last follow-up was consistent with previous studies of revision ACL reconstruction. However, rotational stability and the re-rupture risk were improved. ALL stabilisation is among the techniques that deserve consideration as part of the therapeutic options for revision ACL reconstruction. LEVEL OF EVIDENCE IV, retrospective and prospective cohort study.
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Affiliation(s)
- M-L Louis
- Institut de chirurgie orthopédique et sportive, clinique Juge, 463, rue Paradis, 13008 Marseille, France.
| | - P D'ingrado
- Clinique du Parc, 155, boulevard de Stalingrad, 69006 Lyon, France
| | - F P Ehkirch
- Clinique Maussins-Nollet, 67, rue de Romainville, 75019 Paris, France
| | - S Bertiaux
- Hôpital privé de l'Estuaire, 505, rue Irène-Joliot-Curie, 76620 le Havre, France
| | - P Colombet
- Centre de chirurgie orthopédique et sportive, 2, rue Negrevergne, 33700 Mérignac, France
| | - B Sonnery-Cottet
- Centre orthopédique Santy, 24, avenue Paul-Santy, 69008 Lyon, France
| | - B Schlatterer
- Institut Monégasque de médecine du sport, 11, avenue d'Ostende, 98000, Monaco
| | - R Pailhé
- Clinique universitaire, hôpital Sud, CHU de Grenoble, avenue de Kimberley, 38130 Échirolles, France
| | - J C Panisset
- Clinique des cèdres, 21, rue Albert-Londres, 38432 Échirolles, France
| | - C Steltzlen
- Centre hospitalier de Versailles André-Mignot, 177, rue de Versailles, 78150 Le Chesnay, France
| | - S Lustig
- Centre Albert-Trillat, hôpital de la Croix-Rousse, 103, grande rue de la Croix-Rousse, 69004 Lyon, France
| | - C Lutz
- ICOSS, 50, avenue des Vosges, 67000 Strasbourg, France
| | - F Dalmay
- CEBIMER, faculté de médecine de Limoges, 2, rue du Docteur-Marcland, 87042 Limoges cedex, France
| | - P Imbert
- Institut de chirurgie articulaire et des pathologies du sport, 87, avenue Archimède, 83700 St-Raphael, France
| | - D Saragaglia
- Clinique universitaire, hôpital Sud, CHU de Grenoble, avenue de Kimberley, 38130 Échirolles, France
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Abstract
Background: Significant controversy exists regarding the anterolateral structures of the knee. Purpose: To determine the layer-by-layer anatomic structure of the anterolateral complex of the knee. Study Design: Descriptive laboratory study. Methods: Twenty fresh-frozen cadaveric knees (age range, 38-56 years) underwent a layer-by-layer dissection to systematically expose and identify the various structures of the anterolateral complex. Quantitative measurements were performed, and each layer was documented with high-resolution digital imaging. Results: The anterolateral complex of the knee consisted of different distinct layers, with the superficial and deep iliotibial band (ITB) representing layer 1. The superficial ITB had a distinct connection to the distal femoral metaphysis and femoral condyle (Kaplan fibers), and the deep layers of the ITB were identified originating at the level of the Kaplan fibers proximally. This functional unit, consisting of the superficial and deep ITB, was reinforced by the capsulo-osseous layer of the ITB, which was continuous with the fascia of the lateral gastrocnemius and biceps femoris muscles. These 3 components of the ITB became confluent distally, and the insertion spanned from the Gerdy tubercle anteriorly to the lateral tibia posteriorly on a small tubercle (lateral tibial tuberosity). Layer 3 consisted of the anterolateral capsule, in which 35% (7/20) of specimens had a discreet mid-third capsular ligament. Conclusion: The anterolateral complex consists of the superficial and deep ITB, the capsulo-osseous layer of the ITB, and the anterolateral capsule. The anterolateral complex is defined by the part of the ITB between the Kaplan fibers proximally and its tibial insertion, which forms a functional unit. A discrete anterolateral ligament was not observed; however, the anterolateral ligament described in recent studies likely refers to the capsulo-osseous layer or the mid-third capsular ligament. Clinical Relevance: The anterolateral knee structures form a complex functional unit. Surgeons should use caution when attempting to restore this intricate structure with extra-articular procedures designed to re-create a single discreet ligament.
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Affiliation(s)
- Elmar Herbst
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.,Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Marcio Albers
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jeremy M Burnham
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Freddie H Fu
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Volker Musahl
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Monaco E, Sonnery-Cottet B, Daggett M, Saithna A, Helito CP, Ferretti A. Elimination of the Pivot-Shift Sign After Repair of an Occult Anterolateral Ligament Injury in an ACL-Deficient Knee. Orthop J Sports Med 2017; 5:2325967117728877. [PMID: 28951882 PMCID: PMC5606345 DOI: 10.1177/2325967117728877] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Affiliation(s)
- Edoardo Monaco
- University of Rome La Sapienza, Sant'Andrea Hospital, Kirk Kilgout Sports Injury Center, Rome, Italy
| | - Bertrand Sonnery-Cottet
- Centre Orthopedique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Generale de Sante, Hopital Privé Jean Mermoz, Lyon, France
| | - Matt Daggett
- Kansas City University of Medicine and Biosciences, Kansas City, Missouri, USA
| | - Adnan Saithna
- Southport and Ormskirk Hospital, Southport, UK.,Department of Clinical Engineering, University of Liverpool, Liverpool, UK
| | - Camilo Partezani Helito
- Department of Orthopedics and Traumatology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Andrea Ferretti
- University of Rome La Sapienza, Sant'Andrea Hospital, Kirk Kilgout Sports Injury Center, Rome, Italy
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Segond's fracture: a biomechanical cadaveric study using navigation. J Orthop Traumatol 2017; 18:343-348. [PMID: 28707122 PMCID: PMC5685979 DOI: 10.1007/s10195-017-0460-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 05/08/2017] [Indexed: 01/26/2023] Open
Abstract
Background Segond’s fracture is a well-recognised radiological sign of an anterior cruciate ligament (ACL) tear. While previous studies evaluated the role of the anterolateral ligament (ALL) and complex injuries on rotational stability of the knee, there are no studies on the biomechanical effect of Segond’s fracture in an ACL deficient knee. The aim of this study was to evaluate the effect of a Segond’s fracture on knee rotation stability as evaluated by a navigation system in an ACL deficient knee. Materials and methods Three different conditions were tested on seven knee specimens: intact knee, ACL deficient knee and ACL deficient knee with Segond’s fracture. Static and dynamic measurements of anterior tibial translation (ATT) and axial tibial rotation (ATR) were recorded by the navigation system (2.2 OrthoPilot ACL navigation system B. Braun Aesculap, Tuttlingen, Germany). Results Static measurements at 30° showed that the mean ATT at 30° of knee flexion was 5.1 ± 2.7 mm in the ACL intact condition, 14.3 ± 3.1 mm after ACL cut (P = 0.005), and 15.2 ± 3.6 mm after Segond’s fracture (P = 0.08). The mean ATR at 30° of knee flexion was 20.7° ± 4.8° in the ACL intact condition, 26.9° ± 4.1° in the ACL deficient knee (P > 0.05) and 30.9° ± 3.8° after Segond’s fracture (P = 0.005). Dynamic measurements during the pivot-shift showed that the mean ATT was 7.2 ± 2.7 mm in the intact knee, 9.1 ± 3.3 mm in the ACL deficient knee(P = 0.04) and 9.7 ± 4.3 mm in the ACL deficient knee with Segond’s fracture (P = 0.07). The mean ATR was 9.6° ± 1.8° in the intact knee, 12.3° ± 2.3° in the ACL deficient knee (P > 0.05) and 19.1° ± 3.1° in the ACL deficient knee with Segond’s lesion (P = 0.016). Conclusion An isolated lesion of the ACL only affects ATT during static and dynamic measurements, while the addition of Segond’s fracture has a significant effect on ATR in both static and dynamic execution of the pivot-shift test, as evaluated with the aid of navigation.
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40
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CORR Insights ® : Anterolateral Ligament of the Knee Shows Variable Anatomy in Pediatric Specimens. Clin Orthop Relat Res 2017; 475:1592-1595. [PMID: 28247330 PMCID: PMC5406332 DOI: 10.1007/s11999-016-5214-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 12/14/2016] [Indexed: 01/31/2023]
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Herbst E, Albers M, Burnham JM, Shaikh HS, Naendrup JH, Fu FH, Musahl V. The anterolateral complex of the knee: a pictorial essay. Knee Surg Sports Traumatol Arthrosc 2017; 25:1009-1014. [PMID: 28233023 DOI: 10.1007/s00167-017-4449-2] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 01/20/2017] [Indexed: 01/26/2023]
Abstract
Injuries to the anterolateral complex of the knee can result in increased rotatory knee instability. However, to diagnose and treat patients with persistent instability properly, surgeons need to understand the multifactorial genesis as well as the complex anatomy of the anterolateral aspect of the knee in its entirety. While recent research focused primarily on one structure (anterolateral ligament-ALL), the purpose of this pictorial essay is to provide a detailed layer-by-layer description of the anterolateral complex of the knee, consisting of the iliotibial band with its superficial, middle, deep, and capsulo-osseous layer as well as the anterolateral joint capsule. This may help surgeons to not only understand the anatomy of this particular part of the knee, but may also provide guidance when performing extra-articular procedures in patients with rotatory knee instability. Level of evidence V.
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Affiliation(s)
- Elmar Herbst
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Marcio Albers
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA
| | - Jeremy M Burnham
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA
| | - Humza S Shaikh
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA
| | - Jan-Hendrik Naendrup
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA
| | - Freddie H Fu
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA
| | - Volker Musahl
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA.
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42
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Kinematics of ACL and anterolateral ligament. Part II: anterolateral and anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2017; 25:1062-1067. [PMID: 28280906 DOI: 10.1007/s00167-017-4496-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 02/21/2017] [Indexed: 01/26/2023]
Abstract
PURPOSE To quantify the influence of Single-Bundle with Lateral Plasty and Double-Bundle reconstruction on static and dynamic laxity in combined ACL- and ALL-deficient knees. METHODS The study included 10 fresh-frozen human knees. The joints were analyzed in the following conditions: ACL + ALL resection, Single-Bundle with Lateral Plasty (SBLP) reconstruction, Double-Bundle (DB) reconstruction. Testing parameters were: anterior displacement at 30° and 90° of flexion (AP30, AP90) applying a manual maximum load; internal rotation at 30° and 90° of flexion (INT30, INT90) applying a 5 Nm torque and acceleration and internal rotation Pivot-Shift (PS) test. Kinematics was acquired by a navigation system. Paired Student's t test was conducted to assess statistical difference (P < 0.05). RESULTS At both 30° and 90° of knee flexion, both SBLP and DB surgical techniques showed a significant reduction (P < 0.01) of anterior-posterior tibial displacement compared to the resection of ACL + ALL. At 30° on knee flexion it is the SBLP that allows the greatest reduction of internal rotational laxity when compared to DB reconstruction. Concerning the PS test, only SBPL procedure had a significant laxity decrease considering the acceleration reached by the joint when compared with the ACL + ALL state (P < 0.01). CONCLUSION Clinical relevance of this study is that the internal rotation and PS test were more efficiently controlled by the SBLP technique than by the DB one at both 30° and 90° of flexion in case of ACL + ALL lesions.
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Musahl V, Getgood A, Neyret P, Claes S, Burnham JM, Batailler C, Sonnery-Cottet B, Williams A, Amis A, Zaffagnini S, Karlsson J. Contributions of the anterolateral complex and the anterolateral ligament to rotatory knee stability in the setting of ACL Injury: a roundtable discussion. Knee Surg Sports Traumatol Arthrosc 2017; 25:997-1008. [PMID: 28286916 DOI: 10.1007/s00167-017-4436-7] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 01/16/2017] [Indexed: 02/07/2023]
Abstract
Persistent rotatory knee laxity is increasingly recognized as a common finding after anterior cruciate ligament (ACL) reconstruction. While the reasons behind rotator knee laxity are multifactorial, the impact of the anterolateral knee structures is significant. As such, substantial focus has been directed toward better understanding these structures, including their anatomy, biomechanics, in vivo function, injury patterns, and the ideal procedures with which to address any rotatory knee laxity that results from damage to these structures. However, the complexity of lateral knee anatomy, varying dissection techniques, differing specimen preparation methods, inconsistent sectioning techniques in biomechanical studies, and confusing terminology have led to discrepancies in published studies on the topic. Furthermore, anatomical and functional descriptions have varied widely. As such, we have assembled a panel of expert surgeons and scientists to discuss the roles of the anterolateral structures in rotatory knee laxity, the healing potential of these structures, the most appropriate procedures to address rotatory knee laxity, and the indications for these procedures. In this round table discussion, KSSTA Editor-in-Chief Professor Jón Karlsson poses a variety of relevant and timely questions, and experts from around the world provide answers based on their personal experiences, scientific study, and interpretations of the literature. Level of evidence V.
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Affiliation(s)
- Volker Musahl
- UPMC Center for Sports Medicine, 3200 S Water St, Pittsburgh, PA, 15203, USA.
| | - Alan Getgood
- Fowler Kennedy Sport Medicine Clinic, London, ON, Canada
| | | | - Steven Claes
- Dienst Orthopedie AZ Herentals, Herentals, Belgium
| | - Jeremy M Burnham
- UPMC Center for Sports Medicine, 3200 S Water St, Pittsburgh, PA, 15203, USA
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Lording T, Stinton SK, Neyret P, Branch TP. Diagnostic findings caused by cutting of the iliotibial tract and anterolateral ligament in an ACL intact knee using a standardized and automated clinical knee examination. Knee Surg Sports Traumatol Arthrosc 2017; 25:1161-1169. [PMID: 28314890 PMCID: PMC5420375 DOI: 10.1007/s00167-017-4499-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 02/27/2017] [Indexed: 01/26/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the separate contribution of the two definitions of the anterolateral ligament (ALL), the mid-third lateral capsular ligament (MTLCL) and deep capsule-osseous layer of the iliotibial tract (dcITT) in addition to the superficial iliotibial tract (sITT) to the control of tibial motion with respect to the femur during the application of force/torque seen during the three tests of the standard clinical knee examination (AP Lachman test, tibial axial rotation test and varus-valgus stress test). METHODS Six pelvis-to-toe cadaveric specimens were examined using an automated testing device that carried out the three components of the clinical knee examination. Internal/external rotation torque, anteroposterior load and adduction/abduction torque were applied, while torque/force and positional measurements were recorded. Sequential sectioning of the structures followed the same order for each knee, sITT, dcITT and MTLCL. Testing was repeated after release of each structure. RESULTS During the tibial axial rotation test, releasing the sITT caused an increase in internal rotation of 2.6° (1.4-4.1°, p < 0.0005), while release of the dcITT increased internal rotation an additional 0.8° (0.4-1.1°, p < 0.0015). Changes in secondary motions of the tibia after sITT release demonstrated an increase in anterior translation of 1.2 mm (0.6-2.0 mm, p < 0.0005) during internal rotation, while release of the dcITT increased the same motion an additional 0.4 mm (0.2-0.5 mm, p < 0.0005). During the AP Lachman test, release of the sITT caused the tibia to move more anteriorly by 0.7 mm (0.4-1.1 mm, p < 0.0005) and increased internal rotation by 2.7° (0.9-5.2°, p < 0.004). The additional release of the dcITT resulted in more anterior translation by 0.3 mm (0.1-0.4 mm, p < 0.002) and internal rotation by 0.9° (0.2-1.7°, p < 0.005). During the varus-valgus stress test, release of the sITT permitted 0.9° (0.4-1.4°, p < 0.0005) more adduction of the tibia, while the additional release of the dcITT significantly increased adduction by 0.4° (0.2°-0.5°, p < 0.001). Release of the MTLCL had a nominal but significant increase in internal rotation, 0.6° (0.1-1.1°, p < 0.0068) and external rotation, -0.1° (-0.1° to -0.2°, p < 0.0025) during the tibial axial rotation test, anterior translation of 0.2 mm (0.0-0.4 mm, p < 0.021) only during the AP Lachman test, and adduction rotation, 0.2° (0.0-0.3°, p < 0.034) only during the varus-valgus stress test. CONCLUSION The presence of increased adduction during an automated knee examination provides unique information identifying the release of the sITT, dcITT and the MTLCL in this cadaveric study. While their sequential release caused similar pattern changes in the three components of the automated knee examination, the extent of change due to release of the MTLCL was markedly less than after release of the dcITT which was markedly less than after release of the sITT.
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Affiliation(s)
| | | | - Philippe Neyret
- Department Orthopedic Surgery, Centre Albert-Trillat, Hôpital de la Croix-Rousse, Lyon, France
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