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.

Level III.

No abstract

Knowledge of the anatomic landmarks of the ALL on radiography will permit minimally invasive surgical reconstruction with lower morbidity.

ObjectiveTo evaluate the use of subchondroplasty in the treatment of bone marrow lesions in an initial series of five cases.MethodsThe study included patients aged between 40 and 75 years old, with pain in the knee for at least six months, associated with high-signal MRI lesion on T2 sequences, on the tibia or femur. Patients were assessed using the visual analog pain scale and the KOOS score, one week before surgery and one, three, six, 12, and 24 weeks after the procedure. Subchondroplasty was performed with a technique developed for filling the area of the bone marrow lesion with a calcium phosphate bone substitute.ResultsThe filling was performed on the medial femoral condyle in four patients and medial tibial plateau in one case. The assessment by the KOOS score presented a preoperative average of 38.44 points and 62.7, 58.08, 57.92, 63.34, and 71.26 points with one, three, six, 12, and 24 weeks after surgery, respectively. In the evaluation by the VAS, the average was 7.8 points preoperatively and 2.8, 3, 2.8, 1.8, and 0.6 points over the same periods. All patients were able to ambulate without additional support, on the first day after the procedure. One patient had a minimal graft dislocation to the soft tissue, with local pain, which resolved completely after a week.ConclusionThe subchondroplasty technique provided significant improvements in the parameters of pain and functional capacity in the short-term assessment.

We present a new technique for the combined intra-and extra-articular reconstruction of the anterior cruciate ligament. Intra-articular reconstruction is performed in an outside-in manner according to the precepts of the anatomic femoral tunnel technique. Extra-articular reconstruction is performed with the gracilis tendon while respecting the anatomic parameters of the origin and insertion points and the path described for the knee anterolateral ligament.

ObjectiveTo evaluate the presence of the anterolateral ligament (ALL) of the knee in magnetic resonance imaging (MRI) examinations.MethodsThirty-three MRI examinations on patients’ knees that were done because of indications unrelated to ligament instability or trauma were evaluated. T1-weighted images in the sagittal plane and T2-weighted images with fat saturation in the axial, sagittal and coronal planes were obtained. The images were evaluated by two radiologists with experience of musculoskeletal pathological conditions. In assessing ligament visibility, we divided the analysis into three portions of the ligament: from its origin in the femur to its point of bifurcation; from the bifurcation to the meniscal insertion; and from the bifurcation to the tibial insertion. The capacity to view the ligament in each of its portions and overall was taken to be a dichotomous categorical variable (yes or no).ResultsThe ALL was viewed with signal characteristics similar to those of the other ligament structures of the knee, with T2 hyposignal with fat saturation. The main plane in which the ligament was viewed was the coronal plane. Some portion of the ligament was viewed clearly in 27 knees (81.8%). The meniscal portion was evident in 25 knees (75.7%), the femoral portion in 23 (69.6%) and the tibial portion in 13 (39.3%). The three portions were viewed together in 11 knees (33.3%).ConclusionThe anterolateral ligament of the knee is best viewed in sequences in the coronal plane. The ligament was completely characterized in 33.3% of the cases. The meniscal portion was the part most easily identified and the tibial portion was the part least encountered.

With the increasing number of total knee arthroplasty (TKA) procedures being performed annually, the burden of revision surgery is also expected to increase. Addressing bone loss during revision TKA is a considerable challenge that requires proper preoperative evaluation and surgical planning. In addition to an assessment of femoral and tibial bone loss, a systematic approach to the management of bone loss associated with TKA includes careful implant selection, adherence to the general principles of revision TKA, and an understanding of the available reconstruction options. These options include cement with screws, morcellized allograft, bulk structural allograft, modular wedges, block augments, porous metal cones or sleeves, and megaprostheses.