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Wang H, Yao G, He K, Wang Z, Cheng CK. ACL reconstruction combined with anterolateral structures reconstruction for treating ACL rupture and knee injuries: a finite element analysis. Front Bioeng Biotechnol 2024; 12:1437684. [PMID: 39170062 PMCID: PMC11337200 DOI: 10.3389/fbioe.2024.1437684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Accepted: 07/12/2024] [Indexed: 08/23/2024] Open
Abstract
Introduction: The biomechanical indication for combining anterolateral structures reconstruction (ASLR) with ACL reconstruction (ACLR) to reduce pivot shift in the knee remains unclear. This study aims to investigate knee functionality after ACL rupture with different combinations of injuries, and to compare the effectiveness of ALSR with ACLR for treating these injuries. Methods: A validated finite element model of a human cadaveric knee was used to simulate pivot shift tests on the joint in different states, including 1) an intact knee; 2) after isolated ACL rupture; 3) after ACL rupture combined with different knee injuries or defect, including a posterior tibial slope (PTS) of 20°, an injury to the anterolateral structures (ALS) and an injury to the posterior meniscotibial ligament of the lateral meniscus (LP); 4) after treating the different injuries using isolated ACLR; v. after treating the different injuries using ACLR with ALSR. The knee kinematics, maximum von Mises stress (Max.S) on the tibial articular cartilage (TC) and force in the ACL graft were compared among the different simulation groups. Results and discussion: Comparing with isolated ACL rupture, combined injury to the ALS caused the largest knee laxity, when a combined PTS of 20° induced the largest Max.S on the TC. The joint stability and Max.S on the TC in the knee with an isolated ACL rupture or a combined rupture of ACL and LP were restored to the intact level after being treated with isolated ACLR. The knee biomechanics after a combined rupture of ACL and ALS were restored to the intact level only when being treated with a combination of ACLR and ALSR using a large graft diameter (6 mm) for ALSR. However, for the knee after ACL rupture combined with a PTS of 20°, the ATT and Max.S on the TC were still greater than the intact knee even after being treated with a combination of ACLR and ALSR. The finite element analysis showed that ACLR should include ALSR when treating ACL ruptures accompanied by ALS rupture. However, pivot shift in knees with a PTS of 20° was not eliminated even after a combined ACLR and ALSR.
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Affiliation(s)
- Huizhi Wang
- School of Biomedical Engineering and Engineering Research Center for Digital Medicine of the Ministry of Education, Shanghai Jiao Tong University, Shanghai, China
- Center for Intelligent Medical Equipment and Devices (iMED), University of Science and Technology of China, Suzhou, Jiangsu, China
| | - Gai Yao
- The Fifth Medial Center of Chinese PLA General Hospital, Beijing, China
| | - Kaixin He
- School of Biomedical Engineering and Engineering Research Center for Digital Medicine of the Ministry of Education, Shanghai Jiao Tong University, Shanghai, China
| | - Zimin Wang
- Department of Orthopedic Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Cheng-Kung Cheng
- School of Biomedical Engineering and Engineering Research Center for Digital Medicine of the Ministry of Education, Shanghai Jiao Tong University, Shanghai, China
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Quinn M, Lemme N, Morrissey P, Fadale P, Owens BD. An Update on Emerging Techniques and Considerations in Revision Anterior Cruciate Ligament Reconstruction. JBJS Rev 2024; 12:01874474-202407000-00007. [PMID: 39018384 DOI: 10.2106/jbjs.rvw.24.00047] [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: 07/19/2024]
Abstract
» The rate of primary anterior cruciate ligament reconstruction (ACLR) failure in at-risk populations remains unacceptably high and necessitates thorough evaluation of native alignment and concomitant injuries.» Posterior tibial slope of >12° is a substantial risk factor of ACLR failure and should be corrected through anterior closing wedge osteotomy.» Varus malalignment of >5° exacerbates stress on the ACL graft, increases ACLR failure risks, and should be considered for correction through high tibial osteotomy at the time of revision ACLR.» Injuries to the anterolateral ligamentous complex are prevalent in ACL ruptures, and high-risk patients have shown benefit from anterolateral ligament reconstruction or lateral extra-articular tenodesis in the revision setting.» Addressing posterolateral corner, collateral ligament, and meniscal injuries, during revision ACLR, is vital to mitigate increased graft forces and optimize knee stability and functional outcomes.
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Affiliation(s)
- Matthew Quinn
- Department of Orthopaedic Surgery, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
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Sonnery-Cottet B, Carrozzo A. Lateral Extra-Articular Tenodesis and Anterolateral Procedures. Clin Sports Med 2024; 43:413-431. [PMID: 38811119 DOI: 10.1016/j.csm.2023.08.008] [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] [Indexed: 05/31/2024]
Abstract
The treatment of rotational instability has been an intriguing challenge since the era of modern anterior cruciate ligament (ACL) surgery. Lateral extra-articular procedures (LEAPs) have emerged as a solution to this problem, particularly in high-risk populations. Several studies have shown significant benefits of combining LEAPs with ACL reconstruction, including reduced graft failure rates, improved knee stability, improved rotational stability, and higher return-to-play rates. These findings have led to an in-depth evaluation of LEAPs as lateral extra-articular tenodesis and anterolateral ligament reconstruction and their potential role in improving outcomes after ACL reconstruction.
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Affiliation(s)
- Bertrand Sonnery-Cottet
- Orthopaedic Surgery, Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | - Alessandro Carrozzo
- Orthopedic Unit, Sant'Andrea University Hospital, La Sapienza University, Rome, Italy.
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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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Helito PVP, Helito CP, Rodrigues MB. Anterolateral ligament MRI of the knee in ACL injuries: MRI abnormalities association with instability. Eur Radiol 2023; 33:1456-1464. [PMID: 35976397 DOI: 10.1007/s00330-022-09062-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 06/11/2022] [Accepted: 07/24/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To evaluate anterolateral ligament abnormalities (ALL) at MRI scans and correlate with data from clinical instability tests (Lachman and pivot shift) performed under anesthesia in patients with acute anterior cruciate ligament (ACL) tears. Furthermore, perform multivariate analysis with other variables to isolate the ALL contribution to instability from other abnormalities. METHODS Retrospective analysis of MRI and instability tests of 95 patients with ACL tears. The ALL was classified as no abnormality, abnormality without discontinuity, and discontinuity. Injuries in other knee ligament structures and menisci were also assessed. Results of instability tests (pivot shift and Lachman) with the patient anesthetized for arthroscopic ACL reconstruction were obtained from the patient database. Statistical analysis was performed using the IBM SPSS 22. RESULTS ALL abnormalities and iliotibial band (ITB), lateral (LCL), and medial (MCL) collateral ligament injuries showed a statistically significant correlation with the pivot shift test. The ALL MRI abnormalities were associated with the high-grade pivot shift results (p < 0.0005), with an odds ratio of 55.9 for high degrees of pivot shift in patients with abnormal ALL. The logistic model for all variables analyzed with the results of the pivot shift test demonstrated that the ALL was the only variable with a statistically significant correlation in the model (p < 0.0005). CONCLUSION MRI ALL abnormalities in patients with ACL injuries have a significant association with pivot shift test results in patients under anesthesia. The logistic model for high - grade pivot shift test results demonstrated that ALL abnormalities were the only variable with significant correlation. KEY POINTS • Evaluating the anterolateral ligament with MRI in acute anterior cruciate ligament injuries is useful to predict higher grades of pivot shift test in the moment of the arthroscopic reconstruction. • An abnormal anterolateral ligament presented an odds ratio of 55 for high degrees of pivot shift. • ALL MRI abnormalities association with knee instability is independent from other internal knee injuries.
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Affiliation(s)
- Paulo Victor Partezani Helito
- Musculoskeletal Radiology Department, Institute of Orthopedics and Traumatology, Faculty of Medicine, University of São Paulo, Rua Dr. Ovídio Pires de Campos, 333, Cerqueira Cesar, São Paulo, 05403-010, Brazil. .,Hospital Sírio-Libanês, São Paulo, Brazil. .,Institute of Radiology; Faculty of Medicine, University of São Paulo, São Paulo, Brazil.
| | - Camilo Partezani Helito
- Hospital Sírio-Libanês, São Paulo, Brazil.,Knee Surgery Division, Institute of Orthopedics and Traumatology, Faculty of Medicine, University of São Paulo, Sâo Paulo, Brazil
| | - Marcelo Bordalo Rodrigues
- Musculoskeletal Radiology Department, Institute of Orthopedics and Traumatology, Faculty of Medicine, University of São Paulo, Rua Dr. Ovídio Pires de Campos, 333, Cerqueira Cesar, São Paulo, 05403-010, Brazil.,Hospital Sírio-Libanês, São Paulo, Brazil.,Institute of Radiology; Faculty of Medicine, University of São Paulo, São Paulo, Brazil
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Soudé G, De Villeneuve Bargemon JB, Khakha R, Pithioux M, Argenson JN, Ollivier M, Jacquet C. Pivot shift intraoperative quantitative assessment using a smartphone accelerometer in ACL deficient knees. J Exp Orthop 2023; 10:6. [PMID: 36695976 PMCID: PMC9877253 DOI: 10.1186/s40634-023-00570-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 01/06/2023] [Indexed: 01/26/2023] Open
Abstract
PURPOSE The Pivot Shift (PS) test is a complex clinical sign that assesses the internal rotation and anterior tibial translation, which occurs abnormally in ACL deficient-knees. Because of the high inter-observer variability, different devices have been designed to characterize this complex movement in quantitative variables. The objective of this pilot study is to validate the reproducibility of intraoperative quantitative assessment of the PS with a smartphone accelerometer. METHODS Twelve ACL-injured knees were included and compared with the contralateral uninjured side. The PS was measured by two independent observers utilizing a smartphone accelerometer and graded according to the IKDC classification. Measurements were taken preoperatively, intraoperatively and postoperatively. Intraoperative readings were taken during each stage of reconstruction or repair of meniscoligamentous lesions including meniscal lesions, ramp lesions, ACL reconstruction and lateral tenodesis. Reproducibility of the measurements were evaluated according to an intraclass correlation coefficient (ICC). RESULTS The intra-observer reliability was good for the first examiner and excellent for the second examiner, with the ICC 0.89 [0.67, 0.98] p < 0,001 and ICC 0.97 [0.91, 1.0] p < 0,001 respectively. The inter-observer reliability was excellent between the two observers with the ICC 0.99 [0.97, 1.0] p < 0,001. The mean tibial acceleration measured 3.45 m.s2 (SD = 1.71) preoperatively on the injured knees and 1.03 m.s2 (SD = 0.36) on the healthy knees, demonstrating a significant difference following univariate analysis p < 0.001. Postoperatively, no significant difference was observed between healthy and reconstructed knees The magnitudes of tibial acceleration values were correlated with the PS IKDC grade. CONCLUSION The smartphone accelerometer is a reproducible device to quantitatively assess the internal rotation and anterior tibial translation during ACL reconstruction surgery. The measurements are influenced by the different surgical steps. Other larger cohort studies are needed to evaluate the specific impact of each step of the ACL reconstruction and meniscal repair on this measurement. An external validation using other technologies are needed to validate the reliability of this device to assess the PS test. LEVEL OF EVIDENCE Level IV, case series, pilot study.
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Affiliation(s)
- Guillaume Soudé
- grid.5399.60000 0001 2176 4817Aix-Marseille University, CNRS, ISM UMR 7287, 13288, cedex 09 Marseille, France ,Department of Orthopedic surgery and Traumatology St. Marguerite Hospital, Institute of movement and locomotion, 270 Boulevard Sainte Marguerite, 29 13274 Marseille, BP France
| | - Jean-Baptiste De Villeneuve Bargemon
- Department of Orthopedic surgery and Traumatology St. Marguerite Hospital, Institute of movement and locomotion, 270 Boulevard Sainte Marguerite, 29 13274 Marseille, BP France ,International Wrist Center, Bizet Clinic, Paris, France
| | - Raghbir Khakha
- grid.420545.20000 0004 0489 3985Guys and St Thomas Hospitals, London, UK
| | - Martine Pithioux
- grid.5399.60000 0001 2176 4817Aix-Marseille University, CNRS, ISM UMR 7287, 13288, cedex 09 Marseille, France ,Department of Orthopedic surgery and Traumatology St. Marguerite Hospital, Institute of movement and locomotion, 270 Boulevard Sainte Marguerite, 29 13274 Marseille, BP France
| | - Jean-Noël Argenson
- grid.5399.60000 0001 2176 4817Aix-Marseille University, CNRS, ISM UMR 7287, 13288, cedex 09 Marseille, France ,Department of Orthopedic surgery and Traumatology St. Marguerite Hospital, Institute of movement and locomotion, 270 Boulevard Sainte Marguerite, 29 13274 Marseille, BP France
| | - Matthieu Ollivier
- grid.5399.60000 0001 2176 4817Aix-Marseille University, CNRS, ISM UMR 7287, 13288, cedex 09 Marseille, France ,Department of Orthopedic surgery and Traumatology St. Marguerite Hospital, Institute of movement and locomotion, 270 Boulevard Sainte Marguerite, 29 13274 Marseille, BP France
| | - Christophe Jacquet
- grid.5399.60000 0001 2176 4817Aix-Marseille University, CNRS, ISM UMR 7287, 13288, cedex 09 Marseille, France ,Department of Orthopedic surgery and Traumatology St. Marguerite Hospital, Institute of movement and locomotion, 270 Boulevard Sainte Marguerite, 29 13274 Marseille, BP France
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The anterolateral capsule is infrequently damaged as evaluated arthroscopically in patients undergoing anatomic ACL reconstruction. J ISAKOS 2022; 7:189-194. [PMID: 35798285 DOI: 10.1016/j.jisako.2022.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 06/21/2022] [Accepted: 06/25/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Concomitant anterolateral complex (ALC) injury may contribute to persistent rotatory knee instability following anterior cruciate ligament (ACL) reconstruction. There is no consensus on how to best identify concomitant ALC injury preoperatively, nor how well ALC injury identified on imaging modalities correlates with clinical examination of knee instability. The purpose of this retrospective study was to determine the incidence of concomitant ALC injury in ACL-injured knees, as determined by arthroscopy to preoperative radiography, ultrasound, and MRI. METHODS A total of 117 patients with a unilateral primary ACL injury who underwent individualized anatomic ACLR between June 2016 and May 2019 were enrolled. Preoperative imaging modalities, including X-ray, ultrasound, and MRI, were evaluated for concomitant ALC injury. Clinical examination under anesthesia, including the anterior drawer, Lachman, and pivot shift tests were performed. Anterolateral capsule injury, as defined by hemorrhage and/or capsular tearing on diagnostic arthroscopy, was also determined. Correlative analyses of ALC injury incidence and severity were performed across imaging modalities and against clinical examination grades. RESULTS ALC injury incidence across imaging modalities was as follows: X-ray (3%), arthroscopy (19%), MRI (53%), and US (63%). The ALC injury rate on arthroscopy was significantly less than MRI (p < 0.001) or ultrasound (p < 0.001). ALC injury incidence and severity were significantly correlated between MRI and US grading scales (p = 0.02), but no correlations among other imaging modalities were found. Similarly, no imaging modality meaningfully correlated with physical examination maneuvers. CONCLUSION The incidence of ALC injury varies across imaging modalities, with lower injury rates found on arthroscopy (19%) compared to MRI (53%) and US (63%). Increasing ALC injury severity grades on imaging does not predict increasing anterolateral knee laxity on clinical examination. LEVEL OF EVIDENCE V, retrospective case series.
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Barahona M, Mosquera M, De Padua V, Galan H, Del Castillo J, Mejias S, Bacarreza F, Araya O, Kuhn A, Vaisman A, Graieb A, Almazan A, Helito C, Fuentes C, Collazo C, Esquivel D, Gigante F, Motta F, Ochoa G, Arteaga G, Ferrer G, Zvietcovich G, Cardona J, Hurtado J, Erlund L, Costa-Paz M, Roby M, Ponzo N, Sarmiento P, Yáñez R, Urbieta S, Marques de Olivera V, Álvaro Zamorano, Radice F, Nardin L, Gelink A, Hernandez R, Rosa ADL, Irarrazaval S, Cordivani F, Canuto S, Gravini G. Latin American formal consensus on the appropriate indications of extra-articular lateral procedures in primary anterior cruciate ligament reconstruction. J ISAKOS 2022:S2059-7754(22)00082-7. [PMID: 36087904 DOI: 10.1016/j.jisako.2022.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/09/2022] [Accepted: 08/29/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVES To create a practice guideline for the appropriate indications of an extra-articular procedure in primary anterior cruciate ligament reconstruction (ACLR). METHODS The formal consensus method described by the Haute Autorité de Santé was used. The Latin American Society of Arthroscopy, Articular Replacement, and Sports Injuries (SLARD) recruited three groups of experts on ACLR. Initially, the steering group, consisting of eight surgeons, performed a systematic review of the literature and elaborated on 192 scenarios for primary ACLR. The rating group, composed of 23 surgeons, rated each scenario in two rounds, with an in-between in-person meeting for discussion. Median scores and agreement levels were estimated to classify each scenario as inappropriate, uncertain or appropriate for adding anterolateral reconstruction. Finally, the lecture group, consisting of 10 surgeons, revised each stage of the method, results and interpretation. RESULTS Of the scenarios, 11.97% were rated as appropriate for adding an extra-articular lateral procedure, 7.81% as inappropriate and 80.21% as uncertain. The key recommendations for the addition of extra-articular lateral techniques were as follows: it is appropriate when the patient is under 25 years of age, has high-grade physical examination findings, practises a pivoting sport and has hyperlaxity; meanwhile, it is inappropriate when the patient has low-grade physical examination findings, has normal laxity and does not practise a pivoting sport. CONCLUSIONS The appropriate indications of extra-articular lateral procedures in primary ACLR were determined on the basis of the best available evidence and expert opinion following a formal consensus method. LEVEL OF EVIDENCE V.
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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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Gupta R, Kapoor A, Singhal A, Patil BM, Bansal P. The presence of high-grade pivot shift test preoperatively is associated with inferior functional outcomes. PHYSICIAN SPORTSMED 2022; 50:306-310. [PMID: 33910466 DOI: 10.1080/00913847.2021.1924047] [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] [Indexed: 10/21/2022]
Abstract
BACKGROUND The effect of high-grade preoperative pivot shift test on outcomes of anterior cruciate ligament (ACL) reconstruction surgery is not very well established. The present study was conducted to study the factors associated with high-grade pivot shift test and effect of high-grade preoperative pivot shift test on functional outcomes after ACL reconstruction surgery. METHODS Three hundred and sixty-two patients who underwent primary ACL reconstruction surgery were enrolled in the study. The pivot shift test was performed preoperatively under anesthesia in all patients. Side of the meniscal tear, if present at the time of ACL reconstruction, was documented. Patients were divided into two groups depending upon the grade of pivot shift test: group H, high-grade pivot shift (n = 84/362; 23%); and group L, low-grade pivot shift (n = 278/362; 77%). Patients were further divided into two groups depending upon the duration of injury: acute (<6 months) and chronic (>6 months). The functional assessment was done using Lysholm score and Tegner activity scale. RESULTS The presence of lateral meniscus tear (27/84 vs. 53/278) or both menisci tear (29/84 vs. 60/278) was associated with high-grade pivot shift (p < 0.05). Chronic ACL tears were also observed to be associated with high-grade pivot shift (p = 0.03). The mean Lysholm score in group H and group L patients was 93.8 ± 5.1 and 95.2 ± 5.3, respectively (p = 0.04). The mean post-op Tegner activity scale in group H was 6.8 and in group L was 7.3 (p = 0.0001). Also, 181/253 (71.5%) patients returned to same or higher level of sports activity in group L as compared to 33/72 (46%) patients in group H. The incidence of graft failure in groups H and L was 6.5% (5/77) and 1.6% (4/257; p = 0.03), respectively. CONCLUSIONS The high-grade pivot shift is associated with chronic ACL tear (>6 months) and concomitant lateral meniscus tear. The presence of high-grade pivot shift preoperatively is associated with inferior clinical outcomes and lower rate of return to sports. LEVEL OF EVIDENCE Level IV, case-control study.
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Affiliation(s)
- Ravi Gupta
- Orthopaedics Cum Project Director Sports Injury Centre and Medical Superintendent, Government Medical College Hospital, Chandigarh, India
| | - Anil Kapoor
- Department of Orthopaedics, Government Medical College Hospital, Chandigarh, India
| | - Akash Singhal
- Department of Orthopaedics, Government Medical College Hospital, Chandigarh, India
| | - Bharath Mali Patil
- Department of Orthopaedics, Government Medical College Hospital, Chandigarh, India
| | - Parth Bansal
- Department of Orthopaedics, Government Medical College Hospital, Chandigarh, India
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Lesmana A, Rivera AA. Association between a Concomitant Anterolateral Ligament Tear and Pivot Shift Before and After Single-Bundle Anterior Cruciate Ligament Reconstruction: A Retrospective Cohort Study. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.9230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Regardless of the type of intra-articular anterior cruciate ligament (ACL) reconstruction performed, a certain degree of rotatory instability is often seen after surgery. Recent studies suggest that the anterolateral ligament (ALL) plays a significant role in maintaining stability during internal rotation of the tibia at high knee flexion angles. Unrecognized damage to the ALL may potentially be associated with a positive pivot shift despite a surgically reconstructed ACL being done.
AIM: The primary objective of this study was to determine whether a concomitant ALL tear is associated with a high-grade pivot shift before and after ACL reconstruction.
METHODS: This study was a retrospective cohort study of patients that underwent single-bundle ACL reconstruction surgery in our institution from October 2014 to March 2017. One hundred and forty-four patients were included in this study. All data were extracted from the department of ACL registry. All knee MRIs were reviewed by the author and coauthor to determine the integrity of the ALL. Subjects were divided into two groups based on the grade of pivot shift before surgery. The prevalence of ALL tear based on MRI was further compared between high-grade and low-grade pivot-shift groups.
RESULTS: Overall, the prevalence of a concomitant ALL tear was 70.83%. Comparing the prevalence of concomitant ALL tear between the high-grade pivot-shift group (73.11%) and low-grade pivot-shift group (60%), we had insufficient evidence to demonstrate an association between pre-surgery high-grade pivot shift and concomitant ALL tear. After surgery, none of the patients had a high-grade pivot shift or was positive for Lachman’s test.
CONCLUSION: There is a high prevalence of concomitant ALL tear in patients with torn ACL. We have insufficient evidence to demonstrate an association between the presence of a torn ALL and high-grade pivot shift before and after single-bundle ACL reconstruction.
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12
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Maestro A, Pipa I, Rodríguez N, Toyos C, Torrontegui-Duarte M, Castaño C. Safety and Performance of Titanium Suture Anchors Used in Knee Ligament Repair Procedures. ACTA ACUST UNITED AC 2021; 57:medicina57030287. [PMID: 33808666 PMCID: PMC8003405 DOI: 10.3390/medicina57030287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 03/10/2021] [Accepted: 03/16/2021] [Indexed: 11/16/2022]
Abstract
Injuries to the knee ligaments can be particularly disabling in young patients, given the risk of long-term disability if adequate fixation is not achieved during initial repair. The TWINFIX™ titanium (Ti) suture anchor with ULTRABRAID™ Suture (Smith and Nephew, London, UK) was designed to secure tendon and ligament reconstructions with increased boney ingrowth at the anchor site with minimal invasive technique. This retrospective analysis looked at 33 patients (41 implants) operated with this device between 2015 and 2019 at a single institution. The average age of patients was 33.18 years (standard deviation [SD], 15.26), with an average body mass index of 24.88 (SD, 3.49). The indications were lateral extra-articular tenodesis during anterior cruciate ligament reconstruction, medial patellofemoral ligament reconstruction, quadriceps or patellar tendon repair and medial collateral ligament repair. After an average follow up of 24.3 + 6.53 months, there was no reports of clinical failure or radiographic evidence of implant failure or loosening. One patient experienced a complication unrelated to the study device, requiring manipulation under anesthesia with resolution of symptoms. This case series supports the safety and performance of this implants for the knee procedures in which its use is indicated. Additional follow-up will be required to determine whether these effects are sustained at medium- and long-term durations.
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Affiliation(s)
- Antonio Maestro
- Hospital Begoña, Avda, Pablo Iglesias 92, 33204 Gijón, Spain; (A.M.); (I.P.); (N.R.); (C.T.)
- Real Sporting Gijon SAD, Camino Mareo-Granda, 645, 33390 Gijon, Spain;
| | - Iván Pipa
- Hospital Begoña, Avda, Pablo Iglesias 92, 33204 Gijón, Spain; (A.M.); (I.P.); (N.R.); (C.T.)
| | - Nicolás Rodríguez
- Hospital Begoña, Avda, Pablo Iglesias 92, 33204 Gijón, Spain; (A.M.); (I.P.); (N.R.); (C.T.)
| | - Carmen Toyos
- Hospital Begoña, Avda, Pablo Iglesias 92, 33204 Gijón, Spain; (A.M.); (I.P.); (N.R.); (C.T.)
| | | | - Cesar Castaño
- Real Sporting Gijon SAD, Camino Mareo-Granda, 645, 33390 Gijon, Spain;
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13
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Chen J, Wang C, Xu C, Qiu J, Xu J, Tsai TY, Zhao J. Effects of Anterolateral Structure Augmentation on the In Vivo Kinematics of Anterior Cruciate Ligament-Reconstructed Knees. Am J Sports Med 2021; 49:656-666. [PMID: 33464924 DOI: 10.1177/0363546520981743] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Double-bundle anterior cruciate ligament (ACL) reconstruction (ACLR) is a well-known treatment that restores the stability of ACL-deficient knees. However, some isolated ACL-reconstructed knees ultimately show rotatory laxity and develop osteoarthritis. Whether combined ACLR with anterolateral structure (ALS) augmentation (ALSA) can provide better improvement in the in vivo knee rotational kinematics remains unknown. HYPOTHESIS When compared with isolated double-bundle ACLR, combined double-bundle ACLR with ALSA can improve knee in vivo rotational kinematics and provide better restoration of knee kinematics. STUDY DESIGN Controlled laboratory study. METHODS Sixteen patients with unilateral ACL injury were randomly divided into 2 groups to receive either combined double-bundle ACLR and ALSA (ALSA group) or isolated double-bundle ACLR (ACLR group). All patients performed a single-leg lunge using the operative and nonoperative/contralateral legs under dual-fluoroscopic imaging system surveillance during a hospital visit at a minimum 1 year (12-13 months) of follow-up to assess the 6 degrees of freedom knee kinematics. Functional evaluation using the Lysholm and Marx rating scales and clinical examinations were also performed. RESULTS From full extension to approximately 90° of knee flexion at 5° intervals, the mean ± SD internal rotation of the reconstructed knees in the ALSA group (1.5°± 0.9°) was significantly smaller than that of the contralateral knees (8.2°± 1.9°; P = .008). The ALSA group knees also showed significantly (P = .045) more medial translation than the contralateral knees. In the ACLR group, the mean internal rotation of the reconstructed knee (6.0°± 2.1°) was significantly smaller than that of the contralateral knees (8.9°± 0.6°; P < .001). At full extension, the tibia was significantly more externally rotated than that of the contralateral legs (0.5°± 7.4° vs 7.6°± 3.4°, P = .049). CONCLUSION When compared with isolated double-bundle ACLR, double-bundle ACLR augmented with ALS reconstruction resulted in anterolateral rotatory overconstraint during the lunge motion. CLINICAL RELEVANCE Additional ALSA of double-bundle ACL-reconstructed knees overconstrained rotatory stability. Therefore, the use of ALSA for ACL-reconstructed knees should be considered with caution for patients with ACL deficiency and anterolateral rotatory instability. Longer-term follow-up to evaluate long-term outcomes and altered kinematics over time is recommended.
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Affiliation(s)
- Jiebo Chen
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Cong Wang
- School of Biomedical Engineering and Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China.,Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China.,Shanghai Key Laboratory of Orthopaedic Implants and Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Caiqi Xu
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jiayu Qiu
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Junjie Xu
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Tsung-Yuan Tsai
- School of Biomedical Engineering and Med-X Research Institute, Shanghai Jiao Tong University, Shanghai, China.,Engineering Research Center of Digital Medicine and Clinical Translation, Ministry of Education, Shanghai, China.,Shanghai Key Laboratory of Orthopaedic Implants and Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinzhong Zhao
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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Ferretti A, Monaco E, Gaj E, Andreozzi V, Annibaldi A, Carrozzo A, Vieira TD, Sonnery-Cottet B, Saithna A. Risk Factors for Grade 3 Pivot Shift in Knees With Acute Anterior Cruciate Ligament Injuries: A Comprehensive Evaluation of the Importance of Osseous and Soft Tissue Parameters From the SANTI Study Group. Am J Sports Med 2020; 48:2408-2417. [PMID: 32631068 DOI: 10.1177/0363546520935866] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Preoperative grade 3 pivot shift has been reported to be associated with higher rates of anterior cruciate ligament (ACL) failure, persistent instability, and inferior patient-reported outcomes. The etiology of a high-grade pivot shift is multifactorial, and numerous factors have been suggested to be responsible. More attention has recently been focused on injury to the anterolateral structures (ALS) as a risk factor for a grade 3 pivot shift. PURPOSE To determine risk factors for grade 3 pivot shift, including soft tissue and osseous parameters. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS A prospective evaluation was undertaken of 200 consecutive patients undergoing acute ACL reconstruction (within 10 days of injury). An open exploration of the lateral side of the injured knee was performed at the time of the index procedure. Details regarding patient and injury characteristics were recorded, as were details of soft tissue injuries, including meniscal tears, ALS lesions, medial collateral ligament tears, and chondral injuries. Osseous parameters (tibial slope and condylar ratios) were determined per established magnetic resonance imaging protocols. A multivariate logistic regression with penalized maximum likelihood was used to identify risk factors associated with International Knee Documentation Committee (IKDC) grade 3 pivot shift. RESULTS The mean ± SD age of the population was 28.3 ± 9.8 years; 67.5% of patients were male. Among patients, 35 (17.5%) had a high-grade pivot shift (IKDC grade 3), and 165 (82.5%) had a low-grade pivot shift (IKDC grades 1 and 2). Univariate and multivariate logistic regression analysis demonstrated that injury to the ALS was the only significant risk factor for grade 3 pivot shift (odds ratio, 13.49; 95% CI, 1.80-1725.53). CONCLUSION This comprehensive evaluation of soft tissue and osseous factors has identified that injury to the ALS is the most important risk factor for grade 3 pivot shift in acute ACL-injured knees.
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Affiliation(s)
- Andrea Ferretti
- Orthopaedic Unit and Kirk Kilgour Sports Injury Centre, Sant'Andrea Hospital, University of Rome La Sapienza, Rome, Italy
| | - Edoardo Monaco
- Orthopaedic Unit and Kirk Kilgour Sports Injury Centre, Sant'Andrea Hospital, University of Rome La Sapienza, Rome, Italy
| | - Edoardo Gaj
- Orthopaedic Unit and Kirk Kilgour Sports Injury Centre, Sant'Andrea Hospital, University of Rome La Sapienza, Rome, Italy
| | - Valerio Andreozzi
- Orthopaedic Unit and Kirk Kilgour Sports Injury Centre, Sant'Andrea Hospital, University of Rome La Sapienza, Rome, Italy
| | - Alessandro Annibaldi
- Orthopaedic Unit and Kirk Kilgour Sports Injury Centre, Sant'Andrea Hospital, University of Rome La Sapienza, Rome, Italy
| | - Alessandro Carrozzo
- Orthopaedic Unit and Kirk Kilgour Sports Injury Centre, Sant'Andrea Hospital, University of Rome La Sapienza, Rome, Italy
| | - Thais Dutra Vieira
- Centre Orthopédique Santy; Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Bertrand Sonnery-Cottet
- Centre Orthopédique Santy; Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Adnan Saithna
- Kansas City University of Medicine and Biosciences, Kansas City, Missouri, USA
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Lôbo CFT, Helito PVP, Bordalo-Rodrigues M, Helito CP. Computed tomography (CT), X-ray, and MRI evaluation of two anterolateral knee reconstruction techniques: lateral extra-articular tenodesis (LET) and the anterolateral ligament (ALL) reconstruction. Skeletal Radiol 2020; 49:1037-1049. [PMID: 32147757 DOI: 10.1007/s00256-020-03402-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 02/08/2020] [Accepted: 02/17/2020] [Indexed: 02/02/2023]
Abstract
The anterolateral ligament (ALL) and capsule of the knee are anatomical structures involved in rotational stability and pivot-shift control. As such, it has been demonstrated that the extra-articular anterolateral procedures improve clinical outcome when performed as an augmentation of the anterior cruciate ligament (ACL) reconstruction in specific groups of patients. This review describes the postoperative imaging findings of two techniques used to perform these procedures, using magnetic resonance imaging (MRI), computed tomography (CT), and radiography. The first technique described is the lateral extra-articular tenodesis (LET), which uses a strip of the iliotibial band that is harvested, passed underneath the lateral collateral ligament (LCL) and fixed posterior, and proximal to the lateral femoral epicondyle (LFE), preserving ITB insertion on Gerdy's tubercle. The second technique described is the ALL reconstruction, a procedure that attempts to recreate the anatomy of the ALL, using most often a gracilis autograft. In this procedure, femoral fixation is performed proximal and posterior to the LFE, and tibial fixation is slightly distal to the joint line, halfway from Gerdy's tubercle to the fibular head. The main objective of this review is to provide an overview of the postoperative imaging aspects of these two procedures with MRI, CT, and radiography and to describe possible complications. As they become more common, it is important for the radiologist and the orthopedic surgeon to understand their particularities in combination with the already well-known ACL reconstruction.
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Affiliation(s)
- Carlos Felipe Teixeira Lôbo
- Grupo de Radiologia Musculo-esquelética, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Paulo Victor Partezani Helito
- Grupo de Radiologia Musculo-esquelética, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
- Hospital Sírio Libanês, São Paulo, Brazil
| | - Marcelo Bordalo-Rodrigues
- Grupo de Radiologia Musculo-esquelética, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
- Hospital Sírio Libanês, São Paulo, Brazil
| | - Camilo Partezani Helito
- Hospital Sírio Libanês, São Paulo, Brazil
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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16
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Zhang Z, Zhang K, Mao B, Lai S, Li J, Fu W. [Research progress in anterolateral ligament of knee]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:643-650. [PMID: 32410434 DOI: 10.7507/1002-1892.201909048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Objective To review research progress in the anterolateral ligament (ALL) of knee, and provide a clinical reference for diagnosis and treatment of ALL injury. Methods The literature on the diagnosis and treatment of ALL injury was widely reviewed. The incidence, anatomy, biomechanics, injury mechanism, and treatment status of ALL were summarized. Results The ALL contributes to the effect of controlling the internal rotation and anterior translation of the tibia, which affects the axial migration of the knee. ALL injury can be diagnosed according to the signs and MRI examination. Currently, no consensus exists for the surgical indications of ALL injury, but most surgeons tend to perform ALL reconstruction in patients requiring anterior cruciate ligament (ACL) reconstruction or revision surgery with higher pivot-shift tests. At present, various techniques have been used for ALL reconstruction, and there is no optimal technique. In addition, the long-term effectiveness of ALL reconstruction is unclear due to the lack of high-quality studies and long-term postoperative follow-up. Conclusion The ALL contributes to maintaining knee stability, and the ALL reconstruction technique and its effectiveness still need further research.
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Affiliation(s)
- Zhong Zhang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Kaibo Zhang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Beini Mao
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Sike Lai
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Jian Li
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Weili Fu
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
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17
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Park YB, Lee HJ, Ro DH, Lee GY, Kim S, Kim SH. Anterolateral ligament injury has a synergic impact on the anterolateral rotatory laxity in acute anterior cruciate ligament-injured knees. Knee Surg Sports Traumatol Arthrosc 2019; 27:3334-3344. [PMID: 30631908 DOI: 10.1007/s00167-019-05347-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 01/04/2019] [Indexed: 01/24/2023]
Abstract
PURPOSE To investigate the prevalence of the anterolateral ligament (ALL) injuries and its role in rotatory laxity in acute anterior cruciate ligament (ACL)-injured knees. METHODS Two-hundred and ninety-six consecutive patients with acute ACL injuries were evaluated retrospectively, excluding those with other ligament injury and undetectable path of ALL in MRI. Patients were divided into two groups based on the degree of ACL injury in arthroscopy (complete versus partial group). Logistic regression and discriminant analysis were performed to assess the risk of pivot shift test. RESULTS A total of 169 patients were included (128 with complete and 41 with partial ACL rupture). Overall, 106/169 (62.7%) of ALL injuries were characterized, 87/128 (67.9%) in complete group, and 19/41 (46.3%) in partial group. The incidence of pivot shift was 120/128 (93.8%) and 14/41 (34.1%) in the complete and partial groups, respectively. The odds ratio in the pivot shift of combined ALL injury was found as 3.8 (95% CI 1.8-8.4) with the overall ACL injury, but higher as 17.1 (95% CI 3.1-96.4) with partial group. Higher grade of pivot shift showed a greater incidence of injury of ALL. Degree of ACL injury and ALL injury allowed 87.0% of correct classification of subsequent anterolateral rotatory laxity. CONCLUSION Injury to the ALL could have a synergetic effect on anterolateral rotatory laxity in acute ACL-injured knee, however, its effect might be minor in case of complete tear. Careful assessment about combined ALL injury should be considered, especially in knees with high-grade pivot shift in acute ACL-injured knees. LEVEL OF EVIDENCE Retrospective prognostic study, Level IV.
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Affiliation(s)
- Yong-Beom Park
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, South Korea
| | - Han-Jun Lee
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, South Korea
| | - Du-Hyun Ro
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-Gu, Seoul, 03080, South Korea
| | - Geun Young Lee
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, South Korea
| | - Sujin Kim
- Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, South Korea
| | - Seong Hwan Kim
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, South Korea. .,Orthopedic Department, Centre Hospitalier de Versailles, Le Chesnay, France.
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18
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Andrade R, Rebelo-Marques A, Bastos R, Zaffagnini S, Seil R, Ayeni OR, Espregueira-Mendes J. Identification of Normal and Injured Anterolateral Ligaments of the Knee: A Systematic Review of Magnetic Resonance Imaging Studies. Arthroscopy 2019; 35:1594-1613.e1. [PMID: 31000390 DOI: 10.1016/j.arthro.2018.10.120] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 10/22/2018] [Accepted: 10/25/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To identify the normal and injured magnetic resonance imaging appearance of the anterolateral ligament (ALL). METHODS A systematic review was performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The PubMed and Cochrane Library electronic databases were used to search for studies that reported the imaging outcomes of the appearance of the ALL. Two authors performed the searches in duplicate up to April 30, 2018, and interobserver agreement was calculated. The methodologic quality of included articles was assessed using an adaptation of the Arrivé methodologic quality scale for clinical studies of radiologic examinations. RESULTS From the original 270 records, a total of 24 studies (κ = 0.94) comprising 2,427 knees in 2,388 patients (mean age, 33.3 years; 66% male patients; 63% with anterior cruciate ligament [ACL] injury) were included. The ALL appeared in 51% to 100% of all assessed knees (71%-100% in ACL-injured knees and 64%-97% in uninjured knees) and was injured in 11% to 79% of ACL-injured knees. Reliability rates varied considerably (0.04-1.0 for intraobserver and 0.143-1.0 for interobserver agreement), and the entire portion of the ligament was often not seen. The tibial insertion was seen in 21% to 96% of cases, followed by the meniscal (range, 0%-100%) and femoral (range, 0%-90%) insertions. The mean methodologic quality score was 5.1 ± 1.8 out of a possible score of 9. CONCLUSIONS High variability was found in the identification of normal and injured ALL definition methods and the respective magnetic resonance imaging findings. Reliability rates varied considerably, and the entire portion of the ligament was often not seen. LEVEL OF EVIDENCE Level IV, systematic review of Level II to IV studies.
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Affiliation(s)
- Renato Andrade
- Clínica do Dragão, Espregueira-Mendes Sports Centre-FIFA Medical Centre of Excellence, Porto, Portugal; Dom Henrique Research Centre, Porto, Portugal; Faculty of Sports, University of Porto, Porto, Portugal
| | - Alexandre Rebelo-Marques
- Clínica do Dragão, Espregueira-Mendes Sports Centre-FIFA Medical Centre of Excellence, Porto, Portugal; Dom Henrique Research Centre, Porto, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal; Instituto de Investigação Clínica e Biomédica de Coimbra (iCBR), Coimbra, Portugal
| | - Ricardo Bastos
- Clínica do Dragão, Espregueira-Mendes Sports Centre-FIFA Medical Centre of Excellence, Porto, Portugal; Dom Henrique Research Centre, Porto, Portugal; Fluminense Federal University, Niteroi, Brazil
| | - Stefano Zaffagnini
- Rizzoli Orthopaedic Institute, University of Bologna, Bologna, Italy; Second Orthopaedic and Traumatology Clinic, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Romain Seil
- Département de l'Appareil Locomoteur, Centre Hospitalier de Luxemburg, Luxembourg, Luxembourg; Sports Medicine Research Laboratory, Luxembourg Institute of Health, Luxembourg, Luxembourg
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - João Espregueira-Mendes
- Clínica do Dragão, Espregueira-Mendes Sports Centre-FIFA Medical Centre of Excellence, Porto, Portugal; Dom Henrique Research Centre, Porto, Portugal; Orthopaedics Department of Minho University, Minho, Portugal; 3B's Research Group-Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, Barco, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga, Portugal.
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Vaudreuil NJ, Rothrauff BB, de Sa D, Musahl V. The Pivot Shift: Current Experimental Methodology and Clinical Utility for Anterior Cruciate Ligament Rupture and Associated Injury. Curr Rev Musculoskelet Med 2019; 12:41-49. [PMID: 30706283 PMCID: PMC6388573 DOI: 10.1007/s12178-019-09529-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW The purpose of this manuscript is to (1) examine the history, techniques, and methodology behind quantitative pivot shift investigations to date and (2) review the current status of pivot shift research for its clinical utility for management of anterior cruciate ligament (ACL) rupture with associated injuries including the anterolateral complex (ALC). RECENT FINDINGS The pivot shift is a useful physical exam maneuver for diagnosis of rotatory instability related to ACL tear. Recent evidence suggests that the pivot shift is multifactorial and can be seen in the presence of ACL tear with concomitant injury to secondary stabilizers or with predisposing anatomical factors. The presence of a pivot shift post-operatively is associated with poorer outcomes after ACL reconstruction. Recent clinical and biomechanical investigations can help guide clinicians in utilizing pivot shift in diagnosis and surgical planning. Further research is needed to clarify optimal management of ALC in addition to ACL injury.
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Affiliation(s)
- Nicholas J Vaudreuil
- Department of Orthopaedic Surgery, UPMC Rooney Sports Complex, University of Pittsburgh Medical Center, 3200 S. Water St., Pittsburgh, PA, 15203, USA
| | - Benjamin B Rothrauff
- Department of Orthopaedic Surgery, UPMC Rooney Sports Complex, University of Pittsburgh Medical Center, 3200 S. Water St., Pittsburgh, PA, 15203, USA
| | - Darren de Sa
- Department of Orthopaedic Surgery, UPMC Rooney Sports Complex, University of Pittsburgh Medical Center, 3200 S. Water St., Pittsburgh, PA, 15203, USA
| | - Volker Musahl
- Department of Orthopaedic Surgery, UPMC Rooney Sports Complex, University of Pittsburgh Medical Center, 3200 S. Water St., Pittsburgh, PA, 15203, USA.
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Dejour D, Pungitore M, Valluy J, Nover L, Saffarini M, Demey G. Preoperative laxity in ACL-deficient knees increases with posterior tibial slope and medial meniscal tears. Knee Surg Sports Traumatol Arthrosc 2019; 27:564-572. [PMID: 30269166 DOI: 10.1007/s00167-018-5180-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 09/20/2018] [Indexed: 01/26/2023]
Abstract
PURPOSE The aim of this study was to determine patient and anatomic factors that influence anteroposterior and rotational laxity in knees with ACL tears. Based on the findings of biomechanical studies, we hypothesized that static and dynamic anterior tibial translation (ATT) as well as positive pivot shift would increase with female gender, tibial slope, and meniscal tears. METHODS The authors prospectively collected preoperative data and intraoperative findings of 417 patients that underwent ACL reconstruction. The exclusion criteria were: revision ACL procedures (n = 53), other surgical antecedents (n = 27), prior osteotomies (n = 7) or concomitant ligament tears on the ipsilateral knee (n = 34), and history of ACL tears in the contralateral knee (n = 45), leaving a study cohort of 251 patients. Their preoperative anteroposterior knee laxity was assessed objectively using 'static' monopodal weight-bearing radiographs and 'dynamic' instrumented differential measurements of ATT. Rotational laxity was assessed subjectively using the pivot shift test. RESULTS Multivariable regression showed that static ATT increases only with tibial slope (β = 0.30; p < 0.001), but dynamic ATT increases with tibial slope (β = 0.19; p = 0.041), medial meniscal tears (β = 1.27; p = 0.007), complete ACL tears (β = 2.06; p < 0.001), and to decrease with age (β = - 0.09; p < 0.001). Multivariable regression also indicated that high-grade pivot shift decreases with age (OR 0.94; p < 0.001) and for women (OR 0.25; p < 0.001), and to be higher for knees with complete ACL tears (OR 3.04; p = 0.002) or medial meniscal tears (OR 2.28; p = 0.010). CONCLUSION Contrary to expectations based on biomechanical studies, static ATT was only affected by high posterior tibial slope, while dynamic ATT was affected by both high posterior tibial slopes and medial meniscal tears, but not by gender or lateral meniscal tears. Likewise, pivot shift was affected by gender and medial meniscal tears, but not lateral meniscal tears or posterior tibial slope. These findings are relevant to guide surgeons in optimizing their surgical procedures, such as conserving the menisci when possible, and rehabilitation protocols, by delaying full weight-bearing and return to sports in patients with anatomic and lesional risk factors. LEVEL OF EVIDENCE Cohort study, Level IV.
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Affiliation(s)
- David Dejour
- Lyon-Ortho-Clinic, Clinique de la Sauvegarde, 8 Avenue Ben Gourion, 69009, Lyon, France
| | - Marco Pungitore
- Lyon-Ortho-Clinic, Clinique de la Sauvegarde, 8 Avenue Ben Gourion, 69009, Lyon, France
| | - Jeremy Valluy
- ReSurg SA, Chemin de Vuarpilliere 35, 1260, Nyon, Switzerland
| | - Luca Nover
- ReSurg SA, Chemin de Vuarpilliere 35, 1260, Nyon, Switzerland
| | - Mo Saffarini
- ReSurg SA, Chemin de Vuarpilliere 35, 1260, Nyon, Switzerland.
| | - Guillaume Demey
- Lyon-Ortho-Clinic, Clinique de la Sauvegarde, 8 Avenue Ben Gourion, 69009, Lyon, France
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Abstract
Despite several previous articles in the literature, never before have so many studies with regard to anterolateral knee structures been performed. The anterolateral knee complex consists briefly of the iliotibial band, with its proximal and distal attachments, the joint capsule, and the anterolateral ligament (ALL). The recently introduced ALL has several different descriptions, making it difficult to build a consensus with regard to its anatomy. An extensive description of these structures, particularly the iliotibial band and the ALL, with regard to anatomy and imaging, will be provided in this article.
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Affiliation(s)
- Camilo P. Helito
- Hospital Sírio-Libanês
- Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo
| | - Paulo V.P. Helito
- Hospital Sírio-Libanês
- Grupo de Radiologia Musculo-esquelética, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo-SP, Brazil
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Lee DW, Lee JH, Kim JN, Moon SG, Kim NR, Kim DH, Kim JG. Evaluation of Anterolateral Ligament Injuries and Concomitant Lesions on Magnetic Resonance Imaging After Acute Anterior Cruciate Ligament Rupture. Arthroscopy 2018; 34:2398-2406. [PMID: 29730210 DOI: 10.1016/j.arthro.2018.02.048] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Revised: 02/17/2018] [Accepted: 02/17/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the prevalence and characteristics of anterolateral ligament (ALL) injuries with a ruptured acute anterior cruciate ligament (ACL) and to analyze the presence of concomitant bone contusions and meniscal lesions. METHODS From March 2015 to March 2017, we retrospectively analyzed 378 patients who underwent primary ACL reconstructions. Using magnetic resonance imaging, we evaluated the presence of ALL injury and concomitant lesions within 3 weeks of the injury. Meniscal tears were also identified on representative arthroscopic images. RESULTS Following the inclusion criteria, we included a total of 275 patients in this study. The mean duration from ACL rupture to magnetic resonance imaging examination was 5.0 ± 6.0 days. We visualized ALL in 98.2% of patients, of whom 64% had ALL injuries (10.9%, 4.7%, and 48.4% were complete ruptures, Segond fracture, and partial ruptures, respectively). We found that ALL injuries were most commonly found in the femoral location. The intra- and interobserver agreement on the severity of ALL injury (κ = 0.83 and 0.81, respectively) and the location of ALL injury (κ = 0.85 and 0.84, respectively) were excellent. The association between ALL injury and lateral meniscal lesions was significant (P = .03). In particular, the proportion of the lateral meniscal posterior horn radial tears was significantly larger in nonintact ALL than in intact ALL (P = .042). The correlation between the severity of ALL injury and the degree of bone contusion at lateral compartments was significant but weak (P < .001). CONCLUSIONS We found that more than half of acute ACL ruptures have ALL injuries. The presence of ALL injury was significantly associated with the presence of lateral meniscal lesions, especially lateral meniscal posterior horn radial tears, or lateral bone contusions. Interestingly, the severity of ALL injury significantly correlated with the degree of lateral bone contusions. LEVEL OF EVIDENCE Level III, diagnostic cross-sectional study.
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Affiliation(s)
- Dhong Won Lee
- Department of Orthopaedic Surgery, KonKuk University Medical Center, Seoul, Republic of Korea
| | - Ji Hwan Lee
- Department of Orthopaedic Surgery, KonKuk University Medical Center, Seoul, Republic of Korea
| | - Ji Nam Kim
- Department of Orthopaedic Surgery, KonKuk University Medical Center, Seoul, Republic of Korea
| | - Sung Gyu Moon
- Department of Radiology, KonKuk University Medical Center, Seoul, Republic of Korea
| | - Na Ra Kim
- Department of Radiology, KonKuk University Medical Center, Seoul, Republic of Korea
| | - Du Han Kim
- Department of Orthopaedic Surgery, KonKuk University Medical Center, Seoul, Republic of Korea
| | - Jin Goo Kim
- Department of Orthopaedic Surgery, KonKuk University Medical Center, Seoul, Republic of Korea.
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