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Although anatomic anterior cruciate ligament (ACL) reconstruction is established for the surgical treatment of anterolateral knee instability, there remains a significant cohort of patients who continue to experience post-operative instability. Recent advances in our understanding of the anatomical, biomechanical and radiological characteristics of the native anterolateral ligament (ALL) of the knee have led to a resurgent interest in reconstruction of this structure as part of the management of knee instability. This technical note describes our readily reproducible combined minimally-invasive technique to reconstruct both the ACL and ALL anatomically using autologous semitendinosus and gracilis grafts. This simple method of ALL reconstruction can be easily integrated with all-inside ACL reconstruction, requiring minimal additional operative time, equipment and expertise. Level of evidence: VThe final publication is available at Springer via http://dx.doi. org/10.1007/s00167-015-3783-5 Copyright © 2015, Springer Verlag. Introduction 1Although the existence of the anterolateral ligament (ALL) was first described in anatomical studies 2 over a century ago, a full appreciation of its functional importance in normal and sporting activities is 3 still being established [3,14,19,20,29,32,35,36]. Recent progress has been made in reconstructing 4 the unstable knee, but this has mainly concentrated on restoring the mechanical constraints of the 5 cruciate and collateral ligaments, with little consideration for the potential of the ALL itself as a key 6 supportive structure [5,26]. Cruciate ligament reconstruction alone can provide excellent clinical 7 outcomes, however, a significant proportion of patients continue to suffer from rotational instability 8 post-operatively, with many patients unable to return to their pre-injury level of sporting activity [2]. 9Furthermore, even when the cruciate ligaments are reconstructed anatomically, the procedure does 10 not prevent the progression to early secondary osteoarthritis [21]. Although its function remains 11 controversial, a new appreciation for the existence of the ALL as a distinct anatomical structure with 12 the potential to confer rotational stability to the knee, has led several groups to advocate 13 refinements to previous extra-articular ligament reconstruction techniques to more precisely restore 14 the kinematics of the native knee [8,15]. It is proposed that these procedures, when used in 15 conjunction with arthroscopic anatomic anterior cruciate ligament (ACL) reconstruction, will be 16 particularly beneficial to those patients who present with both anterolateral and rotatory knee 17 instability, or who remain unstable despite standard ligament reconstruction. 18Following collaboration with other research groups and preliminary cadaveric studies, the senior 19 author developed a minimally invasive anatomic technique with which to reconstruct the 20 anterolateral corner of the knee using gracilis tendon autograft, in conjunction with 'All-inside' 21 ...

Purpose: Instability following non-operative treatment of anterior cruciate ligament (ACL) rupture in young children frequently results in secondary chondral and/or meniscal injuries.Therefore many contemporary surgeons advocate ACL reconstruction in these patients, despite the challenges posed by peri-articular physes and the high early failure rate. We report a novel management approach, comprising direct ACL repair reinforced by a temporary internal brace in three children.Methods: Two patients (aged five and six years) with complete proximal ACL ruptures and a third (aged seven) with an associated tibial spine avulsion underwent direct surgical repair, supplemented with an internal brace, that was removed after three months.Results: Second look arthroscopy, examination and imaging at three months confirmed knee stability and complete ACL healing in all cases. Normal activities were resumed at four months and excellent objective measures of function, without limb growth disturbance, were noted beyond two years.Conclusion: ACL repair in young children using this technique negates the requirement and potential morbidity of graft harvest and demonstrates the potential for excellent outcome as an attractive alternative to ACL reconstruction, where an adequate ACL remnant permits direct repair.The final publication is available at Springer via http://dx

Women do not differ significantly from men with regard to either early infarct-related artery patency rates or reocclusion after thrombolytic therapy or ventricular functional response to injury/reperfusion. Gender was an independent determinant of 30-day mortality after acute myocardial infarction.

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