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World J Orthop. Aug 18, 2022; 13(8): 679-692
Published online Aug 18, 2022. doi: 10.5312/wjo.v13.i8.679
Anterolateral complex of the knee: State of the art
Luigi Sabatini, Marcello Capella, Daniele Vezza, Luca Barberis, Daniele Camazzola, Salvatore Risitano, Luca Drocco, Alessandro Massè
Luigi Sabatini, Marcello Capella, Daniele Vezza, Luca Barberis, Daniele Camazzola, Salvatore Risitano, Luca Drocco, Alessandro Massè, Department of Orthopaedics and Traumatology, Università degli Studi di Torino, Torino 10126, Italy
Author contributions: Sabatini L provided the input in writing the paper; Risitano S, Drocco L, and Capella M collected the literature review; Vezza D, Barberis L, and Camazzola D wrote the paper; Massè A coordinated the writing of the paper.
Conflict-of-interest statement: All authors report no relevant conflict of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Luigi Sabatini, MD, Doctor, Surgeon, Department of Orthopaedics and Traumatology, Università degli Studi di Torino, Via Zuretti 29, Torino 10126, Italy. luigisabatini.ort@gmail.com
Received: December 28, 2021
Peer-review started: December 28, 2021
First decision: February 21, 2022
Revised: May 7, 2022
Accepted: July 24, 2022
Article in press: July 24, 2022
Published online: August 18, 2022
Processing time: 231 Days and 0.7 Hours
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.

Keywords: Knee; Knee dislocation; Anterior cruciate ligament reconstruction; Fascia lata; Tenodesis; Joint instability

Core Tip: Residual rotatory instability is present in a significant percentage of patients who underwent anterior cruciate ligament (ACL) reconstruction. Regardless of the injured structure of the anterolateral complex involved, whether the anterolateral ligament itself or different iliotibial band layers, the combination of a lateral extra-articular tenodesis technique has proven to be a safe, easily reproducible, and effective practice in reducing tibial internal rotation, improving ACL graft survival, reducing the overall reintervention rate, and improving the rate of return to previous athletic activity.