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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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Park JG, Han SB, Rhim HC, Jeon OH, Jang KM. Anatomy of the anterolateral ligament of the knee joint. World J Clin Cases 2022; 10:7215-7223. [PMID: 36158026 PMCID: PMC9353924 DOI: 10.12998/wjcc.v10.i21.7215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/26/2022] [Accepted: 06/03/2022] [Indexed: 02/06/2023] Open
Abstract
Despite remarkable improvements in clinical outcomes after anterior cruciate ligament reconstruction, the residual rotational instability of knee joints remains a major concern. The anterolateral ligament (ALL) has recently gained attention as a distinct ligamentous structure on the anterolateral aspect of the knee joint. Numerous studies investigated the anatomy, function, and biomechanics of ALL to establish its potential role as a stabilizer for anterolateral rotational instability. However, controversies regarding its existence, prevalence, and femoral and tibial insertions need to be addressed. According to a recent consensus, ALL exists as a distinct ligamentous structure on the anterolateral aspect of the knee joint, with some anatomic variations. The aim of this article was to review the updated anatomy of ALL and present the most accepted findings among the existing controversies. Generally, ALL originates slightly proximal and posterior to the lateral epicondyle of the distal femur and has an anteroinferior course toward the tibial insertion between the tip of the fibular head and Gerdy’s tubercle below the lateral tibial plateau.
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Affiliation(s)
- Jun-Gu Park
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul 02841, South Korea
| | - Seung-Beom Han
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul 02841, South Korea
| | - Hye Chang Rhim
- Department of Medicine, MetroWest Medical Center/Tufts University School of Medicine, Framingham, MA 02111, United States
| | - Ok Hee Jeon
- Department of Biomedical Sciences, Korea University College of Medicine, Seoul 02841, South Korea
| | - Ki-Mo Jang
- Department of Orthopaedic Surgery, Anam Hospital, Korea University College of Medicine, Seoul 02841, South Korea
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Schulze-Tanzil G, Silawal S, Hoyer M. Anatomical feature of knee joint in Aachen minipig as a novel miniature pig line for experimental research in orthopaedics. Ann Anat 2019; 227:151411. [PMID: 31394168 DOI: 10.1016/j.aanat.2019.07.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 06/08/2019] [Accepted: 07/11/2019] [Indexed: 01/11/2023]
Abstract
BACKGROUND The pig is a commonly used large animal model, since pigs share anatomical and physiological similarities with humans. In contrast to other experimental pig lines the Aachen minipig, as a robust novel minipig does not require housing with any barrier. To estimate transferability of results to human conditions, pig lines should be thoroughly characterized. PURPOSE Therefore, we analyzed the anatomical pecularities of the knee joint of the novel "Aachen minipig" line raised for experimental conditions. METHODS Eight knee joints of four adult Aachen minipigs were dissected measuring the dimensions of typical landmarks using a digital caliper. Hybrid pig and human knee joints served as controls. Cartilage of the Aachen minipig (trochlear groove, femoral condyles, menisci) were assessed histologically. RESULTS The Aachen minipig shared its knee joint anatomy with the hybrid pig. In comparison to humans, peculiarities of the pig were demonstrated in the Aachen minipig: the lateral meniscus and the lateral tibial joint surface were significantly longer than the medial counterparts. The fibular head was covered by fibrocartilage and completely integrated into the lateral lower joint surface. The cartilage at the joint areas usually used for cartilage repair studies was in average 0.66±0.04mm thick. The porcine anterior cruciate ligament (ACL) attached with two bundles at the anterior tibial plateau separated from each other by the lateral anterior meniscotibial ligament. Aachen minipig articular and meniscal cartilage presented the typical histoarchitecture. CONCLUSIONS The Aachen minipig reflects porcine anatomical peculiarities, which should be considered, especially for meniscus and ACL reconstruction.
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Affiliation(s)
- Gundula Schulze-Tanzil
- Department of Anatomy, Paracelsus Medical University, Salzburg and Nuremberg, Prof. Ernst Nathan Str. 1, Nuremberg, 90419, Germany.
| | - Sandeep Silawal
- Department of Anatomy, Paracelsus Medical University, Salzburg and Nuremberg, Prof. Ernst Nathan Str. 1, Nuremberg, 90419, Germany
| | - Mariann Hoyer
- amedes MVZ für Laboratoriumsdiagnostik und Mikrobiologie Halle/Leipzig GmbH, 06112 Halle, Germany
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Sabatini L, Risitano S, Atzori F, Volante M, Aprato A, Indelli PF, Massè A. Histological analysis of the anterolateral ligament of the knee. J Orthop 2019; 16:368-372. [PMID: 31011250 DOI: 10.1016/j.jor.2019.03.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Accepted: 03/31/2019] [Indexed: 12/15/2022] Open
Abstract
Anterolateral ligament (ALL) was recently described as an important structure to control the pivot-shift phenomenon in the knee. Doubts remain regarding its origin and histological properties. The purpose of this study was to identify the ALL histological structure comparing its characteristics with those of the anterior cruciate ligament (ACL) and joint capsule. ALL was harvested in 25 knees during a total knee arthroplasty (TKA) and histologically evaluated investigating for orientation of fibers, adipose tissue, presence of proprioceptors and synovial like coating. Analysis showed significant differences in several aspects between capsule and ALL; analogies were found comparing the ALL with ACL.
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Affiliation(s)
- Luigi Sabatini
- Department of Orthopaedic Surgery and Traumatology, University of Turin, "Città della salute e della scienza"-CTO Hospital of Turin, Turin, ITA, Italy
| | - Salvatore Risitano
- Department of Orthopaedic Surgery and Traumatology, "Maggiore" Hospital of Chieri. Chieri, Turin, ITA, Italy
| | - Francesco Atzori
- Department of Orthopaedic Surgery, Cottolengo Hospital, Turin, Italy
| | - Marco Volante
- Pathologist Department, "San Luigi Gonzaga" Hospital Orbassano, Turin, ITA, Italy
| | - Alessandro Aprato
- Department of Orthopaedic Surgery and Traumatology, University of Turin, "Città della salute e della scienza"-CTO Hospital of Turin, Turin, ITA, Italy
| | - Pier Francesco Indelli
- Department of Orthopaedic Surgery and Bioengineering, Stanford University School of Medicine and the Palo Alto Veterans Affairs Health Care System(PAVAHCS), Palo Alto, CA, USA
| | - Alessandro Massè
- Department of Orthopaedic Surgery and Traumatology, University of Turin, "Città della salute e della scienza"-CTO Hospital of Turin, Turin, ITA, Italy
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Carr JB, Yildirim B, Richter D, Etier BE, Anderson MW, Pierce J, Diduch DR. Primary Anterolateral Ligament Rupture in Patients Requiring Revision Anterior Cruciate Ligament Reconstruction: A Retrospective Case-Control Magnetic Resonance Imaging Review. Arthroscopy 2018; 34:3055-3062. [PMID: 30301631 DOI: 10.1016/j.arthro.2018.06.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 05/31/2018] [Accepted: 06/02/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the initial rate of anterolateral ligament (ALL) injury at the time of anterior cruciate ligament (ACL) rupture in patients who subsequently experienced ACL reconstruction graft failure versus patients who did not experience subsequent ACL reconstruction graft failure. METHODS Our institution's electronic medical record database was queried for patients who underwent primary ACL reconstruction with subsequent ACL graft rupture. Exclusion criteria included unavailable MRI scan, chronic ACL injury, multi-ligamentous injury, previous ACL reconstruction, and age younger than 13 or older than 50 years. Each patient was paired with an age-, gender-, and graft-matched control who underwent ACL reconstruction without subsequent graft rupture. Each patient was diagnosed with an intact, partially injured, or fully ruptured ALL on initial MRI. The location of ALL injury was also noted. The incidence and location of ALL rupture were compared using χ2 analysis. RESULTS 1,967 patients underwent primary ACL reconstruction. 128 patients experienced ACL graft rupture, and 55 patients (43%) had MRI scans available for review. 39 of these patients fulfilled inclusion criteria and were matched with a control patient. In the revision group, the ALL was diagnosed as intact, partially torn, and completely torn in 17, 14, and 8 patients, respectively, compared to 18, 13, and 8 patients, respectively in the control group. No difference was found in frequency of ALL rupture (Pearson χ2 = 0.066; P = .968) or rupture location (Pearson χ2 = 4.00, P = 0.135). CONCLUSIONS The incidence of initial ALL injury as documented on MRI was not different in patients who experienced subsequent ACL graft rupture compared with patients who did not experience ACL graft rupture after primary ACL reconstruction. The ALL was more commonly injured on the tibial side in patients with ACL graft rupture and femoral-sided lesions were more common in control patients. LEVEL OF EVIDENCE Level III, prognostic case-control study.
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Affiliation(s)
- James B Carr
- Department of Orthopaedic Surgery, University of Virginia Health Systems, Charlottesville, Virginia, U.S.A..
| | - Baris Yildirim
- Department of Orthopaedic Surgery, University of Virginia Health Systems, Charlottesville, Virginia, U.S.A
| | - Dustin Richter
- Department of Orthopaedics & Rehabilitation, University of New Mexico, Albuquerque, New Mexico, U.S.A
| | - Brian E Etier
- Acadiana Orthopedic Group at Lafayette General, Lafayette, Louisiana, U.S.A
| | - Mark W Anderson
- Department of Radiology, University of Virginia Health Systems, Charlottesville, Virginia, U.S.A
| | - Jennifer Pierce
- Department of Radiology, University of Virginia Health Systems, Charlottesville, Virginia, U.S.A
| | - David R Diduch
- Department of Orthopaedic Surgery, University of Virginia Health Systems, Charlottesville, Virginia, U.S.A
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Kocher MS, Heyworth BE, Fabricant PD, Tepolt FA, Micheli LJ. Outcomes of Physeal-Sparing ACL Reconstruction with Iliotibial Band Autograft in Skeletally Immature Prepubescent Children. J Bone Joint Surg Am 2018; 100:1087-1094. [PMID: 29975275 DOI: 10.2106/jbjs.17.01327] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) tears are occurring in youth athletes with increasing frequency. Many ACL reconstruction procedures designed to allow for continued growth in patients with open physes have been described, but large series with mid- to long-term outcomes data are lacking. The purpose of the current study was to assess the clinical outcomes of a large cohort of prepubescent children who underwent a physeal-sparing, combined intra- and extra-articular ACL reconstruction with iliotibial (IT) band autograft over a 23-year period. METHODS Included in our analysis were 237 patients (240 knees) who underwent ACL reconstruction using IT band autograft at Tanner stage 1 or 2 (mean age of 11.2 ± 1.7 years). Physical examination data were analyzed for 225 of the 240 knees (mean follow-up, 25.8 months), and 137 (57%) of the knees had corresponding patient-reported clinical outcomes (patient-reported graft rupture and Pediatric International Knee Documentation Committee [Pedi-IKDC], Tegner activity scale, and Lysholm scores; mean follow-up, 6.2 years). Rates of growth arrest, IT band graft-harvest morbidity, and return to sports were analyzed. RESULTS Physical examination revealed that 96.8% of the knees were grade A on the Lachman test and 98.8% were grade A on the pivot-shift test. Graft rupture occurred in 9 (6.6%) of 137 knees, at an average of 33.5 months (range, 8.2 months to 8.0 years) postoperatively. For patients who did not sustain a graft rupture, the mean Pedi-IKDC score was 93.3 ± 11.0, the mean Lysholm score was 93.4 ± 9.9, and the mean score on the Tegner activity scale was 7.8 (mode, 7). While lateral thigh asymmetry at the IT band harvest site was noted by 48% of the subjects, only 1.6% reported associated pain. No cases of limb-length discrepancy or angular deformity were observed. CONCLUSIONS This procedure was associated with excellent functional outcomes, minimal risk of growth disturbance, and a low graft-rupture rate in skeletally immature prepubescent children. These results appear durable at mid- to long-term follow-up, at an average of >6 years postoperatively. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Argento G, Vetrano M, Cristiano L, Suarez T, Bartoloni A, Erroi D, Ferretti A, Vulpiani MC. Ultrasonographic assessment of the anterolateral ligament of the knee in healthy subjects. Muscles Ligaments Tendons J 2018; 7:485-490. [PMID: 29387642 DOI: 10.11138/mltj/2017.7.3.485] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Objective The aim of our study was to determine inter-observer agreement in the ultrasonographic identification of the anterolateral ligament (ALL) and in the evaluation of its length and thickness in healthy subjects. Methods 80 healthy volunteers (160 knees) (42 males and 38 females) were enrolled in the study. All subjects underwent ultrasound (US) examination of both knees, performed by two physicians with over ten years of musculoskeletal US experience. In order to keep the ALL under optimal tension, the knee was flexed at approximately 30-35°, slightly internally rotated and length and thickness of the ligament were measured. Results ALL was identified in 93.8% (150 out of 160) and in 92.5% (148 out of 160) of the knees by Evaluator 1 and Evaluator 2, respectively. Interobserver agreement was substantial to almost perfect for the visualization of the ALL ( =0.90) and for measurements of its length (ICC = 0.83), and strong for measurements of its thickness (ICC = 0.75). Conclusion In our study on healthy subjects, ALL has been visualized with a high rate of reproducibility. Further studies are needed to see if US may be a reliable and reproducible diagnostic tool in patients with traumatic or degenerative knee disorders. Level of evidence II, evidence obtained from cohort study.
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Affiliation(s)
- Giuseppe Argento
- Department of Radiology, Sant'Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
| | - Mario Vetrano
- Physical Medicine and Rehabilitation Unit, Sant'Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
| | - Lara Cristiano
- Department of Radiology, Sant'Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
| | - Tania Suarez
- Physical Medicine and Rehabilitation Unit, Sant'Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
| | - Alessandra Bartoloni
- Department of Radiology, Sant'Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
| | - Davide Erroi
- Physical Medicine and Rehabilitation Unit, Sant'Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
| | - Andrea Ferretti
- Orthopaedic Department and "Kirk Kilgour" Sports Injury Center, Sant'Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
| | - Maria Chiara Vulpiani
- Physical Medicine and Rehabilitation Unit, Sant'Andrea Hospital, "Sapienza" University of Rome, Rome, Italy
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Moroz PA, Quick EE, Horner NS, Duong A, Simunovic N, Ayeni OR. What Is the State of the Evidence in Anterolateral Ligament Research? Clin Sports Med 2018; 37:137-159. [DOI: 10.1016/j.csm.2017.07.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Ferrer GA, Guenther D, Pauyo T, Herbst E, Nagai K, Debski RE, Musahl V. Structural Properties of the Anterolateral Complex and Their Clinical Implications. Clin Sports Med 2018; 37:41-47. [DOI: 10.1016/j.csm.2017.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Gomes JLE, Leie MA, Marczwski M, Sánchez G, Ferrari MB. Intra-articular Anterior Cruciate Ligament Reconstruction With Extra-articular Lateral Tenodesis of the Iliotibial Band. Arthrosc Tech 2017; 6:e1507-e1514. [PMID: 29354466 PMCID: PMC5709921 DOI: 10.1016/j.eats.2017.05.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 05/02/2017] [Indexed: 02/03/2023] Open
Abstract
An increasing concern has been given to the rotation stability of the knee in the setting of an anterior cruciate ligament (ACL) reconstruction. This growing interest stems from a better understanding of the rotational stability of the knee afforded by the identification of the anterolateral ligament. Previously, a residual abnormal pivot-shift test had been found after an anatomic single-band reconstruction of the ACL because of a lack of rotational stability, which may lead to the development of osteoarthritis. Residual instability affects function, especially in high-demand athletes who perform many flexion-rotation movements during sporting activity. The purpose of this Technical Note is to describe our preferred method of intra-articular ACL reconstruction using a hamstring tendon autograft in combination with an extra-articular iliotibial band tenodesis for reinforcement of rotational stability.
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Affiliation(s)
| | | | - Marcos Marczwski
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - George Sánchez
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
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Sonnery-Cottet B, Daggett M, Fayard JM, Ferretti A, Helito CP, Lind M, Monaco E, de Pádua VBC, Thaunat M, Wilson A, Zaffagnini S, Zijl J, Claes S. Anterolateral Ligament Expert Group consensus paper on the management of internal rotation and instability of the anterior cruciate ligament - deficient knee. J Orthop Traumatol 2017; 18:91-106. [PMID: 28220268 PMCID: PMC5429259 DOI: 10.1007/s10195-017-0449-8] [Citation(s) in RCA: 160] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Purpose of this paper is to provide an overview of the latest research on the anterolateral ligament (ALL) and present the consensus of the ALL Expert Group on the anatomy, radiographic landmarks, biomechanics, clinical and radiographic diagnosis, lesion classification, surgical technique and clinical outcomes. A consensus on controversial subjects surrounding the ALL and anterolateral knee instability has been established based on the opinion of experts, the latest publications on the subject and an exchange of experiences during the ALL Experts Meeting (November 2015, Lyon, France). The ALL is found deep to the iliotibial band. The femoral origin is just posterior and proximal to the lateral epicondyle; the tibial attachment is 21.6 mm posterior to Gerdy's tubercle and 4-10 mm below the tibial joint line. On a lateral radiographic view the femoral origin is located in the postero-inferior quadrant and the tibial attachment is close to the centre of the proximal tibial plateau. Favourable isometry of an ALL reconstruction is seen when the femoral position is proximal and posterior to the lateral epicondyle, with the ALL being tight upon extension and lax upon flexion. The ALL can be visualised on ultrasound, or on T2-weighted coronal MRI scans with proton density fat-suppressed evaluation. The ALL injury is associated with a Segond fracture, and often occurs in conjunction with acute anterior cruciate ligament (ACL) injury. Recognition and repair of the ALL lesions should be considered to improve the control of rotational stability provided by ACL reconstruction. For high-risk patients, a combined ACL and ALL reconstruction improves rotational control and reduces the rate of re-rupture, without increased postoperative complication rates compared to ACL-only reconstruction. In conclusion this paper provides a contemporary consensus on all studied features of the ALL. The findings warrant future research in order to further test these early observations, with the ultimate goal of improving the long-term outcomes of ACL-injured patients. Level of evidence Level V-Expert opinion.
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Affiliation(s)
- Bertrand Sonnery-Cottet
- Centre Orthopédique Paul Santy, FIFA Medical Center of Excellence, Groupe Ramsay-Generale de Santé, 24 avenue Paul Santy, 69008 Lyon, France
| | | | - Jean-Marie Fayard
- Centre Orthopédique Paul Santy, FIFA Medical Center of Excellence, Groupe Ramsay-Generale de Santé, 24 avenue Paul Santy, 69008 Lyon, France
| | - Andrea Ferretti
- Orthopaedic Unit and Kirk Kilgour Sports Injury Center, Sant’Andrea University Hospital, “Sapienza” University of Rome, Rome, Italy
| | | | - Martin Lind
- Division of Sportstraumatology, Department of Orthopedics, Aarhus University Hospital, Tage Hansens Gade 2, 8000 Aarhus C, Denmark
| | - Edoardo Monaco
- Orthopaedic Unit and Kirk Kilgour Sports Injury Center, Sant’Andrea University Hospital, “Sapienza” University of Rome, Rome, Italy
| | - Vitor Barion Castro de Pádua
- Associação Beneficente Hospital Universitário de Marilia-SP Brazil, Cidade Universitária, Rua Dr Prospero Cecilio Coimbra 80, Marilia, SP 17525-160 Brazil
| | - Mathieu Thaunat
- Centre Orthopédique Paul Santy, FIFA Medical Center of Excellence, Groupe Ramsay-Generale de Santé, 24 avenue Paul Santy, 69008 Lyon, France
| | - Adrian Wilson
- Department of Sport and Exercise, Sport and Exercise Research Centre, University of Winchester, Winchester, SO22 4NR UK
| | - Stefano Zaffagnini
- Dipartimento Rizzoli Sicilia, Ortopedia e Traumatologia, Università di Bologna, SS 113 al km 246, 90011 Bagheria, PA Italy
| | - Jacco Zijl
- St. Antonius Hospital, Soestwetering 1, 3543 AZ Utrecht, The Netherlands
| | - Steven Claes
- Department of Orthopaedic Surgery and Traumatology, AZ Herentals, Herentals, Belgium
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The anterolateral ligament: A cadaveric study in fetuses. Clin Anat 2017; 30:625-634. [DOI: 10.1002/ca.22887] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 04/08/2017] [Indexed: 01/26/2023]
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Fardin PBA, Lizardo JHDF, Baptista JDS. STUDY OF THE ANTEROLATERAL LIGAMENT OF THE KNEE IN FORMALIN-EMBEDDED CADAVERS. ACTA ORTOPEDICA BRASILEIRA 2017; 25:89-92. [PMID: 28642658 PMCID: PMC5474420 DOI: 10.1590/1413-785220172502162204] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 09/09/2016] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To verify the incidence and characterize morphologically the anterolateral ligament of the knee (ALL) in cadaveric samples of the collection of the Laboratory of Anatomy of the Department of Morphology of the Universidade Federal do Espírito Santo. METHODS Dissections and cross sections were performed for mesoscopic analysis of the anterolateral region of 15 knees preserved in 4% formalin solution in order to identify the ALL. RESULTS After dissection of the skin and subcutaneous tissue of the knee anterolateral region, it was possible to identify the iliotibial tract (ITT), the patellar ligament and the femoral biceps tendon. The ITT was removed from the Gerdy tubercle and the following structures were visualized: knee joint capsule, fibular collateral ligament and popliteal tendon. However, the ALL was not identified in any of the samples. CONCLUSIONS The ALL could not be identified in any of the specimens studied, either through dissection or mesoscopic analysis. Level of Evidence III, Diagnosis Studies - Investigation of an Exam for Diagnosis.
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Affiliation(s)
| | - Juliana Hott de Fúcio Lizardo
- Universidade Federal do Espírito Santo, Department of Morphology, Laboratory of Applied Morphology (LEMA), Vitória, ES, Brazil
| | - Josemberg da Silva Baptista
- Universidade Federal do Espírito Santo, Department of Morphology, Laboratory of Applied Morphology (LEMA), Vitória, ES, Brazil
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Zhang H, Qiu M, Zhou A, Zhang J, Jiang D. Anatomic Anterolateral Ligament Reconstruction Improves Postoperative Clinical Outcomes Combined with Anatomic Anterior Cruciate Ligament Reconstruction. J Sports Sci Med 2016; 15:688-696. [PMID: 27928215 PMCID: PMC5131223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 10/24/2016] [Indexed: 06/06/2023]
Abstract
A significant cohort of patients is plagued by postoperative rotational instability after the anatomic anterior cruciate ligament (ACL) reconstruction surgery. Anatomic anterolateral ligament (ALL) reconstruction was performed in this study with the aim to assess the clinical role of ALL in knee's stability and joint functions. Sixty patients were recruited and divided into three groups to perform the operations of anatomic single-bundle ACL reconstruction, anatomic double-bundle ACL reconstruction, and anatomic single-bundle ACL reconstruction + anterolateral ligament reconstruction, respectively. And then postoperative knee's stability and joint functions were evaluated to compare the clinical outcomes among the three different kind of operations. The postoperative knee's stability and joint functions of the anatomic double-bundle ACL reconstruction group and the anatomic single-bundle ACL reconstruction + ALL reconstruction group were better than the anatomic single-bundle ACL reconstruction group. No significant difference was observed between the anatomic double-bundle ACL reconstruction group and the anatomic single-bundle ACL reconstruction + ALL reconstruction group. The anatomic anterolateral ligament reconstruction could improve the clinical outcomes after patients performed the anatomic single-bundle anterior cruciate ligament reconstruction. This indicates that the anterolateral ligament plays a crucial role in knee's stability and joint function, especially the rotational stability.
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Affiliation(s)
- Hua Zhang
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University , Chongqing, China
| | - Man Qiu
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University , Chongqing, China
| | - Aiguo Zhou
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University , Chongqing, China
| | - Jian Zhang
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University , Chongqing, China
| | - Dianming Jiang
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University , Chongqing, China
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Musahl V, Karlsson J, Zaffagnini S, Fu FH. Authors' Reply. Arthroscopy 2016; 32:1741-4. [PMID: 27594325 DOI: 10.1016/j.arthro.2016.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 07/06/2016] [Indexed: 02/02/2023]
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Yokosawa K, Sasaki K, Muramatsu K, Ono T, Izawa H, Hachiya Y. [Visualization of Anterolateral Ligament of the Knee Using 3D Reconstructed Variable Refocus Flip Angle-Turbo Spin Echo T2 Weighted Image]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2016; 72:416-423. [PMID: 27211087 DOI: 10.6009/jjrt.2016_jsrt_72.5.416] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Anterolateral ligament (ALL) is one of the lateral structures in the knee that contributes to the internal rotational stability of tibia. ALL has been referred to in some recent reports to re-emphasize its importance. We visualized the ALL on 3D-MRI in 32 knees of 27 healthy volunteers (23 male knees, 4 female knees; mean age: 37 years). 3D-MRIs were performed using 1.5-T scanner [T(2) weighted image (WI), SPACE: Sampling Perfection with Application optimized Contrast using different flip angle Evolutions] in the knee extended positions. The visualization rate of the ALL, the mean angle to the lateral collateral ligament (LCL), and the width and the thickness of the ALL at the joint level were investigated. The visualization rate was 100%. The mean angle to the LCL was 10.6 degrees. The mean width and the mean thickness of the ALL were 6.4 mm and 1.0 mm, respectively. The ALL is a very thin ligament with a somewhat oblique course between the lateral femoral epicondyle and the mid-third area of lateral tibial condyle. Therefore, the slice thickness and the slice angle can easily affect the ALL visualization. 3D-MRI enables acquiring thin-slice imaging data over a relatively short time, and arbitrary sections aligned with the course of the ALL can later be selected.
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