A Biomechanical Study of the Role of the Anterolateral Ligament and the Deep Iliotibial Band for Control of a Simulated Pivot Shift With Comparison of Minimally Invasive Extra-articular Anterolateral Tendon Graft Reconstruction Versus Modified Lemaire Reconstruction After Anterior Cruciate Ligament Reconstruction

Smith, Patrick A.; Thomas, Dimitri; Pomajzl, Ryan J.; Bley, Jordan A.; Pfeiffer, Ferris M.; Cook, James L.

doi:10.1016/j.arthro.2018.11.011

Cited by 44 publications

(28 citation statements)

References 40 publications

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“…Trentacosta et al 34 also showed that the LEAT technique using the iliotibial band better restored the intact kinematics as compared with ALLR. Other studies [35][36][37] have found comparable biomechanical outcomes between the two techniques and with no advantage of one over the other. Among other confounders, the results may vary between studies due to techniques employed and fixation angle and fixation site, as it has been shown that these can highly influence residual laxity after ALLR.…”

Section: Editorialmentioning

confidence: 88%

“…38 39 Results from the pool of biomechanical studies discussed earlier suggest that anterolateral procedures using the LEAT seem to be superior in controlling rotational laxity due to ACL insufficiency, 33 34 but no definitive conclusion still cannot be achieved due to some conflicting findings. [35][36][37] The addition of lateral augmentation procedures-either LEAT or ALLR-to ACL reconstruction remains one of the most controversial topics in ACL research, but their role in controlling high rotational laxity and protecting the graft in patients with high-risk profile has gained increasing support. Indeed, the Stability study 40 has shown that adding a LEAT to an anatomical ACL reconstruction reduces the risk of clinical failure by 38% and graft rupture by 67% as compared with ACL reconstruction alone.…”

Section: Editorialmentioning

confidence: 99%

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Is the anterolateral ligament the smoking gun to explain rotational knee laxity or just vaporware?

Espregueira-Mendes

2021

Journal of ISAKOS

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Section: Editorialmentioning

confidence: 88%

Section: Editorialmentioning

confidence: 99%

Is the anterolateral ligament the smoking gun to explain rotational knee laxity or just vaporware?

Espregueira-Mendes

2021

Journal of ISAKOS

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“…Ferretti et al [15] reported that the incidence of ALL injuries associated with ACL tears is about 90%. For these reasons, several clinical studies of combined ACLR and ALLR have been performed and have reported improved rotatory stability of the knee [27,29,42,43,48]. Studies have shown that the pivot-shift test is a reliable examination in evaluating functional instability [4,25].…”

Section: Discussionmentioning

confidence: 99%

Surgical Treatment for Avulsion Fractures of the Anterolateral Ligament Associated with Periarticular Fractures of the Knee

Wei

Wang

et al. 2020

Preprint

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Background: To confirm the existence of the ALL and evaluate the clinical outcomes of surgical management for avulsion fractures involving its insertion when associated with periarticular knee fractures.Methods: Twenty-three patients (16 males and 7 females) with avulsion fractures of the ALL associated with periarticular knee fractures were fixed with a spider plate, cannulated screw, or suture anchor. Eight patients were diagnosed with distal femoral fracture, 10 with tibial plateau fracture, and 5 with tibial eminence avulsion fracture. All patients underwent X-rays at follow-up. Clinical and functional outcomes were assessed with the pivot-shift test, objective and subjective International Knee Documentation Committee (IKDC) score, Lysholm score, and Tegner activity scale.Results: The ALL was found and identified as a distinct ligamentous structure in all patients. Pre-Segond repair, patients had significantly more instability as determined by pivot-shift test than seen postoperatively (P < .0001). At final follow-up, the mean subjective IKDC score was 83.2±10.3. Fourteen patients were graded A, 6 were graded B, and 3 was graded C on the IKDC objective score. The mean Lysholm score was 85.4 ± 12.2. The mean Tegner score was 7.5 ± 1.2.Conclusion: This study confirmed that the ALL is a distinct structure in the anterolateral portion of the knee. The fixation for the avulsion fracture of the ALL associated with periarticular knee fractures can be an effective procedure without specific complications. Longer term and comparative follow-up studies are necessary to confirm the effects.

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“…A sequential sectioning study demonstrated that after an ACL-ALL reconstruction, the deep iliotibial (ITB) fibers were more important than the ALL in controlling the pivot shift. 14 There was no evidence that the ALL reconstruction caused lateral compartment overconstraint. 14 There is currently no clinical evidence supporting concerns about overconstraining the knee out to 29 months of follow-up.…”

mentioning

confidence: 99%

“…14 There was no evidence that the ALL reconstruction caused lateral compartment overconstraint. 14 There is currently no clinical evidence supporting concerns about overconstraining the knee out to 29 months of follow-up. However, it may be that current clinical follow-up times are insufficient to detect overstraining complications.…”

mentioning

confidence: 99%

Editorial Commentary: Lateral Extra-Articular Tenodesis Results in Better Stability After Anterior Cruciate Ligament Reconstruction for Patients With High-Grade Pivot Shifts

Barber¹

2021

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Magnetic resonance imaging of the torn anterior lateral ligament (ALL) is inconsistent and subject to significant intra-and interobserver variability. Like that of an anterior cruciate ligament (ACL), an ALL tear can vary in degree (first, second, or third) and location (tibial or femoral side). These variations may impact the appropriate surgical intervention. Relevant biomechanical data indicate that the deep iliotibial band fibers are more important than the ALL in controlling pivot shift. Lateral compartment overconstraint after ALL reconstruction does not appear to be a biomechanical or clinical issue. An ALL reconstruction creates a nonisometric construct (tight in extension and lax in flexion), allowing physiologic internal tibial rotation at 90 flexion, whereas lateral extra-articular tenodesis (LET) is more isometric, limiting physiologic internal tibial rotation at 90 flexion. The indications for a combined ACL/ALL reconstruction are evolving, but a Segond fracture and ligamentous hyperlaxity of 5 using the modified Beighton system seem reasonable. An ACL/LET reconstruction results in better stability for patients with high-grade pivot shifts.

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Cited by 44 publications

References 40 publications

Is the anterolateral ligament the smoking gun to explain rotational knee laxity or just vaporware?

Is the anterolateral ligament the smoking gun to explain rotational knee laxity or just vaporware?

Surgical Treatment for Avulsion Fractures of the Anterolateral Ligament Associated with Periarticular Fractures of the Knee

Editorial Commentary: Lateral Extra-Articular Tenodesis Results in Better Stability After Anterior Cruciate Ligament Reconstruction for Patients With High-Grade Pivot Shifts

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