An extra-articular procedure improves the clinical outcome in anterior cruciate ligament reconstruction with hamstrings in female athletes

Abstract

The extra-articular MacIntosh procedure modified by Cocker-Arnold in combination with ACL reconstruction significantly reduces the rotational instability of the knee.

Percutaneous Reconstruction of the Anterolateral Ligament of the Knee With a Polyester Tape

“…1 Because of limitations of current intra-articular techniques and inability to fully restore normal knee kinematics, insufficient anterolateral structures may play a role in residual knee laxity. 1,3,4 The role of extra-articular procedures improving knee stability has been a matter of debate, especially with regard to the rotational component (glide), and although authors such as Roth et al, 5 Strum et al, 6 and Barrett et al 7 found no significant improvements with the use of extra-articular plasty, Lerat et al, 8 Noyes et al, 9 and Zaffagnini et al 10 found increased success rates with the addition of an extra-articular procedure.…”

The Fascia Lata Anterolateral Tenodesis Technique

“…A strip of ITT has been widely used in the past for extra-articular nonanatomic tenodesis, [12][13][14] with good results at long-term follow-up. 15,[23][24][25] Moreover, the biomechanical effect of such procedures in controlling rotational stability of the knee has also been shown with the aid of navigation. 6,17 However, all these techniques, acting with nonanatomic behavior, took advantage from the long lever arm not reproducing the anatomy of the lateral aspect of the knee.…”

“…Second, because the ITT is another important secondary restraint of the knee, the use of a strip of ITT could weaken such a structure. 26,27 Nevertheless, strips of ITT have been widely used for extra-articular tenodesis in the past, [12][13][14] with no relation in long-term follow-up results 15,[23][24][25] in terms e84 of osteoarthritis. Moreover, the reconstruction is performed under the ITT, which can be sutured at the end of the procedure.…”

Minimally invasive anatomic reconstruction of the anterolateral ligament with ipsilateral gracilis tendon

“…ACL reconstruction may not entirely restore normal rotatory control, leading to residual pathologic laxity 3 . In addition, untreated concomitant traumatic insufficiency of the anterolateral soft tissue structures may contribute to residual postoperative knee laxity 4 , and extra-articular repair or reconstructions of the lateral knee anatomy [5][6][7][8][9] should therefore be considered. The ALL may be the key to restoring appropriate rotatory stability of the knee joint 10 .…”