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Rabie A, Arafa MS, Bahloul M, Abdelbadie A. The single antegrade sling graft: a novel hamstring autograft technique for combined anterior cruciate ligament and anterolateral ligament reconstruction. Arch Orthop Trauma Surg 2025; 145:126. [PMID: 39812812 PMCID: PMC11735515 DOI: 10.1007/s00402-024-05697-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 09/30/2024] [Indexed: 01/16/2025]
Abstract
INTRODUCTION As a result of increased incidence of anterior cruciate ligament (ACL) injury in young athletes, there is a rise in the indications surgical ACL reconstruction procedures. The value of anterolateral ligament (ALL) reconstruction emerges as a proposed solution to prevent graft failures and improve stability in this high demanding category of patients. The purpose of this study is to present our experience with a novel hamstring auto-grafting technique, the single antegrade sling graft (SASG), for combined reconstruction of both ACL and ALL using autologous gracilis (GR) and semitendinosus (ST) grafts utilizing a single femoral tunnel and double tibial tunnels. MATERIALS AND METHODS From January 2020 to December 2021, 21 soccer players were operated utilizing the SASG technique, a modification of the technique of SANTI study group. Inclusion criteria were participating in pivoting sport, high-grade pivot shift examination (Grade 2-3), and evidence of a lateral femoral notch sign or Segond's fracture on preoperative imaging. Patients were assessed for 2 years postoperatively by Lachman's test for anteroposterior laxity and pivot shift test for rotational laxity. The postoperative outcomes were assessed by Tegner-Lysholm and International knee documentation committee scores. Also, the postoperative complications such as stiffness, infection and graft failure were reported. RESULTS 21 male soccer players with a mean age 26.4 years were included in this study. After 2 years follow up there was a statistically significant improvement in the both post-operative functional scores, P value < 0.001. Fifteen patients (71.4%) could return to their preoperative sport activity level with no giving-way symptoms. Only one case of graft failure was reported in the follow up. CONCLUSIONS The single antegrade sling graft (SASG), for combined reconstruction of both ACL and ALL yielded good results in terms of stability and return to sports. The technique is reproducible, and results are comparable to the available published literature.
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Affiliation(s)
- Ahmed Rabie
- Department of Orthopedic Surgery, Faiyum University Hospital, Faiyum, Egypt
| | - Mohamed S Arafa
- Department of Orthopedic Surgery, Faiyum University Hospital, Faiyum, Egypt
| | - Mahmoud Bahloul
- Department of Orthopedic Surgery, Faiyum University Hospital, Faiyum, Egypt
| | - Ahmed Abdelbadie
- Department of Orthopedic Surgery, Suez Canal University Hospital, Kilo 4.5 Ring Road, Ismailia, 41111, Egypt.
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Maestro A, Rodríguez N, Pipa I, Toyos C, Lanuza L, Machado F, Castaño C, Maestro S. Influence of Extra-Articular Augmentation on Clinical Outcomes and Survival in Patients Undergoing Anterior Cruciate Ligament Reconstruction: A Pseudorandomized Study. MEDICINA (KAUNAS, LITHUANIA) 2025; 61:116. [PMID: 39859098 PMCID: PMC11766875 DOI: 10.3390/medicina61010116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2024] [Revised: 01/08/2025] [Accepted: 01/10/2025] [Indexed: 01/27/2025]
Abstract
Background and Objectives: Up to 27% of anterior cruciate ligament (ACL) reconstruction cases result in a residual positive pivot shift sign, indicating anteroposterior and rotational instability. This instability can compromise returning to sports and increase the risk of further injuries. The biomechanical role of the anterolateral ligament (ALL) in controlling internal knee rotation is well known. However, there are no clinical trials comparing isolated ACL repairs to those combined with ALL reconstruction. Our objective is to compare the results of these techniques, with a primary focus on assessing knee stability and graft survival, to provide evidence for optimizing surgical approaches, particularly for athletes and physically active individuals. Materials and Methods: An observational study using paired score matching as a method of pseudo-randomization was conducted. Subjects were divided into an ACL group and an ACL+ALL group. Demographic and clinical variables were collected, as well as those related to complications and survival. Results: A total of 236 patients were included, which was reduced to 74 ACL and 37 ACL+ALL after pseudo-randomization, resulting in preoperatively comparable groups. During follow-up, differences in favor of ALL reinforcement were found on the pivot shift test (p = 0.007). No differences were found with regard to the Lachman test (p = 0.201), the International Knee Documentation Committee (IKDC) knee score (p = 0.169), the IKDC subjective score (p = 0.095), intensity of pain (p = 0.928), or complications (p = 0.529). Nor were differences found in the limb symmetry index; the single hop test (p = 0.710); the triple hop test (p = 0.653); the crossover hop test (p = 0.682); the 6 meter timed hop test (p = 0.360); the normalized Y-balance test (YBT) (p = 0.459 anterior; p = 0.898 posterolateral; and p = 0.211 posteromedial directions); or the limb symmetry index of the composite YBT (p = 0.488). There were no differences either with respect to return to sports practice (p = 0.723) or survival (p = 0.798). Conclusions: Patients treated by means of the ACL+ALL technique obtained higher rotational stability, as measured by the pivot shift test, than those subjected to an isolated ACL repair. No differences were found with respect to Lachman test, complications, IKDC, pain, or survival.
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Affiliation(s)
| | | | - Iván Pipa
- Hospital Universitario de Cabueñes, 33394 Gijón, Spain; (I.P.); (L.L.)
| | | | - Lucía Lanuza
- Hospital Universitario de Cabueñes, 33394 Gijón, Spain; (I.P.); (L.L.)
| | - Filipe Machado
- Centro Hospitalar de Setúbal, 2910-446 Setúbal, Portugal;
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Mercurio M, Cofano E, Gasparini G, Galasso O, Familiari F, Sanzo V, Ciolli G, Corona K, Cerciello S. Isolated ACL Reconstruction Versus Combined ACL and Anterolateral Ligament Reconstruction: Functional Outcomes, Return to Sport, and Survivorship: An Updated Meta-analysis of Comparative Studies. Am J Sports Med 2025:3635465241251467. [PMID: 39754418 DOI: 10.1177/03635465241251467] [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: 01/06/2025]
Abstract
BACKGROUND Failure, persistent knee instability, and reinjury rates after anterior cruciate ligament (ACL) reconstruction are still concerns. Biomechanical investigations have highlighted the role of the anterolateral ligament (ALL) as a crucial knee stabilizer, and clinical outcomes after combined ACL and ALL reconstruction appear to indicate the success of the procedure. PURPOSE To compare the functional outcomes, return-to-sport (RTS) rate, and complications between combined ACL and ALL reconstruction and isolated ACL reconstruction. STUDY DESIGN Meta-analysis; Level of evidence, 4. METHODS The PubMed/MEDLINE, Scopus, and Cochrane Central databases were used to search keywords, and a total of 16 studies were included. The data extracted for quantitative analysis included the Tegner activity scale score, Lysholm knee score, International Knee Documentation Committee (IKDC) score, laxity measured using the KT-1000 knee arthrometer, number and types of complications, RTS rate, and survival rate. Random- and fixed-effects models were used for the meta-analysis of pooled mean differences and odds ratios. RESULTS A total of 2329 patients were identified, 1116 of whom underwent combined ACL and ALL reconstruction and 1213 of whom underwent isolated ACL reconstruction. The mean ages were 25.4 ± 7.2 years and 26.5 ± 7.8 years for the combined ACL and ALL reconstruction and isolated ACL reconstruction groups, respectively. The mean follow-ups were 40.3 ± 21.4 months and 42.5 ± 21.6 months, respectively. Comparable Tegner activity scale (P = .16), Lysholm knee (P = .13), and IKDC (P = .83) scores were found between groups. Significantly greater postoperative knee laxity was found in the isolated ACL reconstruction group (mean difference, -0.44; 95% CI, -0.85 to -0.04; P = .03). The combined ACL and ALL reconstruction group showed a significantly lower rate of graft failure (odds ratio [OR], 0.37; 95% CI, 0.18-0.77; P = .008), a higher RTS rate (OR, 1.41; 95% CI, 1.11-1.80; P = .005), and a higher survival rate (OR, 2.94; 95% CI, 1.97-4.37; P < .001). CONCLUSION Compared with isolated ACL reconstruction, combined ACL and ALL reconstruction yielded comparable functional outcomes but significantly less residual knee laxity and a lower graft failure rate. Patients who underwent combined ACL and ALL reconstruction also had higher RTS and survival rates.
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Affiliation(s)
- Michele Mercurio
- Department of Orthopedic and Trauma Surgery, Magna Græcia University, Mater Domini University Hospital, Catanzaro, Italy
| | - Erminia Cofano
- Department of Orthopedic and Trauma Surgery, Magna Græcia University, Mater Domini University Hospital, Catanzaro, Italy
| | - Giorgio Gasparini
- Department of Orthopedic and Trauma Surgery, Magna Græcia University, Mater Domini University Hospital, Catanzaro, Italy
| | - Olimpio Galasso
- Department of Orthopedic and Trauma Surgery, Magna Græcia University, Mater Domini University Hospital, Catanzaro, Italy
| | - Filippo Familiari
- Department of Orthopedic and Trauma Surgery, Magna Græcia University, Mater Domini University Hospital, Catanzaro, Italy
| | - Valentina Sanzo
- Department of Orthopedic and Trauma Surgery, Magna Græcia University, Mater Domini University Hospital, Catanzaro, Italy
| | - Gianluca Ciolli
- Department of Orthopaedics, A. Gemelli University Hospital Foundation IRCCS, Catholic University, Rome, Italy
| | - Katia Corona
- Department of Medicine and Health Sciences, Vincenzo Tiberio, University of Molise, Campobasso, Italy
| | - Simone Cerciello
- Department of Orthopaedics, A. Gemelli University Hospital Foundation IRCCS, Catholic University, Rome, Italy
- Casa di Cura Villa Betania, Rome, Italy
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Morales-Avalos R, Lopez-Serna N, Erosa-Villarreal RA, Padilla-Medina JR, Cortés-Álvarez CD, Torres-González V, Huesca-Perez HA, Muñoz-Garza AK, Martinez-Guajardo KV, Soto-Dominguez A, Carles Monllau J. Morphological Description of the Embryonic to Fetal Development of the Menisco- Tibio-Popliteus-Fibular Complex and the Anterolateral Ligament. Orthop J Sports Med 2024; 12:23259671241302770. [PMID: 39697604 PMCID: PMC11653441 DOI: 10.1177/23259671241302770] [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: 05/18/2024] [Accepted: 05/23/2024] [Indexed: 12/20/2024] Open
Abstract
Background Little information is available on the embryology of the structures that connect the lateral meniscus to its nearby structures (proximal tibia, fibular head, and popliteus tendon), which restrict lateral meniscal extrusion. Purpose To describe the menisco-tibio-popliteus-fibular complex (MTPFC)-conformed by the lateral meniscotibial ligament (LMTL), popliteofibular ligament, meniscofibular ligament, and the 2 popliteomeniscal ligaments (superior and inferior)-and anterolateral ligament (ALL) of the knee in human embryos/fetuses from weeks 9 to 37 of gestation. Study Design Descriptive laboratory study. Methods The authors analyzed 36 formalin-fixed embryos/fetus knees, ranging between weeks 9 and 37 of gestation. All had normal external morphological characteristics. A microdissection was performed by meticulously searching the structures of the MTPFC and the ALL, their anatomic relationships, and their appearance over time. Histological sections were taken of the entire knee, the lateral meniscus, the ALL, and the LMTL to observe its structure from its early stages, junctions, and cellularity. In addition, the composition and orientation of the fibers were evaluated. Results The MTPFC was not found in the youngest knees (9 weeks). The ligaments of this complex could not be seen until week 11 of development. Moreover, the ALL was a consistent finding from the 13th week of development onward. All the ligaments of the MTPFC were seen between developmental weeks 11 and 16 in all the specimens. The histological results showed that the histology of the ALL showed dense connective tissue organized into thick bundles of collagen fibers in its central portion, with a parallel and undulating arrangement and the anterolateral capsule demonstrated 3 easily distinguishable layers corresponding to the fibrous membrane, the subsynovial membrane formed by loose connective tissue, and the synovial membrane. Conclusion All the structures of the MTPFC were visualized from week 11, with the LMTL being the first to form. Moreover, the ALL was a consistent finding from week 13 of development onward. Clinical Relevance Understanding the embryological development of the MTPFC and the ALL of the knee is clinically relevant, as it can provide crucial insights into the pathogenesis of knee conditions and inform treatment strategies. By elucidating the timeline and characteristics of these structures' formation, clinicians can better diagnose and manage conditions affecting the lateral meniscus and related structures, ultimately improving patient outcomes and surgical interventions.
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Affiliation(s)
- Rodolfo Morales-Avalos
- Laboratory of Biomechanics, Department of Physiology, School of Medicine, Universidad Autonoma de Nuevo León, Monterrey, Nuevo León, México
| | - Norberto Lopez-Serna
- Department of Embryology, School of Medicine, Universidad Autonoma de Nuevo León, Monterrey, Nuevo León, México
| | - Roger Armando Erosa-Villarreal
- Laboratory of Biomechanics, Department of Physiology, School of Medicine, Universidad Autonoma de Nuevo León, Monterrey, Nuevo León, México
| | - José Ramón Padilla-Medina
- Laboratory of Biomechanics, Department of Physiology, School of Medicine, Universidad Autonoma de Nuevo León, Monterrey, Nuevo León, México
| | | | - Vladimira Torres-González
- Department of Embryology, School of Medicine, Universidad Autonoma de Nuevo León, Monterrey, Nuevo León, México
| | - Héctor A. Huesca-Perez
- Department of Orthopedic Surgery and Traumatology, University Hospital “Dr. José Eleuterio González”, Universidad Autonoma de Nuevo León, Monterrey, Nuevo León, México
| | - Ana Karen Muñoz-Garza
- Servicio de Pediatría, Hospital General de Matamoros, Universidad Autonoma de Tamaulipas, Matamoros, Tamaulipas, México
| | - Karla V. Martinez-Guajardo
- Laboratory of Biomechanics, Department of Physiology, School of Medicine, Universidad Autonoma de Nuevo León, Monterrey, Nuevo León, México
| | - Adolfo Soto-Dominguez
- Department of Histology, School of Medicine, Universidad Autonoma de Nuevo León, Monterrey, Nuevo León, México
| | - Joan Carles Monllau
- ICATKnee, Hospital Universitari Dexeus, Universitat Autonoma de Barcelona, Barcelona, Spain
- Department of Orthopedic Surgery and Traumatology, Hospital del Mar, Universitat Autonoma de Barcelona, Barcelona, Spain
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Hollyer I, Sholtis C, Loughran G, Raji Y, Akhtar M, Smith PA, Musahl V, Verdonk PCM, Sonnery-Cottet B, Getgood A, Sherman SL. Trends in lateral extra-articular augmentation use and surgical technique with anterior cruciate ligament reconstruction from 2016 to 2023, an ACL study group survey. J ISAKOS 2024; 9:100356. [PMID: 39481853 DOI: 10.1016/j.jisako.2024.100356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2024] [Revised: 09/30/2024] [Accepted: 10/22/2024] [Indexed: 11/03/2024]
Abstract
PURPOSE To survey the ACL study group (ACLSG) members to determine the current practice patterns surrounding the use and methodology of lateral extra-articular procedures (LEAPs), including anterolateral ligament reconstruction (ALLR) or lateral extra-articular tenodesis (LET) during ACL reconstruction (ACLR). METHODS A web-based questionnaire was distributed to members of the ACLSG during the 2016, 2018, 2020, and 2023 biennial meetings. Questions explored the indications and techniques when incorporating LEAPs in ACLR. RESULTS Analysis of survey responses found that the reported use of LEAPs in both primary and revision ACLR increased between 2016 and 2023 and that surgeons were using lateral augmentation more frequently over time. Surgical techniques were stable across survey years, with most surgeons using iliotibial band (ITB) autograft attached at Gerdy's tubercle, passed under the lateral collateral ligament (LCL), and anchored proximal/posterior to the lateral femoral epicondyle. CONCLUSION Survey responses demonstrate that LEAPs are becoming more common among ACL surgeons in the ACL SG, with the modified Lemaire LET being the predominant technique. This aligns with recent clinical studies showing improved outcomes and reduced risk of failure in ACLR with lateral augmentation compared to ACLR alone. LEVEL OF EVIDENCE Level V, Expert Opinion.
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Affiliation(s)
- Ian Hollyer
- Department of Orthopaedic Surgery, Stanford University Medical Center, Palo Alto, CA, USA.
| | - Connor Sholtis
- Department of Orthopaedic Surgery, Stanford University Medical Center, Palo Alto, CA, USA
| | - Galvin Loughran
- Department of Orthopaedic Surgery, Stanford University Medical Center, Palo Alto, CA, USA
| | - Yazdan Raji
- Department of Orthopaedic Surgery, Stanford University Medical Center, Palo Alto, CA, USA
| | - Muzammil Akhtar
- Department of Orthopaedic Surgery, Stanford University Medical Center, Palo Alto, CA, USA
| | - Patrick A Smith
- Columbia Orthopaedic Group, Columbia, MO, 65201, USA; Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, 65201, USA
| | - Volker Musahl
- Department of Orthopaedic Surgery, UPMC Freddie Fu Sports Medicine Center, University of Pittsburgh, Pittsburgh, PA, 15203, USA
| | - Peter C M Verdonk
- Department of Orthopaedic Surgery, Antwerp University Hospital, Orthoca, Antwerp, Belgium
| | - Bertrand Sonnery-Cottet
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, 24 Avenue Paul Santy, Lyon 69008, France
| | - Alan Getgood
- Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, N6A 3K7, Canada
| | - Seth L Sherman
- Department of Orthopaedic Surgery, Stanford University Medical Center, Palo Alto, CA, USA
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Hohmann E, Keough N, Molepo M, Arciero R, Imhoff A. The Knee Anterolateral Ligament is Present in 82% of North Americans and 65% of Europeans but Only in 46% of Asian Studies: A Systematic Review of Frequency and Anatomy. Arthroscopy 2024:S0749-8063(24)00870-3. [PMID: 39505156 DOI: 10.1016/j.arthro.2024.10.029] [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: 09/29/2024] [Revised: 10/13/2024] [Accepted: 10/14/2024] [Indexed: 11/08/2024]
Abstract
PURPOSE To perform an updated systematic review on the prevalence and morphological characteristics of the anterolateral ligament (ALL) in human cadaveric specimens. METHODS Medline, Embase, Scopus, and Google Scholar were searched for studies from 2012 to 2024 describing morphology. Study quality was assessed using the Critical Appraisal Skills Programme checklist and Quality Appraisal for Cadaveric Studies scale. Heterogeneity was analyzed with the I2 statistic, funnel plot, and Q-test. Mean effect size and 95% prediction intervals were calculated. Prevalence and anatomical measurements (length, width, thickness) were analyzed using mean and standard deviations. RESULTS Thirty studies were included. The Critical Appraisal Skills Programme identified 3 low-quality studies. Twelve studies met the Quality Appraisal for Cadaveric Studies quality threshold. The prevalence of the ALL was 61.7% (82% in North America, 64.9% in Europe, and 45.8% in Asia). The femoral insertion showed variability near the lateral femoral epicondyle and lateral collateral ligament, while the tibial insertion was midway between Gerdy's tubercle and fibular head. Histological analysis revealed 60% of studies identified ligamentous tissue similar to the anterior cruciate ligament. The mean ALL length was 39.7 mm, width 5.5 mm, and thickness 1.5 mm, with no significant morphological differences among populations. CONCLUSIONS This systematic review reveals that the ALL is present in 61.7%, with prevalence rates of 82% in North American studies, 65% in European studies, and 46% in Asian studies. The femoral insertion exhibited substantial variability at/around the lateral femoral epicondyle and lateral collateral ligament, lacking consistency. The tibial insertion was more consistently described as being located about halfway between Gerdy's tubercle and the fibular head. Histological analysis showed that 60% of the included studies identified the ALL as containing ligament-like or ligamentous tissue. The mean length of the ALL was 39.9 mm (range 31-59 mm), the mean width was 5.7 mm (range 2.2-9.0 mm), and the mean thickness was 1.5 mm (range 1.3-2.7 mm). No significant ethnic population differences were observed in morphological measures. CLINICAL RELEVANCE The ALL is not consistently present in all patients with knee instability, and the indications for performing an ALL reconstruction or lateral tenodesis remain unclear based solely on morphological factors. As a result, the decision to perform these procedures may need to be made on an individualized basis.
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Affiliation(s)
- Erik Hohmann
- Medical School, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa; Department of Orthopaedic Surgery and Sports Medicine, Burjeel Hospital for Advanced Surgery, Dubai, UAE.
| | - Natalie Keough
- Department of Health Sciences, Clinical Anatomy and Imaging, Warwick Medical School, University of Warwick, Coventry, UK; Department of Anatomy, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Maketo Molepo
- Medical School, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Robert Arciero
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - Andreas Imhoff
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
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Tzanetis P, Fluit R, de Souza K, Robertson S, Koopman B, Verdonschot N. ISTA Award 2023: Toward functional reconstruction of the pre-diseased state in total knee arthroplasty. Bone Joint J 2024; 106-B:1231-1239. [PMID: 39481432 DOI: 10.1302/0301-620x.106b11.bjj-2023-1357.r1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2024]
Abstract
Aims The surgical target for optimal implant positioning in robotic-assisted total knee arthroplasty remains the subject of ongoing discussion. One of the proposed targets is to recreate the knee's functional behaviour as per its pre-diseased state. The aim of this study was to optimize implant positioning, starting from mechanical alignment (MA), toward restoring the pre-diseased status, including ligament strain and kinematic patterns, in a patient population. Methods We used an active appearance model-based approach to segment the preoperative CT of 21 osteoarthritic patients, which identified the osteophyte-free surfaces and estimated cartilage from the segmented bones; these geometries were used to construct patient-specific musculoskeletal models of the pre-diseased knee. Subsequently, implantations were simulated using the MA method, and a previously developed optimization technique was employed to find the optimal implant position that minimized the root mean square deviation between pre-diseased and postoperative ligament strains and kinematics. Results There were evident biomechanical differences between the simulated patient models, but also trends that appeared reproducible at the population level. Optimizing the implant position significantly reduced the maximum observed strain root mean square deviations within the cohort from 36.5% to below 5.3% for all but the anterolateral ligament; and concomitantly reduced the kinematic deviations from 3.8 mm (SD 1.7) and 4.7° (SD 1.9°) with MA to 2.7 mm (SD 1.4) and 3.7° (SD 1.9°) relative to the pre-diseased state. To achieve this, the femoral component consistently required translational adjustments in the anterior, lateral, and proximal directions, while the tibial component required a more posterior slope and varus rotation in most cases. Conclusion These findings confirm that MA-induced biomechanical alterations relative to the pre-diseased state can be reduced by optimizing the implant position, and may have implications to further advance pre-planning in robotic-assisted surgery in order to restore pre-diseased knee function.
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Affiliation(s)
- Periklis Tzanetis
- Department of Biomechanical Engineering, University of Twente, Enschede, The Netherlands
| | - René Fluit
- Faculty of Science and Engineering, University of Groningen, Groningen, The Netherlands
| | | | | | - Bart Koopman
- Department of Biomechanical Engineering, University of Twente, Enschede, The Netherlands
| | - Nico Verdonschot
- Department of Biomechanical Engineering, University of Twente, Enschede, The Netherlands
- Orthopaedic Research Laboratory, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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Barroso BG, Canuto SMDG, Helito CP, Rêgo MCF, Martins FS, Rêgo MCF. Combined Anterior Cruciate Ligament and Anterolateral Ligament Reconstruction Using the Superficial Layer Quadriceps Tendon Graft: Surgical Technique Description. Arthrosc Tech 2024; 13:103067. [PMID: 39479041 PMCID: PMC11519883 DOI: 10.1016/j.eats.2024.103067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 04/14/2024] [Indexed: 11/02/2024] Open
Abstract
We present a technique for the combined anterior cruciate ligament (ACL) and anterolateral ligament (ALL) reconstruction using the superficial layer quadriceps tendon graft. Anatomic reconstruction is achieved with outside-in femoral tunnel drilling. The femoral drill guide has an intra-articular placement at the femoral footprint of the ACL and an extra-articular placement at the femoral ALL attachment. This surgical technique does not need any special instruments and consists of 3 bone tunnels. The long length and customized superficial quadriceps tendon graft is harvested in a minimally invasive manner and allows an accessible and low-cost reconstruction of both ligaments.
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Affiliation(s)
| | | | - Camilo Partezani Helito
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Hospital Sírio Libanês, São Paulo, Brazil
| | - Márcio Cabral Fagundes Rêgo
- Grupo de joelho, Hospital Memorial São Francisco, Natal, Brazil
- Departamento Médico do América Futebol Clube, Natal, RN, Brazil
| | - Felipe Silveira Martins
- Grupo do joelho–Clínica de Ortopedia e Traumatologia Balneário Camboriú, Itajaí e Itapema
- Hospital da Unimed, avenida do Estado Dalmo Vieira, Balneário Camboriú, Brazil
| | - Marcelo Cabral Fagundes Rêgo
- Grupo de joelho, Hospital Memorial São Francisco, Natal, Brazil
- Departamento Médico do América Futebol Clube, Natal, RN, Brazil
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Ryu DJ, Kim S, Kim M, Kim JH, Kim WJ, Lim D, Wang JH. It is challenging to reproduce both anatomical and functional aspects of anterolateral reconstruction: postoperative 3D-CT analysis of the femoral tunnel position. Knee Surg Relat Res 2024; 36:26. [PMID: 39210443 PMCID: PMC11360883 DOI: 10.1186/s43019-024-00230-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 08/05/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND This study aimed to evaluate the femoral tunnel position and fiber length of the anterolateral ligament (ALL) reconstruction compared with the natural anatomy of the ALL. We also evaluated whether the femoral tunnel position would affect residual pivot shift. METHODS This study was a retrospective review of 55 knees that underwent ALL reconstruction considering the anatomical and functional aspects, during primary anterior cruciate ligament (ACL) reconstruction in the presence of a high-grade pivot shift or revisional ACL reconstruction. We determined the position of the femoral tunnel and the length of graft using a three-dimensional (3D)-computed tomography (CT) model after ALL reconstruction. We also measured graft excursion during surgery and examined pivot shift 2 years after surgery. We conducted a subgroup analysis of femoral tunnel position, fiber length, isometricity, and residual pivot shift depending on whether the tunnel was anterior or posterior to the lateral epicondyle (LE). We also performed a subgroup analysis depending on whether the ACL reconstruction was primary or revisional. RESULTS The mean femoral tunnel position was 2.04 mm posterior and 14.5 mm proximal from the center of the LE. The mean lengths of the anterior and posterior fibers were 66.6 and 63.4 mm, respectively. The femoral tunnel was positioned more proximally than the anatomical position, and both anterior and posterior ALL fibers were longer than the natural anatomy. The anteroposterior femoral tunnel position was significantly correlated with anterior (p = 0.045) and posterior (p = 0.037) fiber excursion. In the subgroup analysis, there was no significant difference in the residual pivot shift between the posterior and anterior tunnel positions. However, there were significant differences for proximal position (p < 0.001) and fiber length (p = 0.006). There was no significant difference between primary and revisional ACL regarding femoral tunnel position and fiber lengths. CONCLUSION It is challenging to reproduce both anatomical and functional aspects of ALL reconstruction in both primary and revision ACL reconstruction. Especially for functional reconstruction, the femoral tunnel tended to be positioned more proximally than the anatomical position. However, the femoral tunnel position did not affect functional clinical outcomes at the 2-year follow-up. LEVEL OF EVIDENCE Level IV Case series.
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Affiliation(s)
- Dong Jin Ryu
- Department of Orthopaedic Surgery, Inha University Hospital, Inha University School of Medicine, Incheon, South Korea
| | - Seoyeong Kim
- Department of Mechanical Engineering, Sejong University, Seoul, South Korea
| | - Minji Kim
- Department of Mechanical Engineering, Sejong University, Seoul, South Korea
| | - Joo Hwan Kim
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, South Korea
| | - Won Jae Kim
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, South Korea
| | - Dohyung Lim
- Department of Mechanical Engineering, Sejong University, Seoul, South Korea.
- RNX Co., Ltd, Seoul, South Korea.
| | - Joon Ho Wang
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, 06351, South Korea.
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, 06351, South Korea.
- Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, 06351, South Korea.
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10
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Ateş O, Oğul A. Evaluation of anterolateral ligament healing in patients with anterior cruciate ligament injury without anterior cruciate ligament reconstruction and its relationship with clinical examination tests. Knee Surg Sports Traumatol Arthrosc 2024; 32:1926-1937. [PMID: 38686564 DOI: 10.1002/ksa.12212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 03/05/2024] [Accepted: 03/10/2024] [Indexed: 05/02/2024]
Abstract
PURPOSE This study radiologically investigated the potential of preoperative recovery of the anterolateral ligament (ALL) in patients who did not undergo anterior cruciate ligament reconstruction (ACLR) surgery in the early stages despite surgical indication. The secondary aim was to investigate the relationship between ALL injuries in magnetic resonance imaging (MRI) and the results of Lachman and pivot shift tests performed preoperatively and postoperatively under anaesthesia among patients who underwent ACLR in acute and chronic stages. METHODS The study examined 100 patients aged 19-51 years who underwent anatomic single bundle ACLR using hamstring autografts for the ACL. Based on the time between the injury and ACLR, they were divided into acute (≤6 months) and chronic (>6 months) groups. The chronic group had three subgroups of ACLR times: 7-12, 13-24 and >24 months. Complete recovery was defined as a change from grade B or C upon injury to grade A before surgery according to the Muramatsu MRI classification. The relationship between preoperative and postoperative Lachman grades and pivot shifting test results and the degree of ALL injury was evaluated. RESULTS In the chronic group, 19/61 patients (31.1%) had preoperative grade A, and 4/61 patients (6.5%) had grade A at the time of injury. In the acute group, 22/29 patients with grades B and C (76%) had grade 3 preoperative pivot shifting. In the acute group, grades 1 and 2 were more common in patients with grades B and C (10/29, 35%) than grade A (0/10, 0.0%). CONCLUSION The improvement rate was 24.6% among patients who did not receive ACLR in the acute phase and underwent ACLR in the chronic phase. In the acute group, the degree of ALL damage was related to the pivot shift results. However, the results in the chronic phase were not associated with the degree of injury. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Okan Ateş
- Orthopedic and Traumatology Deparment, Bower Hospital, Diyarbakır, Turkey
| | - Ahsen Oğul
- Eskişehir City Hospital, Department of Sports Medicine, Eskişehir, Turkey
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11
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Kang JH, Moon SG, Lee DW. Magnetic Resonance Imaging Features of Anterolateral Ligament in Young Adults without Anterior Cruciate Ligament Injury: Preliminary Evaluation. Diagnostics (Basel) 2024; 14:1226. [PMID: 38928641 PMCID: PMC11202545 DOI: 10.3390/diagnostics14121226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 06/01/2024] [Accepted: 06/08/2024] [Indexed: 06/28/2024] Open
Abstract
This study aimed to characterize the Magnetic Resonance Imaging (MRI) features of the Anterolateral Ligament (ALL) in young adults without Anterior Cruciate Ligament (ACL) injury and evaluate its visibility using MRI. In this retrospective analysis, MRI scans of 66 young adults without ACL injuries were assessed by two radiologists. The ALL was examined from its bone-to-bone attachment between the lateral femoral epicondyle and the lateral tibia. The visibility of the ALL was classified as normal, probably normal, abnormal, or non-visualized, based on ligament continuity and thickness relative to the Meniscotibial Ligament (MTL). A continuous structure with thickness equal to or greater than the MTL was considered normal; continuous but wavy and thin features were categorized as probably normal; discontinuity and angulation were deemed abnormal. The proximal attachment of the ALL was categorized as anterior, central, or posterior to the Fibular Collateral Ligament (FCL), while the distal attachment was noted as either at the same location or distal to the MTL. The ALL was identified in 87.9-95.5% of knees and was non-visualized in 4.5-12.1% of cases. Continuous ligamentous structures were observed in 63.7-71.2% of knees (normal in 30.3-37.9%; probably normal in 27.3-40.9%), whereas 19.7-30.3% exhibited abnormal features. Inter-observer agreement was moderate to substantial (κ = 0.66, 0.56), and intra-observer agreement was substantial to excellent (κ = 0.82, 0.66). Among the 58 visible ALLs, proximal attachments were predominantly anterior (63.8%) or central (32.8%) to the FCL, with a minority posterior (1.7%). In total, 4 of the 19 central insertions were incorporated into the FCL mid-substance, and one case was blended into the meniscofemoral ligament. Distal attachments were equally distributed between the same location (50%) and distal to the MTL (50%) (mean 3.7 mm distal). In conclusion, MRI was feasible for detecting the ALL in most young adults without ACL injury, revealing continuous ligament structures in about two-thirds of cases. Approximately 40% of cases exhibited a thickness equal to or greater than the MTL, with the majority of proximal attachments located anterior to the FCL and distal attachments evenly divided between the same insertion and distal to the MTL.
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Affiliation(s)
- Ji-Hee Kang
- Department of Radiology, Konkuk University Medical Center, Seoul 05030, Republic of Korea;
| | - Sung-Gyu Moon
- Department of Radiology, Konkuk University Medical Center, Seoul 05030, Republic of Korea;
| | - Dhong-Won Lee
- Department of Orthopedic Surgery, Konkuk University Medical Center, Seoul 05030, Republic of Korea;
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12
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Kemler B, Coladonato C, Sonnier JH, Campbell MP, Darius D, Erickson BJ, Tjoumakaris FP, Freedman KB. Evaluation of Failed ACL Reconstruction: An Updated Review. Open Access J Sports Med 2024; 15:29-39. [PMID: 38586217 PMCID: PMC10998505 DOI: 10.2147/oajsm.s427332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 03/23/2024] [Indexed: 04/09/2024] Open
Abstract
Failure rates among primary Anterior Cruciate Ligament Reconstruction (ACLR) range from 3.2% to 11.1%. Recently, there has been increased focus on surgical and anatomic considerations which predispose patients to failure, including excessive posterior tibial slope (PTS), unaddressed high-grade pivot shift, and improper tunnel placement. The purpose of this review was to provide a current summary and analysis of the literature regarding patient-related and technical factors surrounding revision ACLR, rehabilitation considerations, overall outcomes and return to sport (RTS) for patients who undergo revision ACLR. There is a convincingly higher re-tear and revision rate in patients who undergo ACLR with allograft than autograft, especially amongst the young, athletic population. Unrecognized Posterior Cruciate Ligament (PLC) injury is a common cause of ACLR failure and current literature suggests concurrent operative management of high-grade PLC injuries. Given the high rates of revision surgery in young active patients who return to pivoting sports, the authors recommend strong consideration of a combined ACLR + Anterolateral Ligament (ALL) or Lateral extra-articular tenodesis (LET) procedure in this population. Excessive PTS has been identified as an independent risk factor for ACL graft failure. Careful consideration of patient-specific factors such as age and activity level may influence the success of ACL reconstruction. Additional technical considerations including graft choice and fixation method, tunnel position, evaluation of concomitant posterolateral corner and high-grade pivot shift injuries, and the role of excessive posterior tibial slope may play a significant role in preventing failure.
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Affiliation(s)
- Bryson Kemler
- Department of Orthopaedic Surgery, Rothman Institute, Philadelphia, PA, USA
| | - Carlo Coladonato
- Department of Orthopaedic Surgery, Rothman Institute, Philadelphia, PA, USA
| | | | - Michael P Campbell
- Department of Orthopaedic Surgery, Rothman Institute, Philadelphia, PA, USA
| | - Danielle Darius
- Department of Education, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Brandon J Erickson
- Department of Orthopaedic Surgery, Rothman Institute, Philadelphia, PA, USA
| | | | - Kevin B Freedman
- Department of Orthopaedic Surgery, Rothman Institute, Philadelphia, PA, USA
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13
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Garra S, Li ZI, Eskenazi J, Jazrawi T, Rao N, Campbell KA, Alaia MJ, Strauss EJ, Jazrawi LM. Patients With Segond Fracture Demonstrate Similar Rates of Return to Sport and Psychological Readiness After Anterior Cruciate Ligament Reconstruction: A Matched Cohort Study at Minimum 2-Year Follow-Up. Arthroscopy 2024; 40:1247-1255. [PMID: 37716633 DOI: 10.1016/j.arthro.2023.08.080] [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] [Received: 03/28/2023] [Revised: 08/21/2023] [Accepted: 08/28/2023] [Indexed: 09/18/2023]
Abstract
PURPOSE To compare clinical outcomes, rate of return to sports, and psychological readiness among patients undergoing anterior cruciate ligament reconstruction (ACLR) with and without concomitant Segond fracture. METHODS We retrospectively identified patients who underwent primary ACLR from January 2012 to December 2020 with minimum 2-year follow-up. Exclusion criteria were additional ligamentous injury, age <16 years, or a concomitant lateral augmentation procedure. Preoperative knee radiographs were reviewed to identify Segond fractures. Identified patients were matched 1:2 to controls by age/sex/body mass index/graft type. Charts were reviewed for pre- and postoperative knee stability. Surveys administered included preinjury sport participation and return status, Lysholm score, Tegner activity scale, and ACL-Return to Sport Index (ACL-RSI), a metric of psychological sport readiness. Multivariable logistic regression was conducted to identify predictors of return to sport. RESULTS There were 120 patients who were included in the final analysis (40 Segond, 80 controls) at a mean follow-up of 5.7 ± 2.4 years. A total of 52.5% of patients received bone-patellar tendon-bone autograft. The overall rate of return to sport was 79.5% in the Segond group compared with an 83.8% rate of return in the control group (P = .569). In total, 48.7% of the Segond group and 56.8% of the control group returned to their preinjury level of sport (P = .415). Lysholm (89.6 ± 10.3 vs 85.4 ± 16.7, P = .296), Tegner (5.7 ± 1.8 vs 6.1 ± 2.2, P = .723), and ACL-RSI (62.2 ± 25.4 vs 56.6 ± 25.4, P = .578) scores were similar between Segond and control groups. There was a single graft failure in the Segond group 5 years' postoperatively. Increasing ACL-RSI score was significantly predictive of return to sport (P < .001). CONCLUSIONS Patients who had an ACL tear and a concomitant Segond fracture who underwent isolated ACLR without lateral augmentation procedures had similar clinical outcomes and rates of return sport compared with a matched isolated ACLR control group at minimum 2-year follow-up. There was no significant difference in psychological readiness between groups as measured by the ACL-RSI. LEVEL OF EVIDENCE Level III, retrospective cohort study.
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Affiliation(s)
- Sharif Garra
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A.; Division of Orthopedic Surgery, Tel-Hashomer "Sheba" Medical Center, Sackler School of Medicine, Tel-Aviv University, Ramat Gan, Israel.
| | - Zachary I Li
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Jordan Eskenazi
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Taylor Jazrawi
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Naina Rao
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Kirk A Campbell
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Michael J Alaia
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Eric J Strauss
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
| | - Laith M Jazrawi
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, U.S.A
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14
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Garcia M, Momenzadah K, Shariyate MJ, Kheir N, Khak M, Villarreal JB, Abbasian M, Flaherty AF, Hanna P, Ramappa A, Paschos NK, Nazarian A. Plastic and elastic biomechanical properties of anterior cruciate ligament autografts. BMC Musculoskelet Disord 2024; 25:157. [PMID: 38373917 PMCID: PMC10875842 DOI: 10.1186/s12891-024-07262-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 02/05/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Anterior cruciate ligament (ACL) rupture is a common orthopedic injury, occurring in roughly 68.6 per 100,000 persons annually, with the primary treatment option being ACL reconstruction. However, debate remains about the appropriate graft type for restoring the native biomechanical properties of the knee. Furthermore, plastic graft elongation may promote increased knee laxity and instability without rupture. This study aims to investigate the plastic properties of common ACL-R graft options. METHODS Patellar tendon (PT), hamstring tendon (HT), and quadriceps tendon (QT) grafts were harvested from 11 cadaveric knees (6 male and 5 female) with a mean age of 71(range 55-81). All grafts were mechanically tested under uniaxial tension until failure to determine each graft's elastic and plastic biomechanical properties. RESULTS Mechanically, the QT graft was the weakest, exhibiting the lowest failure force and the lowest failure stress (QT < HT, p = 0.032). The PT was the stiffest of the grafts, having a significantly higher stiffness (PT > QT, p = 0.0002) and Young's modulus (PT > QT, p = 0.001; PT > HT, p = 0.041). The HT graft had the highest plastic elongation at 4.01 ± 1.32 mm (HT > PT, p = 0.002). The post-yield behavior of the HT tendon shows increased energy storage capabilities with the highest plastic energy storage (HT > QT, p = 0.012) and the highest toughness (HT > QT, p = 0.032). CONCLUSION Our study agrees with prior studies indicating that the failure load of all grafts is above the requirements for everyday activities. However, grafts may be susceptible to yielding before failure during daily activities. This may result in the eventual loss of functionality for the neo-ACL, resulting in increased knee laxity and instability.
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Affiliation(s)
- Mason Garcia
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, RN123, Boston, MA, 02115, USA
- Mechanical Engineering Department, Boston University, Boston, MA, USA
| | - Kaveh Momenzadah
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, RN123, Boston, MA, 02115, USA
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Mohammad Javad Shariyate
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, RN123, Boston, MA, 02115, USA
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Nadim Kheir
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, RN123, Boston, MA, 02115, USA
| | - Mohammad Khak
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, RN123, Boston, MA, 02115, USA
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Juan B Villarreal
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, RN123, Boston, MA, 02115, USA
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Mohammadreza Abbasian
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, RN123, Boston, MA, 02115, USA
| | - Alexandra F Flaherty
- Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Philip Hanna
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, RN123, Boston, MA, 02115, USA
- Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Arun Ramappa
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Nikolaos K Paschos
- Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Ara Nazarian
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, RN123, Boston, MA, 02115, USA.
- Mechanical Engineering Department, Boston University, Boston, MA, USA.
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
- Department of Orthopaedic Surgery, Yerevan State Medical University, Yerevan, Armenia.
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15
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Yang L, Xing S. Increased lateral femoral condyle ratio measured by MRI is associated with higher risk of solitary meniscus injury. Front Bioeng Biotechnol 2024; 12:1286967. [PMID: 38380265 PMCID: PMC10877371 DOI: 10.3389/fbioe.2024.1286967] [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: 09/01/2023] [Accepted: 01/09/2024] [Indexed: 02/22/2024] Open
Abstract
Background: Past studies found that an increased lateral femoral condyle ratio is associated with anterior cruciate ligament injuries, but it is not clear if there is a link between MRI-measured lateral femoral condyle ratios and meniscal injuries. MRI provides a more accurate selection of measurement planes. Compared to X-rays, it further reduces data errors due to non-standard positions. Objective: To study the relationship between knee bone morphology and Solitary meniscal injuries by MRI. Methods: A total of 175 patients were included in this retrospective case-control study, including 54 cases of pure medial meniscus injury, 44 cases of pure lateral meniscus injury as the experimental group, and 77 control subjects. MRI images were used to measure the femoral notch width, femoral condylar width, femoral notch width index, lateral femoral condylar ratio (LFCR), posterior tibial slope, medial tibial plateau depth, and meniscus slope. In addition, carefully check for the presence of specific signs such as bone contusions and meniscal extrusions. Comparing the anatomical differences in multiple bone morphologies between the two groups, a stepwise forward multifactorial logistic analysis was used to identify the risk factors for Solitary meniscal injuries. Finally, ROC curves were used to determine the critical values and best predictors of risk factors. Results: MTS, LTS, and LFCR ended up as independent risk factors for meniscus injury. Among all risk factors, LFCR had the largest AUC of 0.781 (0.714-0.848) with a threshold of 72.75%. When combined with MTS (>3.63°), diagnostic performance improved with an AUC of 0.833 (0.774-0.892). Conclusion: Steep medial tibial plateau slope, steep lateral tibial plateau slope angle, and deep posterior lateral femoral condyles on MRI are independent risk factors for meniscal injuries. In patients with knee discomfort with the above imaging findings (X-ray, MRI), we should suspect and carefully evaluate the occurrence of meniscal injuries. It not only provides a theoretical basis to understand the mechanism of meniscus injury but also provides theoretical guidance for the prevention of meniscus injury and the development of intervention measures. Level of evidence III.
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Affiliation(s)
- Lei Yang
- Department of North Sichuan Medical College, Nanchong, Sichuan, China
- Department of Orthopedics, Chengdu Fifth People’s Hospital, Chengdu, Sichuan, China
| | - Shuxing Xing
- Department of Orthopedics, Chengdu Fifth People’s Hospital, Chengdu, Sichuan, China
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16
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Ng MK, Vasireddi N, Emara AK, Lam A, Voyvodic L, Rodriguez AN, Pan X, Razi AE, Erez O. Anterolateral knee complex considerations in contemporary anterior cruciate ligament reconstruction and total knee arthroplasty: a systematic review. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:319-330. [PMID: 37490068 DOI: 10.1007/s00590-023-03647-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 07/11/2023] [Indexed: 07/26/2023]
Abstract
The anterolateral ligament (ALL) was first described in 1879 in the context of Segond fractures, which correlate with a 75-100% chance of an anterior cruciate ligament (ACL) tear or a 66-75% chance of a meniscal tear. The purpose of this paper is to provide an updated comprehensive review on the anterolateral ligament complex of the knee focusing on the: (1) anatomy of the ALL/ALC; (2) associated biomechanics/function; and (3) important surgical considerations in contemporary anterior cruciate ligament (ACL) reconstruction and total knee arthroplasty (TKA). A systematic review of studies on ALL was conducted on Pubmed/MEDLINE and Cochrane databases (May 7th, 2020 to February 1st, 2022), with 20 studies meeting inclusion/exclusion criteria. Studies meeting inclusion criteria were anatomical/biomechanical studies assessing ALL function, cadaveric and computer simulations, and comparative studies on surgical outcomes of ALLR (concomitant with ACL reconstruction). Eight studies were included and graded by MINOR and Newcastle-Ottawa scale to identify potential biases. The anatomy of the ALL is part of the anterolateral ligament complex (ALC), which includes the superficial/deep iliotibial band (including the Kaplan fiber system), iliopatellar band, ALL, and anterolateral capsule. Multiple biomechanical studies have characterized the ALC as a secondary passive stabilizer in resisting tibial internal rotation. Given the role of the ALC in resisting internal tibial rotation, lateral extra-articular procedures including ALL augmentation may be considered for chronic ACL tears, ACL revisions, and a high-grade pivot shift test. In the context of TKA, in the event of injury to the ALC, a more constrained implant or soft-tissue reconstruction may be necessary to restore appropriate knee stability.
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Affiliation(s)
- Mitchell K Ng
- Department of Orthopaedic Surgery, Maimonides Medical Center, 927 49th St., Brooklyn, NY, 11219, USA
| | - Nikhil Vasireddi
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Ahmed K Emara
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Aaron Lam
- Department of Orthopaedic Surgery, Maimonides Medical Center, 927 49th St., Brooklyn, NY, 11219, USA
| | - Lucas Voyvodic
- Department of Orthopaedic Surgery, Maimonides Medical Center, 927 49th St., Brooklyn, NY, 11219, USA
| | - Ariel N Rodriguez
- Department of Orthopaedic Surgery, Maimonides Medical Center, 927 49th St., Brooklyn, NY, 11219, USA.
| | - Xuankang Pan
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Afshin E Razi
- Department of Orthopaedic Surgery, Maimonides Medical Center, 927 49th St., Brooklyn, NY, 11219, USA
| | - Orry Erez
- Department of Orthopaedic Surgery, Maimonides Medical Center, 927 49th St., Brooklyn, NY, 11219, USA
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17
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Suzuki N, Watanabe A, Ninomiya T, Nakajima H, Horii M, Watanabe S, Shiko Y, Sasho T. Lateral meniscal injury without medial meniscal injury indicates the existence of the Segond fracture in ACL-deficient knees. Asia Pac J Sports Med Arthrosc Rehabil Technol 2024; 35:59-64. [PMID: 38236496 PMCID: PMC10792093 DOI: 10.1016/j.asmart.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 10/13/2023] [Accepted: 11/27/2023] [Indexed: 01/19/2024] Open
Abstract
Background/Objective The purpose of this study was to find factors indicating the occurrence of the Segond fracture, a specific type of anterolateral ligament injury. Methods From January 2015 to December 2017, we retrospectively reviewed the medical records of patients diagnosed with acute anterior cruciate ligament (ACL) injury who underwent reconstruction within 90 days of injury. Diagnosis of the Segond fracture was determined either by magnetic resonance imaging or plain radiographs. Factors examined were: age at surgery, sex, body mass index (kg/m2), status of menisci, and activities led to ACL injury. After univariate screening, multivariate logistic regression analyses were performed. Patients were divided into four groups based on the presence of lateral meniscal (LM) and/or medial meniscal (MM) injuries and compared with respect to the occurrence of Segond fractures. Results A total of 375 patients were included (163 males, 212 females), with mean age 25.8 years old. Among them, 22 of 375 (5.9 %) had a Segond fracture. We identified injured lateral menisci (adjusted odds ratio (aOR), 3.029; 95 % Confidence Interval (CI), 1.206-7.609; P = 0.018), intact medial menisci (aOR, 0.229; 95 % CI, 0.065-0.810; P = 0.022), and higher body mass index (aOR, 1.102; 95 % CI, 1.008-1.205; P = 0.034) as factors indicative of the occurrence of Segond fracture. LM injury without MM injury suggested the existence of a Segond fracture. Conclusion LM injury without a MM injury indicated the occurrence of a Segond fracture. Higher body mass index also increased the risk for Segond fracture occurrence.
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Affiliation(s)
- Nobutada Suzuki
- Department of Radiology, Eastern Chiba Medical Center, 3-6-1 Okayamadai, Togane, Chiba, 283-8686, Japan
- Center for Preventive Medicine, Musculoskeletal Disease and Pain, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan
| | - Atsuya Watanabe
- Department of Orthopedic Surgery, Eastern Chiba Medical Center, 3-6-1 Okayamadai, Togane, Chiba, 283-8686, Japan
| | - Taishi Ninomiya
- Center for Preventive Medicine, Musculoskeletal Disease and Pain, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan
- Department of Orthopedic Surgery, Funabashi Orthopedic Hospital, 1-833 Hasamacho, Funabashi, Chiba, 274-0822, Japan
| | - Hirofumi Nakajima
- Center for Preventive Medicine, Musculoskeletal Disease and Pain, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan
- Department of Orthopedic Surgery, Funabashi Orthopedic Hospital, 1-833 Hasamacho, Funabashi, Chiba, 274-0822, Japan
| | - Manato Horii
- Department of Orthopedic Surgery, Eastern Chiba Medical Center, 3-6-1 Okayamadai, Togane, Chiba, 283-8686, Japan
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan
| | - Shotaro Watanabe
- Center for Preventive Medicine, Musculoskeletal Disease and Pain, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan
| | - Yuki Shiko
- Biostatistics Section, Clinical Research Center, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-0856, Japan
| | - Takahisa Sasho
- Center for Preventive Medicine, Musculoskeletal Disease and Pain, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan
- Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8670, Japan
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18
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Guo Z, Liu F. Progress in research on and classification of surgical methods of arthroscopic reconstruction of the ACL and ALL using a shared tendon graft through the femoral tunnel. Front Surg 2023; 10:1292530. [PMID: 38186395 PMCID: PMC10766812 DOI: 10.3389/fsurg.2023.1292530] [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: 09/11/2023] [Accepted: 11/14/2023] [Indexed: 01/09/2024] Open
Abstract
Anterior cruciate ligament (ACL) tear is a common clinical injury, and ACL reconstruction has reached a very mature stage. However, with the accumulation of cases, scholars have found that isolated ACL reconstruction may not completely solve the problem of knee rotational stability. With the increase in our understanding of knee joint structure, ACL combined with anterolateral ligament (ALL) reconstruction has become accepted by most scholars, and this operation has also achieved good clinical results. At present, there is no unified surgical method for ACL combined with ALL reconstruction. There are differences in bone tunnel location, reconstruction methods, and graft selection. Compared with the independent reconstruction of the ACL and ALL during the operation, shared tendon graft reconstruction of the ACL and ALL has the advantages of preserving tendon and avoiding tunnel convergence. So far, there is no relevant literature summarizing the reconstruction of the ACL and ALL with a shared tendon graft. This paper reviews the anatomic study of the ALL, the study of isometric points, surgical indications, and surgical methods and their classification for shared tendon graft reconstruction of the ACL and ALL.
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Affiliation(s)
- Ziteng Guo
- Department of Orthopedics, The First Hospital of Qinhuangdao, Qinhuangdao, China
- School of Graduate, Hebei Medical University, Shijiazhuang, China
| | - Fei Liu
- Department of Orthopedics, The First Hospital of Qinhuangdao, Qinhuangdao, China
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19
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Richards JA, Nyland J, Caborn DNM. Editorial Commentary: Proper Anterior Cruciate Ligament Graft Choice Mitigates Against the Need for Anterolateral Ligament Reconstruction. Arthroscopy 2023; 39:2525-2528. [PMID: 37981391 DOI: 10.1016/j.arthro.2023.06.010] [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] [Received: 06/02/2023] [Accepted: 06/04/2023] [Indexed: 11/21/2023]
Abstract
It is not coincidence that fervor surrounding anterolateral ligament (ALL) reconstruction increased as double-bundle anterior cruciate ligament reconstruction (ACLR) enthusiasm cooled. But perhaps we shifted our focus too soon, or perhaps we shifted our focus too much. But we must remember that the ACL is primary. Increases in ACL graft diameter by 1 or 2 mm can significantly increase graft strength and decrease revision rate. Biomechanical and clinical evidence suggests that quadriceps tendon ACLR and patellar tendon ACLR demonstrates less pivot shift phenomena than hamstring ACLR. In addition, As biologically active suture tapes become more mainstream, augmented allografts are an increasingly attractive option. Proper ACL graft choice mitigates against the need for ALL reconstruction. Risk factors for anterolateral rotatory instability may include low body mass index and lateral meniscal pathology, in addition to the well-known risks such as age, gender, activity level, and revision cases. Perhaps lateral extra-articular tenodesis should be reserved for high-risk cases.
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Affiliation(s)
- Jarod A Richards
- University of Louisville (J.A.R., D.N.M.Z.) and University of Missouri (J.A.R.)
| | - John Nyland
- University of Louisville (J.A.R., D.N.M.Z.) and University of Missouri (J.A.R.)
| | - David N M Caborn
- University of Louisville (J.A.R., D.N.M.Z.) and University of Missouri (J.A.R.)
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20
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Turati M, Rigamonti L, Giulivi A, Gaddi D, Accadbled F, Zanchi N, Bremond N, Catalano M, Gorla M, Omeljaniuk RJ, Zatti G, Piatti M, Bigoni M. Management of anterior cruciate ligament tears in Tanner stage 1 and 2 children: a narrative review and treatment algorithm guided by ACL tear location. J Sports Med Phys Fitness 2023; 63:1218-1226. [PMID: 34609098 DOI: 10.23736/s0022-4707.21.12783-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The incidence of anterior cruciate ligament (ACL) tears in skeletally immature patients has acutely increased over the last 20 years, yet there is no consensus on a single "best treatment." Selection of an optimal treatment is critical and based on individual circumstances; consequently, we propose a treatment-selection algorithm based on skeletal development, ACL tear location, type, and quality, as well as parental perspective in order to facilitate the decision-making process. We combined our surgical group's extensive case histories of ACL tear management in Tanner Stage 1 and 2 patients with those in the literature to form a consolidated data base. For each case the diagnostic phase, communication with patient and parents, treatment choice(s), selected surgical techniques and rehabilitation schedule were critically analyzed and compared for patient outcomes. MRI-imaging and intraoperative tissue quality assessment were preeminent in importance for selection of the optimal treatment strategy. Considerations for selecting an optimal treatment included: associated lesions, the child/patient and parent(s)' well-informed and counseled consent, biological potential, and the potential for successful ACL preservative surgery. Complete ACL tears were evaluated according to tear-location. In type I and II ACL tears with remaining good tissue quality, we propose primary ACL repair. In type III and IV ACL tears we propose physeal-sparing reconstruction with an iliotibial band graft. Finally, in the case of a type V ACL tear, we propose that the best treatment be based on the Meyers-McKeever classification. We present a facile decision-making algorithm for ACL management in pediatric patients based on specific elements of tissue damage and status.
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Affiliation(s)
- Marco Turati
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy -
- Department of Orthopedics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy -
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, Monza, Italy -
- Couple Enfant Hospital, Grenoble, France -
- Department of Pediatric Orthopedic Surgery, Couple Enfant Hospital, Grenoble Alpes University, Grenoble, France -
| | - Luca Rigamonti
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Couple Enfant Hospital, Grenoble, France
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Andrea Giulivi
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Couple Enfant Hospital, Grenoble, France
| | - Diego Gaddi
- Department of Orthopedics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Couple Enfant Hospital, Grenoble, France
| | - Franck Accadbled
- Department of Orthopedics, Children's Hospital, CHU de Toulouse, Toulouse, France
| | - Nicolò Zanchi
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Couple Enfant Hospital, Grenoble, France
| | - Nicolas Bremond
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Couple Enfant Hospital, Grenoble, France
- Department of Pediatric Orthopedic Surgery, Couple Enfant Hospital, Grenoble Alpes University, Grenoble, France
| | - Marcello Catalano
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Couple Enfant Hospital, Grenoble, France
| | - Massimo Gorla
- Department of Orthopedics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Couple Enfant Hospital, Grenoble, France
| | - Robert J Omeljaniuk
- Department of Orthopedics, Children's Hospital, CHU de Toulouse, Toulouse, France
- Department of Biology, Lakehead University, Thunder Bay, ON, Canada
| | - Giovanni Zatti
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Department of Orthopedics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Couple Enfant Hospital, Grenoble, France
| | - Massimiliano Piatti
- Department of Orthopedics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Couple Enfant Hospital, Grenoble, France
| | - Marco Bigoni
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Department of Orthopedics, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Couple Enfant Hospital, Grenoble, France
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Sørensen OG, Faunø P, Konradsen L, Nielsen T, Schaarup S, Mygind-Klavsen B, Krogsgaard M, Lind M. Combined anterior cruciate ligament revision with reconstruction of the antero-lateral ligament does not improve outcome at 2-year follow-up compared to isolated acl revision; a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 2023; 31:5077-5086. [PMID: 37733288 PMCID: PMC10598101 DOI: 10.1007/s00167-023-07558-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 08/29/2023] [Indexed: 09/22/2023]
Abstract
PURPOSE It is essential to obtain rotational stability of the knee after anterior cruciate ligament reconstruction (ACL-R) and it is suggested that a supplementary reconstruction of the antero-lateral ligament (ALL-R) may supports this. Theoretically, ALL-R may be particularly advantageous to support revision of failed ACL-Rs. It was hypothesized that ACL revision combined with ALL-R will result in superior outcome compared to isolated ACL revision. METHODS The study was designed as a randomized controlled trial. Patients eligible for first time ACL revision were randomized to either isolated ACL revision (- ALL group) or ACL revision combined with a single-stranded allograft ALL-reconstruction (+ ALL group). Patient reported outcomes and function were evaluated at two-year follow-up by KNEES-ACL, KOOS, and Tegner activity scale. Objective knee laxity was evaluated at one-year follow-up using an instrumented Rolimeter test, the pivot shift test, and a manual Lachman test. RESULTS A total of 103 patients were enrolled with 49 patients randomized to the + ALL group and 54 patients in the - ALL group. There were no differences at baseline between groups regarding age, gender, body mass index, preoperative patient reported outcome scores and concomitant meniscus or cartilage injury. The ACL revision was performed with an allograft in 10 patients (20%) in the + ALL group and 8 patients (15%) in the -ALL group. At follow-up there was no significant difference between the groups in patient reported outcome scores and clinical knee laxity. CONCLUSION Supplementary ALL-R does not improve subjective outcome of first time ACL revision at two-years and clinical knee stability at one-year follow-up compared to isolated ACL revision. LEVEL OF EVIDENCE Level I.
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Affiliation(s)
- Ole Gade Sørensen
- Department of Sports Traumatology, University Hospital of Aarhus, Aarhus, Denmark.
| | - Peter Faunø
- Department of Sports Traumatology, University Hospital of Aarhus, Aarhus, Denmark
| | - Lars Konradsen
- Section for Sports Traumatology, Bispebjerg, Frederiksberg University Hospital, Copenhagen, Denmark
| | - Torsten Nielsen
- Department of Sports Traumatology, University Hospital of Aarhus, Aarhus, Denmark
| | - Susanne Schaarup
- Section for Sports Traumatology, Bispebjerg, Frederiksberg University Hospital, Copenhagen, Denmark
| | | | - Michael Krogsgaard
- Section for Sports Traumatology, Bispebjerg, Frederiksberg University Hospital, Copenhagen, Denmark
| | - Martin Lind
- Department of Sports Traumatology, University Hospital of Aarhus, Aarhus, Denmark
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22
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Lucenti L, Testa G, Montemagno M, Sapienza M, Russo A, Di Maria F, de Cristo C, Pavone V. The Anterolateral Ligament of the Knee in Pediatric Patients: What Do We Know? A Scoping Review. J Funct Morphol Kinesiol 2023; 8:126. [PMID: 37754959 PMCID: PMC10531858 DOI: 10.3390/jfmk8030126] [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: 07/12/2023] [Revised: 08/20/2023] [Accepted: 08/22/2023] [Indexed: 09/28/2023] Open
Abstract
The knowledge on the anatomy, function and biomechanics and the role of surgical procedures on the anterolateral ligament (ALL) of the knee is still controversial. Only a few papers have examined the ALL in children. The aim of this review is to analyze all the available literature about ALL in the pediatric population. Following the PRISMA criteria, the literature was systematically reviewed, examining all the articles about ALL in pediatric patients. Eight articles were involved in this study. Five cadaveric studies, two diagnostic studies, and one cross-sectional study were found. The identification of the ALL is not always possible in diagnostic studies using magnetic resonance (MRI) or in dissecting specimens. A high variability in the presence of the ligament and in its origin and insertion were found among the studies. It is more difficult to identify the ligament in younger patients than in older children, suggesting that its presence may develop at some point during the growth. Further studies are needed for a detailed knowledge of the ALL.
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Affiliation(s)
- Ludovico Lucenti
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, Policlinico Rodolico-San Marco, University of Catania, 95123 Catania, Italy; (L.L.); (G.T.); (M.M.); (M.S.); (F.D.M.); (C.d.C.)
| | - Gianluca Testa
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, Policlinico Rodolico-San Marco, University of Catania, 95123 Catania, Italy; (L.L.); (G.T.); (M.M.); (M.S.); (F.D.M.); (C.d.C.)
| | - Marco Montemagno
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, Policlinico Rodolico-San Marco, University of Catania, 95123 Catania, Italy; (L.L.); (G.T.); (M.M.); (M.S.); (F.D.M.); (C.d.C.)
| | - Marco Sapienza
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, Policlinico Rodolico-San Marco, University of Catania, 95123 Catania, Italy; (L.L.); (G.T.); (M.M.); (M.S.); (F.D.M.); (C.d.C.)
| | - Arcangelo Russo
- Orthopaedic and Traumatology Unit, Umberto I Hospital, 94100 Enna, Italy;
| | - Fabrizio Di Maria
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, Policlinico Rodolico-San Marco, University of Catania, 95123 Catania, Italy; (L.L.); (G.T.); (M.M.); (M.S.); (F.D.M.); (C.d.C.)
| | - Claudia de Cristo
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, Policlinico Rodolico-San Marco, University of Catania, 95123 Catania, Italy; (L.L.); (G.T.); (M.M.); (M.S.); (F.D.M.); (C.d.C.)
| | - Vito Pavone
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, Policlinico Rodolico-San Marco, University of Catania, 95123 Catania, Italy; (L.L.); (G.T.); (M.M.); (M.S.); (F.D.M.); (C.d.C.)
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23
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Kim YS, Koo S, Kim JH, Tae J, Wang JH, Ahn JH, Jang KM, Jeon J, Lee DK. Greater Knee Rotatory Instability After Posterior Meniscocapsular Injury Versus Anterolateral Ligament Injury: A Proposed Mechanism of High-Grade Pivot Shift. Orthop J Sports Med 2023; 11:23259671231188712. [PMID: 37693803 PMCID: PMC10486219 DOI: 10.1177/23259671231188712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 04/24/2023] [Indexed: 09/12/2023] Open
Abstract
Background For anterolateral rotatory instability as a result of secondary soft tissue injuries in anterior cruciate ligament (ACL)-deficient knees, there is increasing interest in secondary stabilizers to prevent internal rotation (IR) of the tibia. Purpose To determine which secondary stabilizer is more important in anterolateral rotatory instability in ACL-deficient knees. Study Design Controlled laboratory study. Methods The lower extremities of 10 fresh-frozen cadavers (20 extremities) without anterior-posterior or rotational instability were included. Matched-pair randomization was performed, with each side per specimen assigned to 1 of 2 groups. In group 1, the ACL was sectioned, followed by the anterolateral ligament (ALL); in group 2, the ACL was sectioned, followed by sequential sectioning of the posterolateral meniscocapsular complex (PLMCC) and posteromedial meniscocapsular complex (PMMCC). The primary outcome was the change in relative tibial IR during a simulated pivot-shift test with 5 N·m of IR torque and 8.9 N of valgus force. The secondary outcomes were the International Knee Documentation Committee grade in the pivot-shift test and the incidence of the grade 3 pivot shift. Results In group 1, compared with baseline, the change in relative tibial IR at 0° of knee flexion was 1.4° (95% CI, -0.1° to 2.9°; P = .052) after ALL release. In group 2, it was 2.5° (95% CI, 0.4° to 4.8°; P = .007) after PLMCC release and 4.1° (95% CI, 0.5° to 7.8°; P = .017) after combined PLMCC and PMMCC release. Combined PLMCC and PMMCC release resulted in greater change of tibial IR with statistical significance at 0°, 15°, and 30° of knee flexion (P = .008, .057, and .004, respectively) compared with ALL release. The incidence of grade 3 pivot shifts was 10% in group 1 and 90% in group 2. Conclusion Posterior meniscocapsular laxity caused an increase in relative tibial IR as much as ALL injury in ACL-deficient knees in our simulated laboratory test, and greater anterolateral rotatory instability occurred with posterior meniscocapsular injury compared with ALL injury. Clinical Relevance Repair of the injured posterior meniscocapsular complex may be an important treatment option for reducing anterolateral rotatory instability in the ACL-deficient knee.
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Affiliation(s)
- Yi-Suk Kim
- Department of Anatomy, Catholic Institute for Applied Anatomy, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seungbum Koo
- Department of Mechanical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Jun Ho Kim
- Department of Orthopedic Surgery, Kyunghee University Hospital at Gangdong, Kyunghee University School of Medicine, Seoul, Republic of Korea
| | - Jungyeun Tae
- Konyang University School of Medicine, Daejeon, Republic of Korea
| | - Joon Ho Wang
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jin Hwan Ahn
- Department of Orthopaedic Surgery, Saeum Hospital, Seoul, Republic of Korea
| | - Ki-Mo Jang
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jongmin Jeon
- Department of Orthopedic Surgery, Changwon Samsung Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Do Kyung Lee
- Department of Orthopedic Surgery, Changwon Samsung Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
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Kumar A, Raza K, Krishna H, Narayan RK, Jha RK, Kumari C, Asghar A, Kumar T, Agrawal P. Sharing of proximal fibers by the anterolateral and lateral collateral ligaments in the human knee: a cadaveric study. Sci Rep 2023; 13:12317. [PMID: 37516773 PMCID: PMC10387103 DOI: 10.1038/s41598-023-38211-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 07/05/2023] [Indexed: 07/31/2023] Open
Abstract
Literature is highly inconsistent in describing the proximal attachment of the anterolateral ligament (ALL) and its relationship with the lateral collateral ligament (LCL) in human knees. This observational study aims to investigate that lacuna. The gross dissection was performed in the lower limbs (n = 83) from the donated adult-age (> 18 years) embalmed cadavers from medical institutions in the north and east India. The dissected knee specimens were first examined macroscopically. Further routine and special staining and microscopic examinations were performed. The ALL was absent in approximately 20.4% of the studied knee specimens (17/83). In remaining, the sharing of ALL and LCL proximal fibers was observed as a consistent finding (~ 97%) with rare exceptions. The mean length of the tibial and meniscal limbs of ALL was 1.57 ± 0.8 cm [Range (R) 0.5-4 cm] and 0.73 ± 0.47 cm [Range (R) 0.1-1.6 cm], respectively. In addition, multiple variations in its presentation were observed. We propose that the proximal sharing of LCL-ALL fibers is a dominant feature in the studied population. The sharing of the fibers may impact the biomechanics and injury mechanisms for both ligaments. The possibility of ethnic variations in the ALL morphology should be a concern during reconstruction surgery.
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Affiliation(s)
- Ashutosh Kumar
- Department of Anatomy, All India Institute of Medical Sciences, Patna, Bihar, 801507, India.
| | - Khursheed Raza
- Department of Anatomy, All India Institute of Medical Sciences, Deoghar, Jharkhand, India
| | - Hare Krishna
- Department of Anatomy, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Ravi K Narayan
- Department of Anatomy, Dr. B.C. Roy Multi Speciality Medical Research Center, Indian Institute of Technology, Kharagpur, West Bengal, India
| | - Rakesh K Jha
- Department of Anatomy, All India Institute of Medical Sciences, Patna, Bihar, 801507, India
| | - Chiman Kumari
- Department of Anatomy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Adil Asghar
- Department of Anatomy, All India Institute of Medical Sciences, Patna, Bihar, 801507, India
| | - Tarun Kumar
- Department of Pathology, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Prabhat Agrawal
- Department of Orthopedics, All India Institute of Medical Sciences, Patna, Bihar, India
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25
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Lee JK, Cho SI, Lee DW, Yang SJ, Kim TW, Kim JG. Additional Anterolateral Ligament Reconstruction Helps Patients Improve Dynamic Postural Stability in Revision Anterior Cruciate Ligament Reconstruction. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1242. [PMID: 37512054 PMCID: PMC10386532 DOI: 10.3390/medicina59071242] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 06/25/2023] [Accepted: 06/28/2023] [Indexed: 07/30/2023]
Abstract
Background and Objectives: The goal in treating anterior cruciate ligament (ACL) injury especially in revision cases is return to sports activity by regaining dynamic postural stability. Among various methods to achieve this goal, additional anterolateral ligament reconstruction (ALLR) is gaining attention. The purpose of this study was to evaluate the effects of additional ALLR in revision ACL reconstruction (RACLR). Materials and Methods: Patients who underwent RACLR between July 2015 and June 2018 were enrolled. The exclusion criteria were less than 1-year follow-up, age older than 45 years, concomitant multiple ligament injuries, contralateral knee injury, subtotal or total meniscectomized state, and articular cartilage lesions worse than Outerbridge grade 3. Thirty-nine patients (20 patients; RACLR only (Group A), 19 patients; RACLR with additional ALLR (Group B)) were included. Clinical scores (Lysholm score, subjective International Knee Documentation Committee (IKDC) score, Tegner activity scale), isokinetic strength test, single-leg-hop for distance test (SLHDT), Y-balance test (YBT) were checked preoperatively and 1-year postoperatively. Results: Limb symmetry index values in YBT showed significantly better result in Group B 1-year postoperatively (Group A: 97.2 ± 4.0, Group B: 100.3 ± 2.9, p = 0.010), although there were no differences preoperatively between groups (Group A: 90.4 ± 6.7, Group B: 89.3 ± 5.5, p = 0.594). Regarding clinical scores, isokinetic strength tests, and SLHDT, there were no differences between groups preoperatively nor 1-year postoperatively. Conclusions: Additional ALLR in RACLR helped patients gain better dynamic postural stability at 1-year postoperative follow-up.
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Affiliation(s)
- Joon Kyu Lee
- Department of Orthopaedic Surgery, Konkuk University Medical Center, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul 05030, Republic of Korea
| | - Seung-Ik Cho
- Department of Orthopaedic Surgery, Konkuk University Medical Center, Seoul 05030, Republic of Korea
| | - Dhong-Won Lee
- Department of Orthopaedic Surgery, Konkuk University Medical Center, Seoul 05030, Republic of Korea
| | - Sang-Jin Yang
- Department of Health & Exercise Management, Tongwon University, Gwangju-si 12813, Republic of Korea
| | - Tae-Wook Kim
- Department of Orthopaedic Surgery, Konkuk University Medical Center, Seoul 05030, Republic of Korea
| | - Jin-Goo Kim
- Department of Orthopaedic Surgery, Myong-Ji Hospital, Goyang-si 10475, Republic of Korea
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26
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McLeod KC, Barber FA. Pivot Shift Syndrome of the Knee. Sports Med Arthrosc Rev 2023; 31:34-40. [PMID: 37418172 DOI: 10.1097/jsa.0000000000000365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
The pivot shift test, in contrast to the Lachman or anterior drawer, is a manually subjective clinical test that simulates the injury mechanism. It is the most sensitive test to determine ACL insufficiency. This paper reviews the history, development, research, and treatment associated with the pivot shift phenomenon which is associated with tearing and loss of function of the knee anterior cruciate ligament. The pivot shift test most closely recapitulates what the symptomatic anterior cruciate ligament deficient patient feels is happening which is an abnormal translation and rotation of the injured joint during flexion or extension. The test is best conducted in the relaxed patient by applying knee flexion, tibial external rotation, and valgus stress. The pivot shift biomechanics and treatment measures are reviewed.
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Affiliation(s)
- Kevin C McLeod
- Baptist Health Specialty - Arkadelphia, Orthopedic Surgeon, 2915 Cypress Rd, Suite D, Arkadelphia, AR
| | - F Alan Barber
- Plano Orthopedic and Sports Medicine Center, Fellowship Director Emeritus, Plano, TX
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Tzanetis P, Fluit R, de Souza K, Robertson S, Koopman B, Verdonschot N. Pre-Planning the Surgical Target for Optimal Implant Positioning in Robotic-Assisted Total Knee Arthroplasty. Bioengineering (Basel) 2023; 10:543. [PMID: 37237613 PMCID: PMC10215074 DOI: 10.3390/bioengineering10050543] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 04/19/2023] [Accepted: 04/26/2023] [Indexed: 05/28/2023] Open
Abstract
Robotic-assisted total knee arthroplasty can attain highly accurate implantation. However, the target for optimal positioning of the components remains debatable. One of the proposed targets is to recreate the functional status of the pre-diseased knee. The aim of this study was to demonstrate the feasibility of reproducing the pre-diseased kinematics and strains of the ligaments and, subsequently, use that information to optimize the position of the femoral and tibial components. For this purpose, we segmented the pre-operative computed tomography of one patient with knee osteoarthritis using an image-based statistical shape model and built a patient-specific musculoskeletal model of the pre-diseased knee. This model was initially implanted with a cruciate-retaining total knee system according to mechanical alignment principles; and an optimization algorithm was then configured seeking the optimal position of the components that minimized the root-mean-square deviation between the pre-diseased and post-operative kinematics and/or ligament strains. With concurrent optimization for kinematics and ligament strains, we managed to reduce the deviations from 2.4 ± 1.4 mm (translations) and 2.7 ± 0.7° (rotations) with mechanical alignment to 1.1 ± 0.5 mm and 1.1 ± 0.6°, and the strains from 6.5% to lower than 3.2% over all the ligaments. These findings confirm that adjusting the implant position from the initial plan allows for a closer match with the pre-diseased biomechanical situation, which can be utilized to optimize the pre-planning of robotic-assisted surgery.
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Affiliation(s)
- Periklis Tzanetis
- Department of Biomechanical Engineering, University of Twente, 7522 LW Enschede, The Netherlands
| | - René Fluit
- Faculty of Science and Engineering, University of Groningen, 9747 AG Groningen, The Netherlands
- Orthopaedic Research Laboratory, Radboud Institute for Health Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | | | | | - Bart Koopman
- Department of Biomechanical Engineering, University of Twente, 7522 LW Enschede, The Netherlands
| | - Nico Verdonschot
- Department of Biomechanical Engineering, University of Twente, 7522 LW Enschede, The Netherlands
- Orthopaedic Research Laboratory, Radboud Institute for Health Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
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Kraeutler MJ, McCulloch PC. A Call for More Studies Evaluating Posttraumatic Knee Osteoarthritis in Patients Undergoing Combined Anterior Cruciate Ligament Reconstruction and Lateral Extra-Articular Stabilization. Arthroscopy 2023; 39:908-910. [PMID: 36872030 DOI: 10.1016/j.arthro.2022.12.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 12/07/2022] [Accepted: 12/12/2022] [Indexed: 03/07/2023]
Affiliation(s)
- Matthew J Kraeutler
- Department of Orthopedics & Sports Medicine, Houston Methodist Hospital, Houston, Texas, U.S.A
| | - Patrick C McCulloch
- Department of Orthopedics & Sports Medicine, Houston Methodist Hospital, Houston, Texas, U.S.A
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Zheng T, Song G, Wang C, Li Y, Zhang Z, Cao Y, Feng Z, Di M, Zhang H. Effect of Anterolateral Ligament Status and Inherent Knee Anatomy on Anterior Tibial Subluxation of the Lateral Compartment After Acute Anterior Cruciate Ligament Injury: A Cohort Study Based on MRI Analysis. Am J Sports Med 2023; 51:968-976. [PMID: 36779576 DOI: 10.1177/03635465231151694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
BACKGROUND Anterior tibial subluxation (ATS) of the lateral compartment entails a pathological tibiofemoral alignment in knees with anterior cruciate ligament (ACL) injury. Causes of increased ATS after an acute ACL injury are not clear, but soft tissue abnormalities and bony variations of the knee are potential causes. PURPOSE To determine whether increased ATS of the lateral compartment in knees with acute ACL injury is associated with (1) anterolateral ligament (ALL) status and (2) inherent anatomy of the lateral femoral condyle (LFC) and lateral tibial plateau (LTP). STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS A total of 337 patients with clinically diagnosed ACL injuries treated between September 2019 and August 2021 were retrospectively reviewed, and 119 patients with acute ACL injury were included. Of them, 79 patients with impaired ALL (ALL injury group) and 40 patients with intact ALL (ALL intact group) were identified based on magnetic resonance imaging (MRI). The ATS of the lateral compartment measured on MRI was compared between the 2 groups. The bony anatomy of knees, quantified by the LFC length, LFC height, LTP length, and LTP slope, was also evaluated on MRI and correlated with the ATS with partial correlation coefficients. Multivariate linear regression was used to identify the independent predictors of increased ATS. RESULTS The ATS of the lateral compartment in the ALL injury group was significantly larger than that in the ALL intact group (6.3 mm vs 4.0 mm, respectively; P = .001). In all included patients, the presence of ALL injuries independently predicted a mean increase in ATS of 1.8 mm (P = .003). In the ALL injury group, ATS was significantly correlated with LFC length (r = 0.463; P < .001), LFC height (r = -0.415; P < .001), and LTP slope (r = 0.453; P < .001); further, a 1-mm increase in LFC length, 1-mm decrease in LFC height, and 1° increase in LTP slope independently predicted a mean increase in ATS of 0.7 mm (P < .001), 0.6 mm (P < .001), and 0.5 mm (P < .001), respectively. In the ALL intact group, there was no significant correlation between ATS and any bony parameter. CONCLUSION An impaired ALL increased the ATS of the lateral compartment after acute ACL injuries. In patients with combined ALL injuries, a flatter LFC and a steeper LTP in the sagittal plane were predictors of a further increase in ATS.
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Affiliation(s)
- Tong Zheng
- Sports Medicine Service, Beijing Jishuitan Hospital, Beijing, China
| | - Guanyang Song
- Sports Medicine Service, Beijing Jishuitan Hospital, Beijing, China
| | - Chao Wang
- Department of Epidemiology and Biostatistics, Beijing Research Institute of Traumatology and Orthopaedics, Beijing Jishuitan Hospital, Beijing, China
| | - Yue Li
- Sports Medicine Service, Beijing Jishuitan Hospital, Beijing, China
| | - Zhijun Zhang
- Sports Medicine Service, Beijing Jishuitan Hospital, Beijing, China
| | - Yanwei Cao
- Sports Medicine Service, Beijing Jishuitan Hospital, Beijing, China
| | - Zheng Feng
- Sports Medicine Service, Beijing Jishuitan Hospital, Beijing, China
| | - Menglinqian Di
- Sports Medicine Service, Beijing Jishuitan Hospital, Beijing, China
| | - Hui Zhang
- Sports Medicine Service, Beijing Jishuitan Hospital, Beijing, China
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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; 59:419. [PMID: 36837620 PMCID: PMC9964873 DOI: 10.3390/medicina59020419] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [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
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Haase L, Nelson G, Raji Y, Brown M, Karns M, Voos J, Calcei JG. Patients With Anterior Cruciate Ligament Rupture and Ipsilateral Segond Fractures Have High Rates of Concurrent Knee Pathology. Arthrosc Sports Med Rehabil 2023; 5:e375-e379. [PMID: 37101873 PMCID: PMC10123414 DOI: 10.1016/j.asmr.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 01/04/2023] [Indexed: 02/13/2023] Open
Abstract
Purpose The purpose of this study was to determine the rates of concomitant knee pathology in patients with ACL injuries and Segond fractures. Methods A retrospective study is undertaken with patients identified via query of CPT codes for ACL reconstruction from 2014 to 2020. All patients with preoperative radiographs were reviewed for the presence of Segond fractures. Operative reports were analyzed for the presence of concurrent pathology, including meniscus, cartilage, and other ligamentous injuries at the time of arthroscopic ACL reconstruction. Results A total of 1,058 patients were included in the study. Segond fractures were identified in 50 (4.7%) patients. Ipsilateral concomitant knee pathology was identified in 84% of Segond patients. Thirty-eight (76%) patients had meniscal pathology with a total 49 meniscal injuries, of which 43 were treated operatively. Multiligamentous injuries were present in 16 patients (32%), with 8 patients undergoing further ligament repair/reconstruction at the time of surgery. Chondral injuries were identified in 13 patients (26%). Conclusions A high prevalence of concomitant meniscal, chondral, and ligamentous injuries was found in patients with Segond fractures. These additional injuries may require further operative management and may place patients at increased risk for future instability or degenerative changes. Patients with Segond fractures should be counseled preoperatively on the nature of their injuries and risk of associated pathologies. Level of Evidence Level IV, prognostic case series.
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Affiliation(s)
- Lucas Haase
- Address correspondence to Lucas Haase, M.D., University Hospitals of Cleveland, 11100 Euclid Ave., Cleveland, OH, 44106, U.S.A.
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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: 7] [Impact Index Per Article: 3.5] [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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Morgan AM, Bi AS, Kaplan DJ, Alaia MJ, Strauss EJ, Jazrawi LM. An eponymous history of the anterolateral ligament complex of the knee. Knee Surg Relat Res 2022; 34:45. [PMID: 36527151 PMCID: PMC9756455 DOI: 10.1186/s43019-022-00172-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 11/22/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Recent interest has surged in the anterolateral ligament (ALL) and complex (ALC) of the knee. Its existence and role in rotary stability of the knee, particularly in the setting of anterior cruciate ligament (ACL) reconstruction, remains a contentious and controversial topic. UNDERSTANDING THE ALC We must review our history and recognize the pioneers who pushed our understanding of the ALL forward before it was popularly recognized as a discrete structure. Additionally, given that many eponyms remain in common use related to the ALC, we must standardize our nomenclature to prevent misuse or misunderstanding of terms in the literature. In this review, modern understanding of the anterolateral ligament complex (ALC) is traced to 1829 by exploring eponymous terms first in anatomy and then in surgical technique. Understanding our history and terminology will allow us to better understand the ALC itself. CONCLUSION This review aims to provide historical context, define terminology, and provide insight into the clinical relevance of the ALC.
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Affiliation(s)
- Allison M. Morgan
- grid.137628.90000 0004 1936 8753NYU Langone Orthopedic Center, 301 E 17th Street, New York, NY 10010 USA
| | - Andrew S. Bi
- grid.137628.90000 0004 1936 8753NYU Langone Orthopedic Center, 301 E 17th Street, New York, NY 10010 USA
| | - Daniel J. Kaplan
- grid.137628.90000 0004 1936 8753NYU Langone Orthopedic Center, 301 E 17th Street, New York, NY 10010 USA
| | - Michael J. Alaia
- grid.137628.90000 0004 1936 8753NYU Langone Orthopedic Center, 301 E 17th Street, New York, NY 10010 USA
| | - Eric J. Strauss
- grid.137628.90000 0004 1936 8753NYU Langone Orthopedic Center, 301 E 17th Street, New York, NY 10010 USA
| | - Laith M. Jazrawi
- grid.137628.90000 0004 1936 8753NYU Langone Orthopedic Center, 301 E 17th Street, New York, NY 10010 USA
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Haase L, Magister S, Nelson G, Raji Y, Calcei J, Voos J, Karns M. Ipsilateral ACL injured patients with Segond fractures demonstrate increased posterior tibial slope. Knee 2022; 38:76-81. [PMID: 35930896 DOI: 10.1016/j.knee.2022.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/26/2022] [Accepted: 07/15/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND The anterolateral complex has been demonstrated to assist with rotational stability and prevention of anterior tibial translation during the pivot shift. In this study the Segond fracture is used as a surrogate for an anterolateral complex injury to determine if there is an association between Segond fracture and increased posterior tibial slope. METHODS Patients' charts and radiographs were analyzed retrospectively for the presence of Segond fractures on injury radiographs. These patients, the Segond cohort, were then age and gender matched to a control cohort. Demographic as well MRI measurements of medial and lateral posterior tibial slope and lateral-to-medial slope asymmetry were collected for each cohort. Secondary outcome of anterior cruciate ligament reconstruction failure data was also collected. RESULTS The Segond group demonstrated a statistically significantly greater lateral posterior tibial slope (8.42° versus 6.55°, P = 0.003) as well as medial posterior tibial slope (6.57° versus 5.34° degrees, P = 0.045). There was no significant differences between lateral-to-medial asymmetry (2.18°versus 1.83°, P = 0.246). CONCLUSION Patients with Segond fractures at the time of anterior cruciate ligament injury have increased medial and lateral posterior tibial slope. This may relate to increased rotational and translational instability associated with anterolateral complex injuries. Surgeons treating these patient may use this information to counsel their patients on the risks of associated pathology at the time of arthroscopy such as lateral meniscal posterior root tears.
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Affiliation(s)
- Lucas Haase
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
| | - Steven Magister
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Grant Nelson
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Yazdan Raji
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Jacob Calcei
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - James Voos
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Michael Karns
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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Baxter T, Majumdar A, Heyworth BE. Anterior Cruciate Ligament Reconstruction Procedures Using the Iliotibial Band Autograft. Clin Sports Med 2022; 41:549-567. [PMID: 36210158 DOI: 10.1016/j.csm.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The Micheli anterior cruciate ligament (ACL) procedure is a combined intra-articular and extra-articular knee stabilization technique that combines lateral augmentation with ACL reconstruction using the iliotibial band as an autograft for both aspects of the technique. Its primary indication is for ACL reconstruction in skeletally immature patients with more than 2 years of growth remaining. Studies have shown it to be effective at restoring knee biomechanics to have minimal risk of complications, including those associated with growth disturbances and a relatively low ACL graft rupture rate. Additional studies are needed to better understand the potential utilization of this technique and related modifications in the marginally skeletally immature patient, skeletally mature adolescent, adult, and revision ACL reconstruction settings.
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Affiliation(s)
- Tara Baxter
- Sports Medicine Division, Boston Children's Hospital, 319 Longwood Avenue, Boston, MA 02115, USA
| | - Aditi Majumdar
- Sports Medicine, Children's Hospital Orange County, 1310 W Stewart Drive, Suite 508, Orange, CA 92868, USA
| | - Benton E Heyworth
- Sports Medicine Division, Boston Children's Hospital, 319 Longwood Avenue, Boston, MA 02115, USA.
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Weinerman J, Constantinescu DS, Lizardi JJ, Sudah SY, Vanden Berge DJ, Carvajal Alba J. Characteristics and Trends of the Most Cited Knee Surgery, Sports Traumatology, Arthroscopy Articles. Orthop Rev (Pavia) 2022; 14:37506. [PMID: 36045695 DOI: 10.52965/001c.37506] [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: 11/06/2022] Open
Abstract
Purpose To compile and analyze the top 50 most frequently cited articles published in the Knee Surgery, Sports Traumatology, Arthroscopy journal. Methods Guidelines set by the Preferred Reporting Items for Systematic Reviews were used as the foundation for data collection and analysis. Scopus database was used to acquire the metric analyzed in the study. Once collected, the data was exported to an excel sheet in order to be organized, sorted, and analyzed in accordance with the metrics of interest. Results The United States was the most contributory nation with 14 publications, followed by Sweden with13 publications and Germany with eight publications. The most contributory institution was Umeå University in Vasterbottens, Sweden (8) followed by National Institute for Working Life in Stockholm, Sweden (7) and The University of Pittsburgh (5). Most publications were either Level II (19) or Level III (19) in terms of Level of Evidence. There was only one publication that was classified as a Level I paper. Conclusion The Journal of Knee Surgery, Sports Traumatology, and Arthroscopy has published very influential research papers as noted by the number of citations amassed by its most popular articles. KSSTA's top cited publications hail largely from major European and United States institutions and are composed of high-quality reports of mostly Level 2 and Level 3 evidence classifications. Level of Evidence 3.
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Affiliation(s)
| | | | - Juan J Lizardi
- Orthopedic Surgery, University of Miami Miller School of Medicine
| | - Suleiman Y Sudah
- Orthopedic Surgery, University of Miami Miller School of Medicine
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Garcia-Mansilla I, Zicaro JP, Martinez EF, Astoul J, Yacuzzi C, Costa-Paz M. Overview of the anterolateral complex of the knee. World J Clin Cases 2022; 10:8474-8481. [PMID: 36157829 PMCID: PMC9453364 DOI: 10.12998/wjcc.v10.i24.8474] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 06/08/2022] [Accepted: 07/22/2022] [Indexed: 02/05/2023] Open
Abstract
In the last few years, much more information on the anterolateral complex of the knee has become available. It has now been demonstrated how it works in conjunction with the anterior cruciate ligament (ACL) controlling anterolateral rotatory laxity. Biomechanical studies have shown that the anterolateral complex (ALC) has a role as a secondary stabilizer to the ACL in opposing anterior tibial translation and internal tibial rotation. It is of utmost importance that surgeons comprehend the intricate anatomy of the entire anterolateral aspect of the knee. Although most studies have only focused on the anterolateral ligament (ALL), the ALC of the knee consists of a functional unit formed by the layers of the iliotibial band combined with the anterolateral joint capsule. Considerable interest has also been given to imaging evaluation using magnetic resonance and several studies have targeted the evaluation of the ALC in the setting of ACL injury. Results are inconsistent with a lack of association between magnetic resonance imaging evidence of injury and clinical findings. Isolated ACL reconstruction may not always reestablish knee rotatory stability in patients with associated ALC injury. In such cases, additional procedures, such as anterolateral reconstruction or lateral tenodesis, may be indicated. There are several techniques available for ALL reconstruction. Graft options include the iliotibial band, gracilis or semitendinosus tendon autograft, or allograft.
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Affiliation(s)
| | - Juan Pablo Zicaro
- Knee Surgery, Hospital Italiano de Buenos Aires, Buenos Aires 1199, Argentina
| | | | - Juan Astoul
- Knee Surgery, Hospital Italiano de Buenos Aires, Buenos Aires 1199, Argentina
| | - Carlos Yacuzzi
- Knee Surgery, Hospital Italiano de Buenos Aires, Buenos Aires 1199, Argentina
| | - Matias Costa-Paz
- Knee Surgery, Hospital Italiano de Buenos Aires, Buenos Aires 1199, Argentina
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Sabatini L, Capella M, Vezza D, Barberis L, Camazzola D, Risitano S, Drocco L, Massè A. Anterolateral complex of the knee: State of the art. World J Orthop 2022; 13:679-692. [PMID: 36159618 PMCID: PMC9453282 DOI: 10.5312/wjo.v13.i8.679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 03/07/2022] [Accepted: 07/25/2022] [Indexed: 02/06/2023] Open
Abstract
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.
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Affiliation(s)
- Luigi Sabatini
- Department of Orthopaedics and Traumatology, Università degli Studi di Torino, Torino 10126, Italy
| | - Marcello Capella
- Department of Orthopaedics and Traumatology, Università degli Studi di Torino, Torino 10126, Italy
| | - Daniele Vezza
- Department of Orthopaedics and Traumatology, Università degli Studi di Torino, Torino 10126, Italy
| | - Luca Barberis
- Department of Orthopaedics and Traumatology, Università degli Studi di Torino, Torino 10126, Italy
| | - Daniele Camazzola
- Department of Orthopaedics and Traumatology, Università degli Studi di Torino, Torino 10126, Italy
| | - Salvatore Risitano
- Department of Orthopaedics and Traumatology, Università degli Studi di Torino, Torino 10126, Italy
| | - Luca Drocco
- Department of Orthopaedics and Traumatology, Università degli Studi di Torino, Torino 10126, Italy
| | - Alessandro Massè
- Department of Orthopaedics and Traumatology, Università degli Studi di Torino, Torino 10126, Italy
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Marshall DC, Silva FD, Goldenberg BT, Quintero D, Baraga MG, Jose J. Imaging Findings of Complications After Lateral Extra-Articular Tenodesis of the Knee: A Current Concepts Review. Orthop J Sports Med 2022; 10:23259671221114820. [PMID: 36062159 PMCID: PMC9434692 DOI: 10.1177/23259671221114820] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 05/11/2022] [Indexed: 11/16/2022] Open
Abstract
Background Despite successful anterior cruciate ligament (ACL) reconstruction, many patients continue to experience persistent anterolateral rotatory instability. Lateral extra-articular tenodesis (LET) is used to address this instability by harvesting a portion of the iliotibial band, passing it underneath the fibular collateral ligament, and attaching it just proximal and posterior to the lateral femoral epicondyle. Based on the most recent clinical evidence, the addition of LET to ACL reconstruction improves clinical outcomes, which has led to an increase in the use of this technique. Purpose To provide an overview of the postoperative complications of the LET procedure and their associated imaging findings, with a focus on magnetic resonance imaging (MRI). Study Design Narrative review. Methods In this scoping review, the authors reviewed available radiographic, computed tomography, and MRI scans of patients who experienced postoperative complications after ACL reconstruction with LET, in which the complication was determined to be from the LET procedure. Images were reviewed and subsequently described by an on-staff musculoskeletal radiologist. Results The authors found 9 different complications associated with LET: graft failure, hematoma, infection, chronic pain, tunnel convergence, fixation device migration, muscular hernia, peroneal nerve palsy, and knee stiffness. They supplemented these findings with radiographic evidence from 6 patients. Conclusion As extra-articular reconstruction techniques including LET become more popular among orthopaedic surgeons, it is important that radiologists and surgeons be adept at recognizing the normal imaging findings of LET and associated complications.
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Affiliation(s)
- Danielle C. Marshall
- Department of Orthopaedics, University of Miami/Jackson Memorial
Hospital, Miami, Florida, USA
| | - Flavio D. Silva
- Department of Radiology, Grupo Osteomuscular, Fleury Medicine e
Saúde, São Paulo, Brazil
| | - Brandon T. Goldenberg
- Department of Orthopaedics, University of Miami/Jackson Memorial
Hospital, Miami, Florida, USA
| | - Daniel Quintero
- Department of Orthopaedics, University of Miami/Jackson Memorial
Hospital, Miami, Florida, USA
- Department of Radiology, University of Miami/Jackson Memorial
Hospital, Miami, Florida, USA
| | - Michael G. Baraga
- Department of Orthopaedics, University of Miami/Jackson Memorial
Hospital, Miami, Florida, USA
| | - Jean Jose
- Department of Radiology, University of Miami/Jackson Memorial
Hospital, Miami, Florida, USA
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Park JG, Han SB, Rhim HC, Jeon OH, Jang KM. Anatomy of the anterolateral ligament of the knee joint. World J Clin Cases 2022; 10:7215-7223. [PMID: 36158026 PMCID: PMC9353924 DOI: 10.12998/wjcc.v10.i21.7215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/26/2022] [Accepted: 06/03/2022] [Indexed: 02/06/2023] Open
Abstract
Despite remarkable improvements in clinical outcomes after anterior cruciate ligament reconstruction, the residual rotational instability of knee joints remains a major concern. The anterolateral ligament (ALL) has recently gained attention as a distinct ligamentous structure on the anterolateral aspect of the knee joint. Numerous studies investigated the anatomy, function, and biomechanics of ALL to establish its potential role as a stabilizer for anterolateral rotational instability. However, controversies regarding its existence, prevalence, and femoral and tibial insertions need to be addressed. According to a recent consensus, ALL exists as a distinct ligamentous structure on the anterolateral aspect of the knee joint, with some anatomic variations. The aim of this article was to review the updated anatomy of ALL and present the most accepted findings among the existing controversies. Generally, ALL originates slightly proximal and posterior to the lateral epicondyle of the distal femur and has an anteroinferior course toward the tibial insertion between the tip of the fibular head and Gerdy’s tubercle below the lateral tibial plateau.
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Affiliation(s)
- Jun-Gu Park
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul 02841, South Korea
| | - Seung-Beom Han
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul 02841, South Korea
| | - Hye Chang Rhim
- Department of Medicine, MetroWest Medical Center/Tufts University School of Medicine, Framingham, MA 02111, United States
| | - Ok Hee Jeon
- Department of Biomedical Sciences, Korea University College of Medicine, Seoul 02841, South Korea
| | - Ki-Mo Jang
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul 02841, South Korea
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Kang KT, Koh YG, Park KM, Choi CH, Jung M, Cho H, Kim SH. Effects of the Anterolateral Ligament and Anterior Cruciate Ligament on Knee Joint Mechanics: A Biomechanical Study Using Computational Modeling. Orthop J Sports Med 2022; 10:23259671221084970. [PMID: 35400144 PMCID: PMC8988680 DOI: 10.1177/23259671221084970] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 12/22/2021] [Indexed: 11/15/2022] Open
Abstract
Background: Recent studies on lateral knee anatomy have reported the presence of a true ligament structure, the anterolateral ligament (ALL), in the anterolateral region of the knee joint. However, its biomechanical effects have not been fully elucidated. Purpose: To investigate, by using computer simulation, the association between the ALL and anterior cruciate ligament (ACL) under dynamic loading conditions. Study Design: Descriptive laboratory study; Level of evidence, 5. Methods: The authors combined medical imaging from 5 healthy participants with motion capture to create participant-specific knee models that simulated the entire 12 degrees of freedom of tibiofemoral (TF) and patellofemoral (PF) joint behaviors. These dynamic computational models were validated using electromyographic data, muscle activation data, and data from previous experimental studies. Forces exerted on the ALL with ACL deficiency and on the ACL with ALL deficiency, as well as TF and PF contact forces with deficiencies of the ACL, ALL, and the entire ligament structure, were evaluated under gait and squat loading. A single gait cycle and squat cycle were divided into 11 time points (periods 0.0-1.0). Simulated ligament forces and contact forces were compared using nonparametric repeated-measures Friedman tests. Results: Force exerted on the ALL significantly increased with ACL deficiency under both gait- and squat-loading conditions. With ACL deficiency, the mean force on the ALL increased by 129.7% under gait loading in the 0.4 period ( P < .05) and increased by 189% under high flexion during the entire cycle of squat loading ( P < .05). A similar trend of significantly increased force on the ACL was observed with ALL deficiency. Contact forces on the TF and PF joints with deficiencies of the ACL, ALL, and entire ligament structure showed a complicated pattern. However, contact force exerted on TF and PF joints with respect to deficiencies of ACL and ALL significantly increased under both gait- and squat-loading conditions. Conclusion: The results of this computer simulation study indicate that the ACL and the ALL of the lateral knee joint act as secondary stabilizers to each other under dynamic load conditions.
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Affiliation(s)
- Kyoung-Tak Kang
- Department of Mechanical Engineering, Yonsei University, Seoul, Republic of Korea
| | - Yong-Gon Koh
- Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, Seoul, Republic of Korea
| | - Kyoung-Mi Park
- Department of Mechanical Engineering, Yonsei University, Seoul, Republic of Korea
| | - Chong-Hyuk Choi
- Department of Orthopedic Surgery, Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Min Jung
- Department of Orthopedic Surgery, Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyunik Cho
- Department of Orthopedic Surgery, Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung-Hwan Kim
- Department of Orthopedic Surgery, Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
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Niu X, Mai H, Wu T, Jiang Y, Duan X, Liu M, Liu J, Ding L, Ao Y. Reliability of a Novel Automatic Knee Arthrometer for Measuring Knee Laxity After Anterior Cruciate Ligament Ruptures. Orthop J Sports Med 2022; 10:23259671211051301. [PMID: 35187181 PMCID: PMC8855393 DOI: 10.1177/23259671211051301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 07/14/2021] [Indexed: 11/20/2022] Open
Abstract
Background: The accuracy of existing devices for measuring knee laxity is adversely
affected by examiner reliability. Purpose: To compare the accuracy of a novel automatic knee arthrometer (AKA) to that
of the KT-2000 arthrometer for measuring knee laxity after anterior cruciate
ligament (ACL) ruptures. Study Design: Cohort study; Level of evidence, 2. Methods: We measured anterior displacement and the anterior displacement difference
(ADD) at 134 N of anterior force in 221 healthy volunteers and 200 patients
with ACL ruptures. All trials were performed by the same 2 examiners. We
first analyzed the effects of examiner, side assessed, and device type using
the intraclass correlation coefficient (ICC), t test, and
F test. We then used the receiver operating
characteristic curve to compare the diagnostic value of the measurements
between devices. Results: In repeated measurements for a single healthy volunteer, there were no
differences in the variance of the measurements between sides according to
the AKA (standard deviation of right vs left knee for examiner A: 0.43 vs
0.58 mm, respectively [P = .39]; for examiner B: 0.49 vs
0.77 mm, respectively [P = .81]), while the KT-2000
measurements showed differences (standard deviation of right vs left knee
for examiner A: 1.47 vs 0.80 mm, respectively [P = .02];
for examiner B: 1.78 vs 0.91 mm, respectively [P = .01]).
The ADD assessed by the AKA was not significantly different between
examiners A and B (0.50 vs 0.75 mm, respectively; P = .27;
ICC = 0.83), but the KT-2000 showed a difference (1.07 vs 2.01 mm,
respectively; P = .01; ICC = 0.55). The ADD of 20 healthy
volunteers assessed by the AKA was less than that by the KT-2000 (0.98 vs
1.41 mm, respectively; P = .04). When comparing the
diagnostic value of the 2 devices in the sample of 200 patients with ACL
ruptures and 200 healthy controls, the area under the receiver operating
characteristic curve for the AKA was larger than that for the KT-2000 (0.93
vs 0.87, respectively; P ≤ .01), and the threshold values
were 1.75 and 2.73 mm, respectively. Conclusion: The AKA can be used to determine the degree of knee laxity in ACL injuries
and to provide indications for treatment.
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Affiliation(s)
- Xingyue Niu
- Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine, Peking University Third Hospital, Peking University, Beijing, China
| | - Hemuti Mai
- Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine, Peking University Third Hospital, Peking University, Beijing, China
| | - Tong Wu
- Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine, Peking University Third Hospital, Peking University, Beijing, China
| | - Yanfang Jiang
- Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine, Peking University Third Hospital, Peking University, Beijing, China
| | - Xiaoning Duan
- Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine, Peking University Third Hospital, Peking University, Beijing, China
| | - Mengzhen Liu
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Jingyu Liu
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Li Ding
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Yingfang Ao
- Department of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Institute of Sports Medicine, Peking University Third Hospital, Peking University, Beijing, China
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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: 5] [Impact Index Per Article: 1.7] [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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Kim JN, Park HJ, Kim MS, Won SY, Kim M, Park JH, Kim E, Park JY. Prevalence of anterolateral ligament injuries and lateral meniscus tear on MR imaging in patients with both-bundle tear vs. selective bundle incomplete tear of the anterior cruciate ligament. Eur Radiol 2022; 32:3954-3962. [PMID: 35020013 DOI: 10.1007/s00330-021-08472-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 11/17/2021] [Accepted: 11/18/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVES We investigated the prevalence of anterolateral ligament (ALL) injury and lateral meniscus (LM) tear in cases with both-bundle tear and selective bundle incomplete tear of the anterior cruciate ligament (ACL). METHODS A total of 174 cases of magnetic resonance (MR) images that had an ACL tear and underwent arthroscopic ACL reconstruction were retrospectively reviewed. ACL injury was classified into both bundle, anteromedial bundle, and posterolateral bundle (PL) on arthroscopic finding. The ALL was divided into three portions: femoral, meniscal, and tibial. ALL injury was scored into three groups: grade 0 is intact; grade 1 is stranding and edema surrounds the expected location of the ALL; grade 2 is clear discontinuity of the ALL consistent with rupture. Traumatic LM tear was also assessed on MR images. RESULTS The total prevalence of ALL injury was 36.2% (reader 1) and 42.0% (reader 2). ALL injury was statistically related to the selective bundle tear (p = 0.002 and 0.004, readers 1 and 2). PL bundle tear was significantly correlated with the ALL injury (p value < 0.001, readers 1 and 2, both). The location and grade of ALL injury were not significantly correlated with the type of ACL injury. LM tear was not significantly related to the types of ACL tear (p = 0.208 and 0.907, readers 1 and 2) and ALL injury (p value = 0.096 and 0.383, readers 1 and 2). CONCLUSIONS ALL injury was significantly related to the PL bundle tear of the ACL. LM tear was not significantly correlated with the types of ACL injury and ALL injury. KEY POINTS • Anterolateral ligament (ALL) injury was significantly related to the posterolateral bundle (PL) tear of the anterior cruciate ligament (ACL). • Lateral meniscus (LM) tear was not significantly correlated with the types of ACL injury and ALL injury. • Clinicians and radiologists should be aware of these relationships and scrutinize ALL injury in cases with PL bundle tears, even with an incomplete ACL injury.
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Affiliation(s)
- Ji Na Kim
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, #108 Pyung-dong, Jongno-gu, Seoul, 03181, Republic of Korea
| | - Hee Jin Park
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, #108 Pyung-dong, Jongno-gu, Seoul, 03181, Republic of Korea.
| | - Myung Sub Kim
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, #108 Pyung-dong, Jongno-gu, Seoul, 03181, Republic of Korea
| | - So Yeon Won
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, #108 Pyung-dong, Jongno-gu, Seoul, 03181, Republic of Korea
| | - Minchul Kim
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, #108 Pyung-dong, Jongno-gu, Seoul, 03181, Republic of Korea
| | - Jai Hyung Park
- Department of Orthopaedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Eugene Kim
- Department of Orthopaedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ji Yeon Park
- Department of Radiology, Inje University Ilsan Paik Hospital, Goyang, Gyeonggido, Republic of Korea
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Interlinked Hamstrings for Combined Anterolateral and Anterior Cruciate Ligament Reconstruction: A Novel Technique for ALL. Indian J Orthop 2021; 56:621-627. [PMID: 35342523 PMCID: PMC8921427 DOI: 10.1007/s43465-021-00551-x] [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: 05/27/2021] [Accepted: 10/15/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Anterolateral ligament (ALL) reconstruction provides rotational stability in patients undergoing anterior cruciate ligament (ACL) reconstruction. The aim of this study was to assess the outcome of patients who underwent combined ACL and ALL reconstruction with a novel anatomic technique using hamstring tendon autograft and fixed loop suspensory device. METHODS From 2016 to 2018, 25 patients who underwent combined reconstruction of ACL and ALL in our Institution were evaluated retrospectively. International Knee Documentation Committee (IKDC) Score, Tegner Lysholm Knee Score, grade of pivot shift was assessed at a final follow-up. RESULTS Mean follow-up was 31.5 months (28-42). Mean IKDC (81.5) and Tegner Lysholm (82.8) Knee Scores improved significantly at a final follow-up, with all knees demonstrating negative pivot shift. All patients had good outcomes at 2 years follow-up with no graft failure and with no residual instability. CONCLUSION ACL and ALL reconstruction using this technique described for the anterolateral instability of the knee was satisfactory in our patients. This technique is simple, easily reproducible and avoids additional implants for ALL in the tibia. LEVEL OF EVIDENCE IV.
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Suh D, Chang MJ, Park HJ, Chang CB, Kang SB. Assessment of Anterolateral Ligament of the Knee After Primary Versus Revision Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med 2021; 9:23259671211026237. [PMID: 34676268 PMCID: PMC8524717 DOI: 10.1177/23259671211026237] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 02/28/2021] [Indexed: 01/26/2023] Open
Abstract
Background: The anterolateral ligament of the knee (ALL) is a component of the lateral
complex that stabilizes the structure against rotational force and may be
associated with the outcome of anterior cruciate ligament (ACL)
reconstruction (ACLR). Purpose: To (1) find whether the visibility of the structure of the ALL is different
in primary and revision ACLR groups, (2) determine whether the abnormal
findings of the ALL structure on magnetic resonance imaging (MRI) scans are
associated with type of trauma in ACL injury and mode of graft failure, and
(3) determine whether there are differences in knee functional scores
between patients with or without abnormal findings of the ALL structure on
MRI scans in primary and revision ACLR groups. Study Design: Cohort study; Level of evidence, 3. Methods: This retrospective study included 40 patients who underwent primary ACLR and
39 patients who underwent revision ACLR. Conventional MRI (1.5-T) scans
taken before primary or revision ACLR were obtained and analyzed for
visibility of the ALL, frequency and degree of injury of the ALL, and ALL
signal anomalies. We also evaluated 1-year postoperative functional knee
scores using the subjective International Knee Documentation Committee and
Lysholm scores. Results: Visibility of the ALL was better in the primary ACLR group than the revision
ACLR group (38% vs 14%; P = .041). The primary ACLR group
showed a lower degree of injury across the femoral, meniscal, and tibial
attachment sites than did the revision ACLR group (30% vs 13%, 41% vs 8%,
and 62% vs 26%, respectively). Relative signal anomaly of the ALL was more
frequent in the case of contact versus noncontact trauma of the ACL (85% vs
15%; P = .035), while absolute signal anomaly was equally
observed between cases of contact and noncontact trauma in the primary ACLR
group (50% vs 50%). No association was observed between ALL signal anomalies
and 1-year postoperative functional knee scores. Conclusion: The revision ACLR group offered less visibility and showed a tendency for
more frequent, higher degree of injury to the structure of the ALL.
Regardless of observational differences between the 2 groups, no definite
relevance was observed between the image and the functional outcome. For the
assessment of the ALL, routinely performed conventional MRI alone is
insufficient to make a clinical decision.
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Affiliation(s)
- Dongwhan Suh
- Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, College of Medicine, Catholic University of Korea, Daejeon, Republic of Korea
| | - Moon Jong Chang
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyung Jun Park
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chong Bum Chang
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Seung-Baik Kang
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
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Yoon KH, Hwang IU, Kim EJ, Kwon YB, Kim SG. Anterolateral Ligament Reconstruction Improves Anteroposterior Stability As Well As Rotational Stability in Revision Anterior Cruciate Ligament Reconstruction with High-Grade Pivot Shift. J Knee Surg 2021; 34:1310-1317. [PMID: 32369841 DOI: 10.1055/s-0040-1708055] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This study aimed to investigate the effect of anterolateral ligament reconstruction (ALLR) in revision anterior cruciate ligament reconstruction (ACLR) with high-grade pivot shift. The hypothesis was that revision ACLR combined with ALLR (RACLR with ALLR group) would show superior clinical outcomes to those of isolated revision ACLR. We retrospectively evaluated consecutive patients who underwent revision ACLR (RACLR) combined with ALLR between October 2015 and January 2017. The indication for combination of ALLR with revision ACLR was failed ACLR with ≥G2 pivot-shift instability. The control group included patients who underwent isolated revision ACLR (isolated RACLR group) for the same indication between July 2013 and September 2015. Exclusion criteria were ≤G1 pivot-shift instability, multiple ligament reconstruction, bilateral ligament injury, double-bundle reconstruction, insufficient medical records, postoperative infection, and follow-up loss at postoperative 2 years. Clinical scores, stability tests, and failure rates were compared between groups at the 2-year follow-up. The RACLR with ALLR group had 18 patients (mean age, 32.9 ± 10.8 years) and the RACLR group had 21 patients (mean age, 29.6 ± 10.2 years). Clinical scores at the 2-year follow-up showed no significant differences between groups. However, the RACLR with ALLR group showed better stability in the Lachman test (p = 0.005), pivot-shift test (p = 0.030), and side-to-side difference in stress radiographs (3.9 ± 3.0 mm vs. 5.9 ± 2.8 mm, p = 0.018) than the isolated RACLR group. The RACLR with ALLR group had two failures (11.1%), and the RACLR group had three failures (14.3%). In conclusion, ALLR in revision ACLR with high-grade pivot shift improves anteroposterior stability as well as rotational stability at 2-year follow-up. Therefore, ALLR is recommended with revision ACLR, especially in patients with high-grade pivot shift. This is a Level III, retrospective cohort review.
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Affiliation(s)
- Kyoung Ho Yoon
- Department of Orthopaedic Surgery, Kyung Hee University Hospital, Seoul, Korea
| | - In Uk Hwang
- Department of Orthopaedic Surgery, Kyung Hee University Hospital, Seoul, Korea
| | - Eung Ju Kim
- Department of Orthopaedic Surgery, Kyung Hee University Hospital, Seoul, Korea
| | - Yoo Beom Kwon
- Department of Orthopaedic Surgery, Kyung Hee University Hospital, Seoul, Korea
| | - Sang-Gyun Kim
- Department of Orthopaedic Surgery, Korea University Ansan Hospital, Gyeongki-do, Korea
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Ariel de Lima D, de Lima LL, de Souza NGR, de Moraes Perez RA, Sobrado MF, Guimarães TM, Helito CP. Clinical outcomes of combined anterior cruciate ligament and anterolateral ligament reconstruction: a systematic review and meta-analysis. Knee Surg Relat Res 2021; 33:33. [PMID: 34556187 PMCID: PMC8461945 DOI: 10.1186/s43019-021-00115-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/08/2021] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES To compare the clinical outcomes of isolated anterior cruciate ligament (ACL) reconstruction with combined reconstruction of the ACL and anterolateral ligament (ALL) of the knee. METHODS A search was conducted on the PubMed, Medline, Google Scholar, EMBASE, and Cochrane library databases, in line with the PRISMA protocol. The indexation terms used were "anterior cruciate ligament" OR "acl" AND "anterolateral ligament" AND "reconstruction." Articles that compared patients submitted to combined ACL and ALL reconstruction with those submitted to isolated reconstruction of the ACL, with levels of evidence I, II, and III, were included. Studies with follow-up of less than 2 years and articles that did not use "anatomical" techniques for ALL reconstruction, such as extraarticular tenodesis, were excluded. A meta-analysis with R software was conducted, with a random effects model, presented as risk ratio (RR) or mean difference (MD), with a 95% confidence level (CI) and statistically significant at p < 0.05. RESULTS Ten articles were selected, with a total of 1495 patients, most of whom were men, of whom 674 submitted to ACL and ALL reconstruction and 821 to isolated ACL reconstruction. Combined ACL and ALL reconstruction exhibited a statistically significant advantage in residual pivot shift (RR 0.34, 95% CI 0.24-0.47, I2 = 0%, p < 0.01), rerupture rate (RR 0.34, 95% CI 0.19-0.62, I2 = 0%, p < 0.01), Lachman test (RR 0.59, 95% CI 0.40-0.86, I2 = 21%, p < 0.01), and postoperative Lysholm score (MD 2.28, CI 95% 0.75-3.81, I2 = 73%, p < 0.01). CONCLUSIONS Combined ACL and ALL reconstruction obtained better postoperative clinical outcomes when compared with isolated ACL reconstruction, especially in reducing residual pivot shift and rerupture rate.
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Affiliation(s)
- Diego Ariel de Lima
- UFERSA, Universidade Federal Rural do Semi-Árido, R. Francisco Mota, 572, Pres. Costa e Silva, Mossoró, RN, CEP: 59625-900, Brazil. .,Hospital Tarcísio Maia, Mossoró, Brazil.
| | - Lana Lacerda de Lima
- UFERSA, Universidade Federal Rural do Semi-Árido, R. Francisco Mota, 572, Pres. Costa e Silva, Mossoró, RN, CEP: 59625-900, Brazil.,Hospital Tarcísio Maia, Mossoró, Brazil
| | | | | | - Marcel Faraco Sobrado
- USP, Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Hospital Sírio Libanês, São Paulo, Brazil
| | - Tales Mollica Guimarães
- USP, Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Camilo Partezani Helito
- USP, Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Hospital Sírio Libanês, São Paulo, Brazil
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Beckers L, Vivacqua T, Firth AD, Getgood AMJ. Clinical outcomes of contemporary lateral augmentation techniques in primary ACL reconstruction: a systematic review and meta-analysis. J Exp Orthop 2021; 8:59. [PMID: 34383156 PMCID: PMC8360253 DOI: 10.1186/s40634-021-00368-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 06/24/2021] [Indexed: 12/19/2022] Open
Abstract
PURPOSE The purpose of this investigation was to systematically review the contemporary literature to determine if a lateral augmentation (LA) added to an Anterior Cruciate Ligament Reconstruction (ACLR) provides better clinical and patient reported outcomes compared to an isolated ACLR. METHODS A systematic review and meta-analysis was performed according to the Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) criteria. Two authors independently conducted an electronic search using MEDLINE® and Embase® on February 6th, 2021 for level I-III randomized controlled trials (RCT) and prospective cohort studies without randomization, published after 2012 and with a minimum of two year follow-up. Publications were included when they reported on the objective knee stability examination, patient reported outcome scores, return to sports or graft rupture rate of any type of primary, isolated ACLR compared to ACLR combined with any type of LA. RESULTS A total of 11 studies that reported on a combined total of 1892 unique patients were eligible for data extraction, including five RCTs and six prospective cohort studies. In 6 studies, an Anterolateral Ligament reconstruction (ALLR) was the LA of choice, while the 5 other publications used different types of Lateral Extra-articular Tenodesis (LET). A significant reduction in graft ruptures was found in patients treated with ACLR + LA (3%) compared to isolated ACLR (12%). Rotational laxity was significantly higher in isolated ACLR (14%) compared to ACLR + LA (6%). Addition of a LA reduced anterior translation when assessed via instrumented laxity testing. No significant difference was found in the patient reported outcome scores (IKDC and Tegner) between both patient groups, except for the Lysholm Score which was significant in favour of the ACLR + LA group. CONCLUSION Combination of a primary ACLR with a LA can significantly reduce the risk of graft rupture and provide better rotatory stability, without jeopardizing patient reported outcomes. LEVEL OF EVIDENCE Level III, Systematic Review of Level I, II and III studies.
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Affiliation(s)
- Lucas Beckers
- Department of Orthopedic Surgery, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, 3M Centre, 1151 Richmond Street, London, ON, N6A 3K7, Canada
| | - Thiago Vivacqua
- Department of Orthopedic Surgery, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, 3M Centre, 1151 Richmond Street, London, ON, N6A 3K7, Canada
| | - Andrew D Firth
- Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Western Ontario, 3M Centre, 1151 Richmond Street, London, ON, N6A 3K7, Canada
| | - Alan M J Getgood
- Department of Orthopedic Surgery, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, 3M Centre, 1151 Richmond Street, London, ON, N6A 3K7, Canada.
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Yin J, Yang K, Zheng D, Xu N. Anatomic reconstruction of the anterior cruciate ligament of the knee with or without reconstruction of the anterolateral ligament: A meta-analysis. J Orthop Surg (Hong Kong) 2021; 29:2309499020985195. [PMID: 33410381 DOI: 10.1177/2309499020985195] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
PURPOSE To systematically analyze the effectiveness between combined anterior cruciate ligament and anterolateral ligament reconstruction (ACL+ALLR) and isolated anterior cruciate ligament reconstruction (ACLR) for treatment of patients with injured ACL. METHODS We performed a systematic search in MEDLINE, EMBASE, PubMed, Web of Science, Cochrane databases, Chinese Biomedical Literature Database, CNKI, and Wanfang Data for all relevant studies. All statistical analysis was performed using Review Manager version 5.3. RESULTS A total of six articles with 460 study subjects were included, with 193 patients in ACL+ALL reconstruction group and 267 patients in ACL reconstruction group. The results of the meta-analysis showed that the ACL+ALL reconstruction group had significantly lower KT measured value (P < 0.00001), Lachman test positive-rate (P = 0.02), Pivot-shift test positive-rate (P < 0.00001) and graft rupture rate (P = 0.02) compared with the ACL reconstruction group. Higher IKDC score (P < 0.00001) and Lysholm score (P < 0.00001) were measured in ACL+ALL reconstruction group, while infection rate (P = 0.86) and other complications rate (P = 0.29) showed no significant differences between the two groups. CONCLUSIONS Anatomic reconstruction of the ACL of the knee with reconstruction of the ALL indicates better postoperative knee function and clinical outcomes compared with isolated ACL reconstruction. The infection rate and other complications rate showed no significant difference between two groups.
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Affiliation(s)
- Jianjian Yin
- Department of Orthopedics, The Affiliated Changzhou No.2 People's Hospital with Nanjing Medical University, Changzhou, China
| | - Kaiyuan Yang
- Department of Orthopedics, The Affiliated Changzhou No.2 People's Hospital with Nanjing Medical University, Changzhou, China
| | - Dong Zheng
- Department of Orthopedics, The Affiliated Changzhou No.2 People's Hospital with Nanjing Medical University, Changzhou, China
| | - Nanwei Xu
- Department of Orthopedics, The Affiliated Changzhou No.2 People's Hospital with Nanjing Medical University, Changzhou, China
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