Anterolateral complex of the knee: State of the art

Rotatory instability of the knee represents the main reason for failure and poor clinical outcomes regarding anterior cruciate ligament (ACL) reconstruction techniques. It is now clear that the anterolateral complex (ALC) of the knee possesses a fundamental role, in association with the ACL, in controlling internal rotation. Over the past decade, ever since the anterolateral ligament has been identified and described as a distinct structure, there has been a renewed interest in the scientific community about the whole ALC: Lateral extra-articular tenodesis have made a comeback in association with ACL reconstructions to improve functional outcomes, reducing the risks of graft failure and associated injuries. Modern ACL reconstruction surgery must therefore investigate residual instability and proceed, when necessary, to extra-articular techniques, whether functional tenodesis or anatomical reconstruction.This review aims to investigate the latest anatomical and histological descriptions, and the role in rotational control and knee biomechanics of the ALC and its components. The diagnostic tools for its identification, different reconstruction techniques, and possible surgical indications are described.. In addition, clinical and functional results available in the literature are reported.

Tripled semitendinosus with single harvesting is as effective but less invasive compared to standard gracilis-semitendinosus harvesting

Introduction

The anterior cruciate ligament (ACL) reconstruction with pes anserinus tendons has been increasingly used throughout the last years. Although less invasive compared to other autologous grafts, a reduction of internal rotation and flexion strength after gracilis and semitendinosus harvesting has been reported. Harvesting one tendon instead of two from the pes anserinus can reduce the deficit of the knee flexor strength and improve the functional recover without weakening the reconstructed ligament.

Methods

Forty-five (45) patients who had ACL reconstruction with triple semitendinosus graft (ST3) have been compared with other 45 similar patients who had ACL reconstruction with double gracilis-semitendinosus tendons (GST). Patients have been evaluated at a minimum of 12 months after surgery: IKDC scale, KT-1000, One Leg Hop Test for the objective stability; Isokinetic test for the strength; Tegner scale, Lysholm and IKDC subjective evaluation form for the function.

Results

No differences have been detected between the groups for the objective item assessed. Male patients' subjective IKDC score was statistically better for the ST3 group. Recreational soccer players showed a higher Lysholm and subjective IKDC score in ST3 group compared to GST group. There was no difference regarding the return to sport.

Conclusion

ST3 guarantees the same objective knee stability compared to a GST. It is a viable option for ACL reconstruction that allows a better preservation of patient's anatomy and a less invasive harvesting surgery.

Level of evidence

III b, case control study.

Posterior ankle and subtalar arthroscopy: indications, technique, and results

Over the decades, arthroscopy has grown in popularity for the treatment of many foot and ankle pathologies. While anterior ankle arthroscopy is a widely accepted technique, posterior ankle/subtalar arthroscopy is still a relatively new procedure. The goal of this review is to outline the indications, surgical techniques, and results of posterior ankle/subtalar arthroscopy. The main indications include: 1) osteochondral lesions (of subtalar and posterior ankle joint); 2) posterior soft tissue or bony impingement; 3) os trigonum syndrome; 4) posterior loose bodies; 5) flexor hallucis longus (FHL) tenosynovitis; 6) posterior synovitis; 7) subtalar (or ankle) joint arthritis; 8) posterior tibial, talar, or calcaneal fractures (for arthroscopic reduction and internal fixation). Although posterior ankle/subtalar arthroscopy has shown to be safe and effective in the treatment of many of the above mentioned conditions, thorough knowledge of the anatomy, correct indications, and a precise surgical technique are essential to produce good outcomes.