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Bechis M, Rosso F, Blonna D, Rossi R, Bonasia DE. Lateral Extra-Articular Tenodesis with Indirect Femoral Fixation Using an Anterior Cruciate Ligament Reconstruction Suspensory Device. J Clin Med 2024; 13:377. [PMID: 38256513 PMCID: PMC10816928 DOI: 10.3390/jcm13020377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/05/2024] [Accepted: 01/08/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND The lateral extra-articular tenodesis (LET) procedure associated with anterior cruciate ligament (ACL) reconstruction can be considered in selected patients to diminish the risk of persistent rotatory instability and achieve a protective effect on the graft. Several techniques have been described in the literature to treat rotatory instability. Usually, a strip of the iliotibial band (ITB) is harvested from its middle while leaving the distal insertion, then passed underneath the lateral collateral ligament and fixed on the lateral aspect of the distal femur with various fixation methods such as staples, screws, anchors or extracortical suspensory devices. Despite their effectiveness, these fixation methods may be associated with complications such as lateral pain, over-constraint and tunnel convergence. METHODS This study presents a detailed surgical description of a new technique to perform an LET during ACL reconstruction with any type of graft fixing the ITB strip with the sutures of the ACL femoral button, comparing its pros and cons in relation to similar techniques found in the literature. CONCLUSIONS This technique represents a reproducible, easy to learn and inexpensive solution to perform a lateral extra-articular tenodesis associated with an ACL reconstruction using the high-resistance sutures of the femoral button.
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Affiliation(s)
- Marco Bechis
- AO Ordine Mauriziano Hospital, Department of Orthopedics and Traumatology, University of Torino, 10124 Turin, Italy
| | | | | | | | - Davide Edoardo Bonasia
- AO Ordine Mauriziano Hospital, Department of Orthopedics and Traumatology, University of Torino, 10124 Turin, Italy
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Darville GL, Young BL, Lamplot JD, Xerogeanes JW. Arthroscopic-Assisted Lateral Extra-Articular Tenodesis With Knotless Anchor Fixation. Arthrosc Tech 2023; 12:e2257-e2264. [PMID: 38196854 PMCID: PMC10772996 DOI: 10.1016/j.eats.2023.07.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 07/30/2023] [Indexed: 01/11/2024] Open
Abstract
Recent studies have reported the biomechanical and clinical advantages of lateral extraarticular augmentation procedures including the modified lateral extra-articular tenodesis (LET) in the setting of anterior cruciate ligament reconstruction. LET has been shown to significantly decrease re-rupture rates in high-risk patients and decrease anterior cruciate ligament graft forces during pivoting loads and instrumented anterior laxity testing. Many variations of the modified LET approaches have been described. However, concerns including lateral hematoma, wound-healing complications, and increased operative time exist. This minimally invasive, arthroscopic-assisted approach using a knotless, all-suture anchor allows for direct visualization through a 2-cm incision and inherently decreases the morbidity associated with traditional LET techniques.
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Affiliation(s)
- Gregory L. Darville
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia, U.S.A
| | - Bradley L. Young
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia, U.S.A
| | - Joseph D. Lamplot
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia, U.S.A
| | - John W. Xerogeanes
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia, U.S.A
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Behrendt P, Fahlbusch H, Akoto R, Thürig G, Frings J, Herbst E, Raschke MJ, Frosch KH, Kittl C, Krause M. Comparison of Onlay Anchor Fixation Versus Transosseous Fixation for Lateral Extra-articular Tenodesis During Revision ACL Reconstruction. Orthop J Sports Med 2023; 11:23259671231166380. [PMID: 37213658 PMCID: PMC10196542 DOI: 10.1177/23259671231166380] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 01/30/2023] [Indexed: 05/23/2023] Open
Abstract
Background There is evidence on the clinical effectiveness of the Lemaire technique for lateral extra-articular tenodesis (LET) in patients undergoing revision anterior cruciate ligament reconstruction (ACLR), but the best fixation technique is unknown. Purpose To compare the clinical outcomes of 2 fixation techniques after revision ACLR: (1) onlay anchor fixation, which would avoid tunnel conflict and physis injury, and (2) transosseous tightening and interference screw fixation. Pain at the area of LET fixation was also assessed. Study Design Cohort study; Level of evidence, 3. Methods This was a retrospective 2-center study of patients with first-time revision ACLR and either LET with anchor fixation (aLET) with a 2.4-mm suture anchor or LET with transosseous fixation (tLET). Outcomes at minimum 12-month follow-up were assessed with the International Knee Documentation Committee score, Knee injury and Osteoarthritis Outcome Score, visual analog scale for pain at the LET fixation area, Tegner score, and anterior tibial translation (ATT). A subgroup analysis within the aLET group investigated passing the graft over or under the lateral collateral ligament (LCL). Results In total, 52 patients were included (26 patients in each group); the mean ± SD follow-up was 13.7 ± 3.4 months. No statistically significant differences were detected between the groups with respect to patient-reported outcome scores, clinical examination, or instrumented testing (side-to-side difference in ATT at 30° of flexion; aLET, 1.5 ± 2.5 mm; tLET, 1.6 ± 1.7 mm). Clinical failure was detected in 1 patient with aLET and none with tLET. Subgroup analysis revealed a small, nonsignificant flexion deficit in knees in which the iliotibial band strand was passed under (n = 42) or over (n = 10) the LCL. No clinically relevant tenderness was detected at the area of LET fixation in any group (aLET, 0.6 ± 1.3; tLET, 0.9 ± 1.7; over the LCL, 0.2 ± 0.6; under the LCL, 0.9 ± 1.6). Conclusion Onlay anchor fixation and transosseous fixation of the LET were equivalent with respect to outcome scores and instrumented ATT testing. Clinically, there were minor differences in passage of the LET graft over or under the LCL.
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Affiliation(s)
- Peter Behrendt
- Department of Trauma Surgery,
Orthopedics and Sportsorthopedics, Asklepios St Georg, Hamburg, Germany
- Department of Trauma and Orthopaedic
Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Anatomy,
Christian-Albrechts-University, Kiel, Germany
| | - Hendrik Fahlbusch
- Department of Trauma and Orthopaedic
Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ralph Akoto
- Department of Trauma Surgery,
Orthopaedics and Sports Traumatology, BG Hospital Hamburg, Hamburg, Germany
| | - Grégoire Thürig
- Department of Orthopedics and
Traumatology, Cantonal Hospital Fribourg, Fribourg, Switzerland
| | - Jannik Frings
- Department of Trauma and Orthopaedic
Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Elmar Herbst
- Department of Trauma, Hand and
Reconstructive Surgery, University of Muenster, Muenster, Germany
| | - Michael J. Raschke
- Department of Trauma, Hand and
Reconstructive Surgery, University of Muenster, Muenster, Germany
| | - Karl-Heinz Frosch
- Department of Trauma and Orthopaedic
Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Trauma Surgery,
Orthopaedics and Sports Traumatology, BG Hospital Hamburg, Hamburg, Germany
| | - Christoph Kittl
- Department of Trauma, Hand and
Reconstructive Surgery, University of Muenster, Muenster, Germany
| | - Matthias Krause
- Department of Trauma and Orthopaedic
Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Matthias Krause, Priv-Doz,
Dr med, Department of Trauma and Orthopaedic Surgery, University Medical Center
Hamburg-Eppendorf, Martinistraße 52, 20251 Hamburg, Germany (
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Lamplot JD, Petit CB, Thompson D, Xerogeanes JW, Gonzalez FM, Diekfuss JA, Myer GD, Jimenez ML. A Landmark-Based Technique for Determining an Isometric Femoral Attachment Site for Lateral Extraarticular Tenodesis is Inaccurate. Arthrosc Sports Med Rehabil 2022; 5:e217-e224. [PMID: 36866313 PMCID: PMC9971892 DOI: 10.1016/j.asmr.2022.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 11/09/2022] [Indexed: 12/29/2022] Open
Abstract
Purpose To evaluate the reliability and accuracy of a method of placing the femoral fixation location for lateral extra-articular tenodesis (LET) within a safe isometric area using anatomic landmarks. Methods Using a pilot cadaveric specimen, the center of the radiographic safe isometric area for femoral fixation of LET, defined as a 1 cm (proximal-distal) area located proximal to the metaphyseal flare and posterior to the posterior cortical extension line (PCEL), was located using fluoroscopy and found to be 20 mm directly proximal to the center of the fibular collateral ligament (FCL) origin. Using 10 additional specimens, the center of the FCL origin and a location 20 mm directly proximal was identified. K-wires were placed at each location. A lateral radiograph was obtained, and distances of the proximal K-wire relative to the PCEL and metaphyseal flare were measured. The location of the proximal K-wire relative to the radiographic safe isometric area was assessed by 2 independent observers. Intrarater and inter-rater reliability was calculated for all measurements using intraclass coefficients (ICCs). Results There was excellent intrarater and inter-rater reliability for all radiographic measurements (.908 to .975 and .968 to .988, respectively). In 5/10 specimens, the proximal K-wire was outside of the radiographic safe isometric area, with 4/5 anterior to the PCEL. Overall, the mean distance from the PCEL was 1 mm ± 4 mm (anterior), and the mean distance from the metaphyseal flare was 7.4 mm ± 2.9 mm (proximal). Conclusion A landmark-based technique referencing the FCL origin was inaccurate in the placement of femoral fixation within a radiographic safe isometric area for LET. Therefore intraoperative imaging should be considered to ensure accurate placement. Clinical Relevance These findings may help to decrease the likelihood of misplacement of femoral fixation during LET by showing that landmark-based methods without intraoperative image guidance may be unreliable.
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Affiliation(s)
- Joseph D. Lamplot
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, Atlanta, Georgia
- Emory Sports Medicine Center, Atlanta, Georgia
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia
- Address correspondence to Joseph D. Lamplot, M.D., Emory University, Sports Medicine Division, 4450 Falcon Parkway, Flowery Branch, GA 30097.
| | - Camryn B. Petit
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, Atlanta, Georgia
- Emory Sports Medicine Center, Atlanta, Georgia
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia
| | - Dan Thompson
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia
| | - John W. Xerogeanes
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, Atlanta, Georgia
- Emory Sports Medicine Center, Atlanta, Georgia
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia
| | | | - Jed A. Diekfuss
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, Atlanta, Georgia
- Emory Sports Medicine Center, Atlanta, Georgia
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia
| | - Gregory D. Myer
- Emory Sports Performance And Research Center (SPARC), Flowery Branch, Atlanta, Georgia
- Emory Sports Medicine Center, Atlanta, Georgia
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia
- The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, USA
| | - Megan Lisset Jimenez
- Emory Sports Medicine Center, Atlanta, Georgia
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia
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Morgan AM, Bi AS, Kaplan DJ, Alaia MJ, Strauss EJ, Jazrawi LM. An eponymous history of the anterolateral ligament complex of the knee. Knee Surg Relat Res 2022; 34:45. [PMID: 36527151 PMCID: PMC9756455 DOI: 10.1186/s43019-022-00172-0] [Citation(s) in RCA: 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: 08/23/2022] [Accepted: 11/22/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Recent interest has surged in the anterolateral ligament (ALL) and complex (ALC) of the knee. Its existence and role in rotary stability of the knee, particularly in the setting of anterior cruciate ligament (ACL) reconstruction, remains a contentious and controversial topic. UNDERSTANDING THE ALC We must review our history and recognize the pioneers who pushed our understanding of the ALL forward before it was popularly recognized as a discrete structure. Additionally, given that many eponyms remain in common use related to the ALC, we must standardize our nomenclature to prevent misuse or misunderstanding of terms in the literature. In this review, modern understanding of the anterolateral ligament complex (ALC) is traced to 1829 by exploring eponymous terms first in anatomy and then in surgical technique. Understanding our history and terminology will allow us to better understand the ALC itself. CONCLUSION This review aims to provide historical context, define terminology, and provide insight into the clinical relevance of the ALC.
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Affiliation(s)
- Allison M. Morgan
- grid.137628.90000 0004 1936 8753NYU Langone Orthopedic Center, 301 E 17th Street, New York, NY 10010 USA
| | - Andrew S. Bi
- grid.137628.90000 0004 1936 8753NYU Langone Orthopedic Center, 301 E 17th Street, New York, NY 10010 USA
| | - Daniel J. Kaplan
- grid.137628.90000 0004 1936 8753NYU Langone Orthopedic Center, 301 E 17th Street, New York, NY 10010 USA
| | - Michael J. Alaia
- grid.137628.90000 0004 1936 8753NYU Langone Orthopedic Center, 301 E 17th Street, New York, NY 10010 USA
| | - Eric J. Strauss
- grid.137628.90000 0004 1936 8753NYU Langone Orthopedic Center, 301 E 17th Street, New York, NY 10010 USA
| | - Laith M. Jazrawi
- grid.137628.90000 0004 1936 8753NYU Langone Orthopedic Center, 301 E 17th Street, New York, NY 10010 USA
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Xu J, Qiao Y, Han K, Xu C, Dong S, Zhao J. Modified Lemaire Lateral Extra-articular Tenodesis With the Iliotibial Band Strip Fixed on the Femoral Cortical Surface Reduces Laxity and Causes Less Overconstraint in the Anterolateral Lesioned Knee: A Biomechanical Study. Arthroscopy 2022; 38:3162-3171. [PMID: 35777678 DOI: 10.1016/j.arthro.2022.06.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 06/03/2022] [Accepted: 06/06/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the biomechanical effects of femoral cortical surface fixation and intra-tunnel fixation in modified Lemaire tenodesis on the restoration of native kinematics in anterolateral structure-deficient knees. METHODS Eight fresh-frozen cadaveric knees were mounted in a knee-customized jig to evaluate anterior translation in anterior load and internal rotation degree in internal rotation torque at 0°, 30°, 60°, and 90°, as well as anterolateral translation (ALT) in a simulated pivot-shift test at 0°, 15°, 30°, and 45°. Kinematic tests were performed in the following states: intact; anterolateral knee lesion (AL-Les); modified Lemaire lateral extra-articular tenodesis (LET) with the femoral iliotibial band (ITB) strip fixed on the cortical surface (cortical fixation), deep to the lateral collateral ligament (LCL) (deep LET-C); and LET with the femoral ITB strip fixed into a tunnel (intra-tunnel fixation), deep to the LCL (deep LET-IT) or superficial to the LCL (superficial LET-IT). The knee kinematic changes in the AL-Les state and the 3 LET states were compared with each other, with the intact state as the baseline. RESULTS In the AL-Les state, the increased anterior translation instabilities were significantly mitigated by the 3 LETs at 30°, 60°, and 90° (all P < .001), with overconstraint observed in both the deep LET-IT and superficial LET-IT states at 60° (P = .047 and P < .001, respectively) and 90° (both P < .001). Similarly, the 3 LETs significantly reduced the internal rotation instabilities in the AL-Les state at all flexion angles. The superficial LET-IT state overconstrained the knee at 60° (P = .009) and 90° (P < .001) during internal rotation torque, and the deep LET-IT state did so at 60° (P = .012). Furthermore, the ALT instabilities found in the AL-Les state were significantly reduced by the 3 LETs during the simulated pivot-shift test. At 30° and 45°, these LET states resulted in overconstraint when compared with the intact state, but the superficial LET-IT state (P < .001) or deep LET-IT state (P = .016) presented a larger overconstraint than that in the deep LET-C at 45°, respectively. CONCLUSIONS The 3 Lemaire LET procedures evaluated reduced the anterior, internal rotational, and ALT laxities in AL-Les knees and restored these parameters to the native baseline of the intact state at most flexion angles. However, in deep flexion, some overconstraint occurred in all LETs when compared with the intact state, of which the deep LET-C state resulted in less overconstraint in anterior translation and internal rotation than the deep LET-IT and superficial LET-IT states. CLINICAL RELEVANCE This biomechanical study supports using the femoral cortical fixation technique to fix the ITB strip in the modified Lemaire LET, which similarly improves knee kinematic stability and causes less overconstraint compared with conventional intra-tunnel fixation. These findings need more verification in clinical scenarios.
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Affiliation(s)
- Junjie Xu
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yi Qiao
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Kang Han
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Caiqi Xu
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Shikui Dong
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
| | - Jinzhong Zhao
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
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Koukoulias NE, Dimitriadis T, Vasiliadis AV, Germanou E, Boutovinos AP. ACL Reconstruction and Modified Lemaire Tenodesis Utilizing Common Suspensory Femoral Fixation. Arthrosc Tech 2022; 11:e2185-e2193. [PMID: 36632409 PMCID: PMC9826977 DOI: 10.1016/j.eats.2022.08.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 08/14/2022] [Indexed: 11/19/2022] Open
Abstract
Persistent rotatory instability after anterior cruciate ligament (ACL) reconstruction has been well studied and recognized as the cause of unsatisfactory clinical results. Various anterolateral techniques have been described as an adjunct to the ACL reconstruction to improve clinical outcomes. Modified deep Lemaire lateral extra-articular tenodesis has been tested both biomechanically and clinically and proved an efficient solution in controlling tibia internal rotation, when performed in conjunction with ACL reconstruction. We describe a simple, versatile, effective, and reproducible technique of lateral extra-articular tenodesis, using common suspensory femoral fixation, with no additional cost and surgical risk.
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Affiliation(s)
- Nikolaos E. Koukoulias
- Address correspondence to Nikolaos E. Koukoulias, M.D., Ph.D., 5 Agiou Georgiou Street, Pylaia, Thessaloniki, GR57001 Greece.
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8
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Foissey C, Thaunat M, Caron E, Haidar I, Vieira TD, Gomes L, Freychet B, Sonnery-Cottet B, Fayard JM. Combining Anterior Cruciate Ligament Reconstruction With Lateral Extra-Articular Procedures in Skeletally Immature Patients Is Safe and Associated With a Low Failure Rate. Arthrosc Sports Med Rehabil 2022; 4:e1941-e1951. [PMID: 36579042 PMCID: PMC9791843 DOI: 10.1016/j.asmr.2022.08.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 08/01/2022] [Indexed: 12/23/2022] Open
Abstract
Purpose To analyze the rates of graft ruptures and growth disorders, the level of return to sport, and the clinical results of 2 lateral extra-articular procedures in growing children. Methods This study was a retrospective, single-center study of patients undergoing anterior cruciate ligament (ACL) surgery combined with 2 different lateral extra-articular procedures (anatomic reconstruction with a gracilis graft or modified Lemaire technique with a strip of fascia lata). The measurements of side-to-side anterior laxity and pivot shift were performed preoperatively and at the last follow-up. The sports level and the complications rate were assessed. The minimal clinically important differences (MCID) and patient acceptable symptoms state threshold scores were calculated. Results Thirty-nine patients (40 ACLs) were included (20 anatomic and 20 modified Lemaire) at an average follow-up of 57 months ± 10 [42-74]. One patient (2.5%) was lost to follow-up. The mean age at surgery was 13.8 ± 1.4 years old [9.8; 16.5]. One graft failure was reported (2.6% [0.06-13.5]) at 35.6 months after surgery. Two cases (5.4%) of femoral overgrowth were observed, and one of them required distal femoral epiphysiodesis. Ninety-two percent of the patients returned to sports. At the final follow-up, side-to-side anterior laxity was significantly improved, and no residual pivot shift was recorded in 95% of patients. Eighty-nine percent of the patients presented a Pedi-International Knee Documentation Committee score greater than the MCID postoperatively, and 77% presented a Lysholm score greater than the MCID. Conclusions This series of ACL reconstructions combined with 2 different lateral extra-articular procedures in skeletally immature patients demonstrated promising findings. The low rate of observed complications, including graft rupture and growth disturbance, is encouraging, but the small study population and lack of comparative group precludes reliable conclusions. Level of Evidence IV, therapeutic case series.
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Affiliation(s)
| | | | | | | | - Thais Dutra Vieira
- Address correspondence to Thais Dutra Vieira, M.D., Centre Orthopédique Santy, 24 avenue Paul Santy, 69008 Lyon, France.
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Athanasiou V, Panagopoulos A, Kouzelis A, Kokkalis ZT, Lakoumentas J, Katsanos K, Gliatis J. A Review of Current Concepts of the Anterolateral Complex of the Knee. Orthop Rev (Pavia) 2022; 14:38651. [PMID: 36213619 PMCID: PMC9536860 DOI: 10.52965/001c.38651] [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: 08/19/2023] Open
Abstract
The anterolateral complex (ALC) of the knee has gained increased interest over the last decades due to the high revision rates of anterior cruciate ligament reconstruction (ACLR). Furthermore, in patients with an ACL tear, the injury of at least one of the ALC's anatomic structures has been shown to be significantly higher, thus affecting its secondary stabilizing role at the knee joint. As such, ACLR augmentation techniques, that embrace the ALC, have been proposed recently, and indications for these procedures are still evolving. This review aims to present and discuss the most current anatomical, biomechanical, and imaging data, current reconstruction techniques, and the clinical results of ALC reconstruction.
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Affiliation(s)
| | | | | | | | - John Lakoumentas
- Medical Physics Department, Medical School, University of Patras, Patras, Greece
| | | | - John Gliatis
- Orthopaedic Department, Patras University Hospital, Greece
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10
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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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11
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Moreno Mateo F, Perea SH, Green DW. Lateral-extra articular tenodesis vs. anterolateral ligament reconstruction in skeletally immature patients undergoing anterior cruciate ligament reconstruction. Curr Opin Pediatr 2022; 34:71-75. [PMID: 34845153 DOI: 10.1097/mop.0000000000001084] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The aim of this study was to review the most recent available evidence about lateral-extra articular tenodesis (LET) and anterolateral ligament (ALL) reconstruction in young patients treated for anterior cruciate ligament (ACL) injury. RECENT FINDINGS The ALL of the knee acts as a secondary stabilizer of the knee preventing anterior translation and internal rotation. In vitro and in vivo biomechanical studies as well as prospective clinical trials have shown the importance of the ALL in knee biomechanics. The ALL injury has a synergetic impact on the knee stability in patients with acute ACL injury. ALL augmentation of ACL provides reduction of knee instability and graft failure and higher return to sport rates in high-risk patients. It has not been demonstrated that extra-articular procedures increase the risk of knee osteoarthritis secondary to knee over-constriction. Both Iliotibial band (ITB) ALL reconstruction and modified Lemaire LET have been shown safe and effective. Minimal biomechanical or clinical differences have been found between the two reconstruction methods. SUMMARY Young patients with ACL tears and risk factors such as laxity or pivot shift willing to return to sports may benefit from ALL augmentation. Therefore, it is essential to identify these high-risk patients to individualize treatment.
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Affiliation(s)
- Fernando Moreno Mateo
- Division of Pediatric Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
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