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Rodriguez AN, Liechti DJ, LaPrade RF. Open Popliteus Tendon Reconstruction Using a Hamstring Tendon Autograft. Arthrosc Tech 2023; 12:e453-e457. [PMID: 37138686 PMCID: PMC10149783 DOI: 10.1016/j.eats.2022.11.028] [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: 09/17/2022] [Accepted: 11/10/2022] [Indexed: 05/05/2023] Open
Abstract
The popliteus tendon plays a critical role in restraining the tibia against external rotation. It is often injured in the setting of posterolateral corner injuries. However, it is rarely injured in isolation from other structures of the posterolateral corner. This Technical Note describes an open anatomic reconstruction of the popliteus tendon. Although several techniques exist, this technique has been biomechanically validated and shown to have good outcomes. An early rehabilitation protocol focused on protected range of motion, edema control, quadriceps strengthening, and pain control is essential for maximizing patient outcomes.
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Affiliation(s)
| | | | - Robert F. LaPrade
- Address correspondence to Robert F. LaPrade, M.D., Ph.D., Twin Cities Orthopedics, Edina-Crosstown, 4010 W 65th St, Edina, MN 55435.
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Shiwaku K, Kamiya T, Suzuki D, Yamakawa S, Otsubo H, Suzuki T, Takahashi K, Okada Y, Teramoto A, Ohnishi H, Fujie H, Yamashita T. The Role of the Medial Meniscus in Anterior Knee Stability. Orthop J Sports Med 2022; 10:23259671221132845. [PMID: 36389621 PMCID: PMC9663633 DOI: 10.1177/23259671221132845] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 08/12/2022] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Few studies have compared the force distribution between the anterolateral, posterolateral, and medial structures of the knee. PURPOSE To investigate the important structures in an intact knee contributing to force distribution in response to anterior tibial load. STUDY DESIGN Controlled laboratory study. METHODS Nine fresh-frozen cadaveric knee specimens underwent robotic testing. First, 100 N of anterior tibial load was applied to the intact knee at 0°, 15°, 30°, 60°, and 90° of knee flexion. The anterior cruciate ligament (ACL), anterolateral capsule, lateral collateral ligament, popliteal tendon, posterior root of the lateral meniscus, superficial medial collateral ligament, posterior root of the medial meniscus (MM), and posterior cruciate ligament were then completely transected in sequential order. After each transection, the authors reproduced the intact knee motion when a 100-N anterior tibial load was applied. By applying the principle of superposition, the resultant force of each structure was determined based on the 6 degrees of freedom force/torque data of each state. RESULTS At every measured knee flexion angle, the resultant force of the ACL was the largest of the tested structures. At knee flexion angles of 60° and 90°, the resultant force of the MM was larger than that of all other structures with the exception of the ACL. CONCLUSION The MM was identified as playing an important role in response to anterior tibial load at 60° and 90° of flexion. CLINICAL RELEVANCE In clinical settings, the ACL of patients with a poorly functioning MM, such as tear of the MM posterior root, should be monitored considering the large resultant force in response to an anterior tibial load.
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Affiliation(s)
- Kousuke Shiwaku
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Tomoaki Kamiya
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Daisuke Suzuki
- Department of Health Science, Hokkaido Chitose College of Rehabilitation, Chitose, Japan
| | - Satoshi Yamakawa
- Department of Sports Medical Biomechanics, Graduate School of Medicine, Osaka University, Osaka, Japan
| | | | | | - Katsunori Takahashi
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Yohei Okada
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Atsushi Teramoto
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Hirofumi Ohnishi
- Department of Public Health, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Hiromichi Fujie
- Department of Mechanical Engineering, Graduate School of Science and Engineering, Tokyo Metropolitan University, Tokyo, Japan
| | - Toshihiko Yamashita
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
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van der Wal WA, Meijer DT, Hoogeslag RAG, LaPrade RF. Meniscal Tears, Posterolateral and Posteromedial Corner Injuries, Increased Coronal Plane, and Increased Sagittal Plane Tibial Slope All Influence Anterior Cruciate Ligament-Related Knee Kinematics and Increase Forces on the Native and Reconstructed Anterior Cruciate Ligament: A Systematic Review of Cadaveric Studies. Arthroscopy 2022; 38:1664-1688.e1. [PMID: 34883197 DOI: 10.1016/j.arthro.2021.11.044] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 10/27/2021] [Accepted: 11/29/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To obtain a comprehensive list of pathologies that cause increased anterior cruciate ligament (ACL) forces and pathologic knee kinematics to evaluate for in both primary and revision ACL reconstruction to decrease the risk of subsequent graft overload. METHODS An electronic search was performed in the Embase and MEDLINE databases for the period between January 1, 1990, and December 10, 2020. All articles investigating medial and lateral meniscal injury, (postero)lateral corner injury, (postero)medial corner/medial collateral ligament injury, valgus alignment, varus alignment, and tibial slope in relation to ACL (graft) force and knee kinematics were included. RESULTS Data of 43 studies were included. The studies reported that high-volume medial and lateral meniscectomies, peripheral meniscus tears, medial meniscus ramp tears, lateral meniscus root tears, posterolateral corner injuries, medial collateral ligament tears, increased tibial slope, and valgus and varus alignment were reported to have a significant impact on ACL (graft) force and related knee kinematics. CONCLUSIONS This systematic review on biomechanical cadaver studies provides a rationale to systematically identify and treat pathologies in ACL-injured knees, because when undiagnosed or left untreated, these specific concomitant pathologies could lead to ACL graft overload in both primary and revision ACL-reconstructed knees. CLINICAL RELEVANCE it is necessary that orthopaedic surgeons who treat ACL-injured knees understand the surgically relevant biomechanical consequences of additional pathologies and use this knowledge to optimize treatment in ACL-injured patients.
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Affiliation(s)
| | - Diederik T Meijer
- Department of Orthopedic Surgery, Amsterdam UMC, Amsterdam, The Netherlands
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Mutou M, Abe Y, Kataoka H, Fuzisawa T, Takahashi Y. Anatomical reconstruction of the Posterolateral Corner of the knee preserving dynamic function of the popliteus tendon complex. Asia Pac J Sports Med Arthrosc Rehabil Technol 2022; 28:1-5. [PMID: 35355686 PMCID: PMC8927785 DOI: 10.1016/j.asmart.2022.02.001] [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: 04/06/2021] [Revised: 01/01/2022] [Accepted: 02/11/2022] [Indexed: 11/28/2022] Open
Abstract
Almost cases of Posterolateral Corner (PLC) injuries are combined injuries involving the anterior or posterior cruciate ligament. Although numerous techniques of PLC reconstruction have been reported, it is unknown whether these techniques reconstruct PLC sufficiently. The anatomy of PLC is complex of tendon-muscle and ligament. The major structures are the fibular collateral ligament (FCL) and the Popliteus Tendon Complex. The latter comprises the popliteus tendon-muscle and the popliteo-fibular ligament (PFL). The FCL and PFL are static stabilizers, whereas the popliteus tendon-muscle is a dynamic stabilizer. The most of current PLC reconstructions statically restore all component parts, therefore not true “anatomically”. We describe an operative technique to reconstruct PLC anatomically. Our technique preserves dynamic stability of the popliteus tendon-muscle and reconstructs the PFL and FCL selectively.Semitendinosus tendon is harvested, and almost used for the anterior or posterior cruciate ligament reconstruction. Gracilis tendon or contralateral semitendinosus tendon is used for PLC. Femoral bone tunnel for FCL is prepared at anatomical insertion. Fibular bone tunnel is prepared to connect PFL insertion with FCL insertion. One end of the graft is sutured to the popliteus tendon. The other end is passed though the fibular tunnel, and fixed at the femoral tunnel. The interference screws are used at each tunnel. One half of the graft composes PFL part, the other half composes FCL part. Advantages of this technique are preservation of dynamic popliteus tendon-muscle function, and simplifying preparation.
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Key Words
- ACL, anterior cruciate ligament
- Anatomical reconstruction
- FCL, fibular collateral ligament
- ITB, iliotibial band
- MRI, magnetic resonance imaging
- PCL, posterior cruciate ligament
- PFL, popliteo-fibular ligament
- PLC, posterolateral corner
- PLLA, poly-L-lactic acid
- Popliteo-fibular ligament
- Popliteus tendon complex
- Popliteus tendon-muscle
- Posterolateral corner
- ROM, range of motion
- ST tendon, semitendinosus tendon
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Affiliation(s)
- Masanori Mutou
- Department of Orthopaedic Surgery, Saiseikai Shimonoseki General Hospital, 8-5-1, Yasuoka-cho, Shimonoseki, 759-6603, Japan
- Corresponding author.
| | - Yukio Abe
- Department of Orthopaedic Surgery, Saiseikai Shimonoseki General Hospital, 8-5-1, Yasuoka-cho, Shimonoseki, 759-6603, Japan
| | - Hideo Kataoka
- Department of Orthopaedic Surgery, Saiseikai Shimonoseki General Hospital, 8-5-1, Yasuoka-cho, Shimonoseki, 759-6603, Japan
| | - Takenobu Fuzisawa
- Department of Orthopaedic Surgery, Saiseikai Shimonoseki General Hospital, 8-5-1, Yasuoka-cho, Shimonoseki, 759-6603, Japan
| | - Youhei Takahashi
- Department of Orthopaedic Surgery, Saiseikai Shimonoseki General Hospital, 8-5-1, Yasuoka-cho, Shimonoseki, 759-6603, Japan
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Ferle M, Guo R, Hurschler C. The Laxity of the Native Knee: A Meta-Analysis of in Vitro Studies. J Bone Joint Surg Am 2019; 101:1119-1131. [PMID: 31220029 DOI: 10.2106/jbjs.18.00754] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Although soft-tissue balancing plays an important role in knee arthroplasty, we are aware of no objective target parameters describing the soft-tissue tension of the native knee. In the present study, we aimed to meta-analyze data from studies investigating native knee laxity to create a guide for creating a naturally balanced knee joint. METHODS PubMed and Web of Science were searched for studies with laxity data published from 1996 through 2016. Graphs were digitally segmented in cases in which numerical data were not available in text or table form. Three-level random-effects meta-analyses were conducted. RESULTS Seventy-six studies evaluating knee laxity at various flexion angles (0° to 90°) were included. Knee laxity was significantly different between 0° and 90° of flexion (p < 0.001) in all 6 testing directions, with mean differences of 0.94 mm and -0.35 mm for anterior and posterior translation, 1.61° and 4.25° for varus and valgus rotation, and 1.62° and 6.42° for internal and external rotation, respectively. CONCLUSIONS Knee laxity was dependent on the flexion angle of the knee joint in all degrees of freedom investigated. Furthermore, asymmetry between anterior-posterior, varus-valgus, and internal-external rotation was substantial and depended on the joint flexion angle. CLINICAL RELEVANCE If the goal of knee arthroplasty is to restore the kinematics of the knee as well as possible, pooled laxity data of the intact soft tissue envelope could be useful as a general guide for soft-tissue balancing in total knee arthroplasty.
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Affiliation(s)
- Manuel Ferle
- Laboratory for Biomechanics and Biomaterials, Hannover Medical School, Hannover, Germany
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Midterm outcomes following anatomic-based popliteus tendon reconstructions. Knee Surg Sports Traumatol Arthrosc 2018; 26:812-818. [PMID: 28084495 DOI: 10.1007/s00167-016-4382-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 11/15/2016] [Indexed: 11/27/2022]
Abstract
PURPOSE The purpose of this study was to document subjective outcomes following anatomic-based reconstruction of the popliteus tendon when the popliteus tendon was the only injured posterolateral knee structure. It was hypothesized that popliteus tendon reconstruction would result in improved patient outcomes after surgery regardless of the concurrent ligamentous or intra articular pathology. METHODS A consecutive series of 5 patients with a median age of 23 years (range, 22-36 years) who underwent anatomic popliteus tendon reconstruction along with concomitant ligament reconstruction or meniscus repair (if needed) were included in this study. All patients completed pre-operative and post-operative subjective questionnaires, which included the Lysholm score to document function, the Tegner activity scale to document activity level, and a patient satisfaction with outcome question. RESULTS All patients were available for a final follow-up at a median time of 2.8 years (range, 2-3.9 years) following the index surgery. Three patients had a combined popliteus tendon and posterior cruciate ligament reconstruction. Two of the three PCL reconstructions were revision procedures. The Lysholm score improved to from 53 (range, 34-90) to 91 (range, 44-100) at post-operative follow-up. The median pre-operative Tegner activity scale improved from 3 (range, 0-9) to a median score of 4.8 (range, 2-7) at post-operative follow-up. The median patient satisfaction with outcome was 9 (range, 7-10). The dial test at 30° and 90° improved in all patients following surgery. CONCLUSIONS Anatomic-based popliteus tendon reconstructions resulted in improved outcomes and a high patient satisfaction in patients with a complete tear of the popliteus tendon and symptomatic knee instability. LEVEL OF EVIDENCE IV, case series.
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Bates NA, Nesbitt RJ, Shearn JT, Myer GD, Hewett TE. The influence of internal and external tibial rotation offsets on knee joint and ligament biomechanics during simulated athletic tasks. Clin Biomech (Bristol, Avon) 2018; 52:109-116. [PMID: 29425835 PMCID: PMC5835205 DOI: 10.1016/j.clinbiomech.2018.01.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 01/16/2018] [Accepted: 01/22/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Following anterior cruciate ligament injury and subsequent reconstruction transverse plane tibiofemoral rotation becomes underconstrained and overconstrained, respectively. Conflicting reports exist on how rotations influence loading at the knee. This investigation aimed to determine the mechanical effects of internal and external tibial rotation offsets on knee kinematics and ligament strains during in vitro simulations of in vivo recorded kinematics. METHOD A 6-degree-of-freedom robotic manipulator arm was used to articulate 11 cadaveric tibiofemoral joint specimens through simulations of four athletic tasks produced from in vivo recorded kinematics. These simulations were then repeated with 4° tibial rotation offsets applied to the baseline joint orientation. FINDINGS Rotational offsets had a significant effect on peak posterior force for female motion simulations (P < 0.01), peak lateral force for most simulated tasks (P < 0.01), and peak anterior force, internal torque, and flexion torque for sidestep cutting tasks (P ≤ 0.01). Rotational offsets did not exhibit statistically significant effects on peak anterior cruciate ligament strain (P > 0.05) or medial collateral ligament strain (P > 0.05) for any task. INTERPRETATION Transverse plane rotational offsets comparable to those observed in anterior cruciate ligament deficient and reconstructed patients alter knee kinetics without significantly altering anterior cruciate ligament strain. As knee degeneration is attributed to abnormal knee loading profiles, altered transverse plane kinematics may contribute to this. However, altered transverse plane rotations likely play a limited role in anterior cruciate ligament injury risk as physiologic offsets failed to significantly influence anterior cruciate ligament strain during athletic tasks.
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Affiliation(s)
- Nathaniel A. Bates
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA,Department of Biomedical Engineering and Physiology, Mayo Clinic, Rochester, MN, USA
| | - Rebecca J. Nesbitt
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH, USA
| | - Jason T. Shearn
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH, USA
| | - Gregory D. Myer
- Division of Sports Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA,Department of Orthopaedic Surgery, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Timothy E. Hewett
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA,Department of Biomedical Engineering and Physiology, Mayo Clinic, Rochester, MN, USA,Sports Medicine Center, Mayo Clinic, Rochester, MN, USA,Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
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Hinckel BB, Demange MK, Gobbi RG, Pécora JR, Camanho GL. The Effect of Mechanical Varus on Anterior Cruciate Ligament and Lateral Collateral Ligament Stress: Finite Element Analyses. Orthopedics 2016; 39:e729-36. [PMID: 27111082 DOI: 10.3928/01477447-20160421-02] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 02/10/2016] [Indexed: 02/03/2023]
Abstract
The current study analyzed changes in anterior cruciate ligament (ACL) and lateral collateral ligament stress as a result of mechanical varus. In an exploratory pilot study, progressive mechanical varus was introduced to a male finite element model of the lower limb at different knee flexion angles. Nine situations were analyzed (combinations of 0°, 30°, and 60° knee flexion and 0°, 5°, and 10° varus). The ACL stress was measured via changes in section force, von Mises stress, and fiber stress. Lateral collateral ligament stress was measured via changes in section force. For all 3 measures of the ACL, maximum stress values were found in extension, stress decreased with flexion, and the effect of varus introduction was most significant at 30° flexion. With 60° flexion, varus introduction produced a decrease in section force and von Mises stress and a small increase in fiber stress. In all situations and stress measures except fiber stress at 60° flexion, stress was concentrated at the posterolateral bundle. For the lateral collateral ligament, the introduction of 5° and 10° varus caused an increase in section force at all degrees of flexion. Stress in the ligament decreased with flexion. Mechanical varus of less than 10° was responsible for increased ACL stress, particularly at 0° and 30° knee flexion, and for increased lateral collateral ligament stress at all degrees of flexion. Stress was mostly concentrated on the posterolateral bundle of the ACL. [Orthopedics. 2016; 39(4):e729-e736.].
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Bates NA, Myer GD, Shearn JT, Hewett TE. Anterior cruciate ligament biomechanics during robotic and mechanical simulations of physiologic and clinical motion tasks: a systematic review and meta-analysis. Clin Biomech (Bristol, Avon) 2015; 30:1-13. [PMID: 25547070 PMCID: PMC4298459 DOI: 10.1016/j.clinbiomech.2014.12.006] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 12/14/2014] [Accepted: 12/15/2014] [Indexed: 02/07/2023]
Abstract
Investigators use in vitro joint simulations to invasively study the biomechanical behaviors of the anterior cruciate ligament. The aims of these simulations are to replicate physiologic conditions, but multiple mechanisms can be used to drive in vitro motions, which may influence biomechanical outcomes. The objective of this review was to examine, summarize, and compare biomechanical evidence related to anterior cruciate ligament function from in vitro simulations of knee motion. A systematic review was conducted (2004 to 2013) in Scopus, PubMed/Medline, and SPORTDiscus to identify peer-reviewed studies that reported kinematic and kinetic outcomes from in vitro simulations of physiologic or clinical tasks at the knee. Inclusion criteria for relevant studies were articles published in English that reported on whole-ligament anterior cruciate ligament mechanics during the in vitro simulation of physiologic or clinical motions on cadaveric knees that were unaltered outside of the anterior-cruciate-ligament-intact, -deficient, and -reconstructed conditions. A meta-analysis was performed to synthesize biomechanical differences between the anterior-cruciate-ligament-intact and reconstructed conditions. 77 studies met our inclusion/exclusion criteria and were reviewed. Combined joint rotations have the greatest impact on anterior cruciate ligament loads, but the magnitude by which individual kinematic degrees of freedom contribute to ligament loading during in vitro simulations is technique-dependent. Biomechanical data collected in prospective, longitudinal studies corresponds better with robotic-manipulator simulations than mechanical-impact simulations. Robotic simulation indicated that the ability to restore intact anterior cruciate ligament mechanics with anterior cruciate ligament reconstructions was dependent on loading condition and degree of freedom examined.
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Affiliation(s)
- Nathaniel A. Bates
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH, USA,The Sports Health and Performance Institute, OSU Sports Medicine, The Ohio State University, Columbus, OH, USA,Sports Medicine Biodynamics Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Gregory D. Myer
- Sports Medicine Biodynamics Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA,Department Orthopaedic Surgery, College of Medicine, University of Cincinnati, OH, USA,Athletic Training Division, School of Allied Medical Professions, The Ohio State University, Columbus, OH, USA
| | - Jason T. Shearn
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH, USA
| | - Timothy E. Hewett
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH, USA,The Sports Health and Performance Institute, OSU Sports Medicine, The Ohio State University, Columbus, OH, USA,Sports Medicine Biodynamics Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA,Departments of Physiology and Cell Biology, Orthopaedic Surgery, Family Medicine and Biomedical Engineering, The Ohio State University, Columbus, OH, USA
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Helito CP, Demange MK, Bonadio MB, Tírico LEP, Gobbi RG, Pécora JR, Camanho GL. Anatomy and Histology of the Knee Anterolateral Ligament. Orthop J Sports Med 2013; 1:2325967113513546. [PMID: 26535259 PMCID: PMC4555517 DOI: 10.1177/2325967113513546] [Citation(s) in RCA: 199] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Reconstruction of the anterior cruciate ligament (ACL) is one of the most common procedures in orthopaedic surgery. However, even with advances in surgical techniques and implants, some patients still have residual anterolateral rotatory laxity after reconstruction. A thorough study of the anatomy of the anterolateral region of the knee is needed. PURPOSE To study the anterolateral region and determine the measurements and points of attachments of the anterolateral ligament (ALL). STUDY DESIGN Descriptive laboratory study. METHODS Dissections of the anterolateral structures of the knee were performed in 20 human cadavers. After isolating the ALL, its length, thickness, width, and points of attachments were determined. The femoral attachment of the ALL was based on the anterior-posterior and proximal-distal distances from the attachment of the lateral collateral ligament (LCL). The tibial attachment point was based on the distance from the Gerdy tubercle to the fibular head and the distance from the lateral tibial plateau. The ligaments from the first 10 dissections were sent for histological analysis. RESULTS The ALL was found in all 20 knees. The femoral attachment of the ALL at the lateral epicondyle averaged 3.5 mm distal and 2.2 mm anterior to the attachment of the LCL. Two distal attachments were observed: one inserts into the lateral meniscus, the other between the Gerdy tubercle and the fibular head, approximately 4.4 mm distal to the tibial articular cartilage. The mean measurements for the ligament were 37.3 mm (length), 7.4 mm (width), and 2.7 mm (thickness). The histological analysis of the ligaments revealed dense connective tissue. CONCLUSION The ALL is consistently present in the anterolateral region of the knee. Its attachment to the femur is anterior and distal to the attachment of the LCL. Moving distally, it bifurcates at close to half of its length. The ALL features 2 distal attachments, one at the lateral meniscus and the other between the Gerdy tubercle and the fibular head. CLINICAL RELEVANCE The ALL may be important in maintaining normal rotatory limits of knee motion; ALL rupture could be responsible for rotatory laxity after isolated intra-articular reconstruction of the ACL.
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Affiliation(s)
- Camilo Partezani Helito
- Investigation performed at the Department of Orthopedics and Traumatology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
- Department of Orthopaedics and Traumatology, Institute of Orthopedics and Traumatology–Hospital and Clinics, Faculty of Medicine, University of São Paulo (IOT-HCFMUSP), São Paulo, Brazil
| | - Marco Kawamura Demange
- Department of Orthopaedics and Traumatology, Institute of Orthopedics and Traumatology–Hospital and Clinics, Faculty of Medicine, University of São Paulo (IOT-HCFMUSP), São Paulo, Brazil
| | - Marcelo Batista Bonadio
- Department of Orthopaedics and Traumatology, Institute of Orthopedics and Traumatology–Hospital and Clinics, Faculty of Medicine, University of São Paulo (IOT-HCFMUSP), São Paulo, Brazil
| | - Luis Eduardo Passarelli Tírico
- Department of Orthopaedics and Traumatology, Institute of Orthopedics and Traumatology–Hospital and Clinics, Faculty of Medicine, University of São Paulo (IOT-HCFMUSP), São Paulo, Brazil
| | - Riccardo Gomes Gobbi
- Department of Orthopaedics and Traumatology, Institute of Orthopedics and Traumatology–Hospital and Clinics, Faculty of Medicine, University of São Paulo (IOT-HCFMUSP), São Paulo, Brazil
| | - José Ricardo Pécora
- Department of Orthopaedics and Traumatology, Institute of Orthopedics and Traumatology–Hospital and Clinics, Faculty of Medicine, University of São Paulo (IOT-HCFMUSP), São Paulo, Brazil
| | - Gilberto Luis Camanho
- Department of Orthopaedics and Traumatology, Institute of Orthopedics and Traumatology–Hospital and Clinics, Faculty of Medicine, University of São Paulo (IOT-HCFMUSP), São Paulo, Brazil
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Anatomic study of popliteus complex of the knee in a Chinese population. Anat Sci Int 2011; 86:213-8. [DOI: 10.1007/s12565-011-0112-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Accepted: 07/13/2011] [Indexed: 01/14/2023]
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