Anterolateral Extra-articular Soft Tissue Reconstruction in Anterolateral Rotatory Instability of the Knee

Kernkamp, Willem A.; Velde, Samuel K. Van de; Bakker, Eric W. P.; Arkel, Ewoud R.A. van

doi:10.1016/j.eats.2015.08.015

Cited by 21 publications

(19 citation statements)

References 21 publications

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“…Some laboratory results on various “modern” anatomic ALL reconstruction procedures may seem conflicting at first, and definitely, among the existing techniques [29, 43, 49, 83, 86], no one has been proven superior to others, but in order to compare ex vivo and in vivo outcomes of contemporary ALL reconstruction techniques, proper terminology should be used.…”

Section: Future Directions and Conclusionmentioning

confidence: 99%

Anterolateral Ligament Expert Group consensus paper on the management of internal rotation and instability of the anterior cruciate ligament - deficient knee

et al. 2017

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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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Section: Future Directions and Conclusionmentioning

confidence: 99%

Anterolateral Ligament Expert Group consensus paper on the management of internal rotation and instability of the anterior cruciate ligament - deficient knee

et al. 2017

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“…This is consistent with the currently available literature, which frequently references revision cases and high-grade pivot shift as primary indications for proceeding with ALL reconstruction. 20 , 31 , 35 Biomechanical studies have shown that grade III pivot shift occurs with sectioning of the ALL and ACL versus the ACL alone. 31 Residual rotational instability may be a cause of clinical ACL reconstruction failure, and ALL reconstruction potentially increases rotary stability following revision surgery.…”

Section: Discussionmentioning

confidence: 99%

Anterolateral Ligament Reconstruction Practice Patterns Across the United States

Tramer

Fidai

Kadri

et al. 2018

Orthopaedic Journal of Sports Medicine

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Background:A proposed mechanism for recurrent instability following anterior cruciate ligament (ACL) reconstruction is failure of the anterolateral ligament (ALL). Presently, there are a number of approaches to treating ALL pathology.Purpose:To determine practice patterns among orthopaedic surgeons regarding ALL during ACL reconstruction.Study Design:Cross-sectional study.Methods:An online 7-question survey was sent to all physicians registered with the American Orthopaedic Society for Sports Medicine between June and July 2017. Results were analyzed with the survey website.Results:Overall, 225 of 3467 surgeons responded to the survey, 86 of whom performed ALL reconstruction and completed each question in the survey. Eighty-six (38.2%) surgeons who responded to the questionnaire stated that they perform ALL reconstruction/lateral extra-articular tenodesis in conjunction with ACL reconstruction. The most common indications for ALL reconstruction were grade III pivot-shift test (46.0%) on physical examination and revision ACL reconstruction (46.0%). The most common technique used to perform ALL reconstruction was hamstring autograft (48.2%). The majority of participating surgeons (87.5%) stated that they do not make any alterations to their postoperative rehabilitation protocol after they perform ALL reconstruction. In addition, most surgeons responding to the survey (91.3%) anticipated either an increase in or the same number of ALL procedures performed in the coming year.Conclusion:The majority of surgeons who responded to the survey did not routinely reconstruct the ALL. Revision procedures and grade III pivot shift were the most cited indications for performing lateral augmentation. Anatomic reconstruction with hamstring was the most commonly used procedure, although there was no consensus among surgeons responding to the survey. Understanding the ALL and its contribution to knee stability is essential. For a community of physicians, it is useful to discover how fellow sports orthopaedic surgeons address ALL pathology to integrate effective and efficient treatment strategies into practice.

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“…7 Therefore, techniques have shifted from nonanatomic procedures to procedures attempting to reproduce the anatomy, and techniques for anatomic ALL reconstruction have been proposed using soft-tissue grafts such as gracilis tendon and fascia lata. [18][19][20][21] However, because the ALL is a part of a more complex ligamentous structure (anterolateral complex) involving the whole lateral capsule extending from anterior to posterior, acting along with the ACL in controlling the pivot-shift phenomenon, often injured in the case of acute ACL tears, 22 an anterolateral capsule reinforcement in addition to anatomic ALL reconstruction could be useful with the goal to control rotatory loads.…”

Section: Discussionmentioning

confidence: 99%

The Fascia Lata Anterolateral Tenodesis Technique

Ferretti

Monaco

Fabbri

et al. 2017

Arthroscopy Techniques

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Abstract:A technique for anatomic reconstruction of the anterolateral complex addressing anterolateral rotatory instability both in primary anterior cruciate ligament reconstruction and in revision cases is presented. The extra-articular reconstruction is performed with a pedicle strip of iliotibial tract, fixed on the anatomic origin and insertion points of the anterolateral ligament of the knee in a double-bundle V-shaped fashion.

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Anterolateral Extra-articular Soft Tissue Reconstruction in Anterolateral Rotatory Instability of the Knee

Cited by 21 publications

References 21 publications

Anterolateral Ligament Expert Group consensus paper on the management of internal rotation and instability of the anterior cruciate ligament - deficient knee

Anterolateral Ligament Expert Group consensus paper on the management of internal rotation and instability of the anterior cruciate ligament - deficient knee

Anterolateral Ligament Reconstruction Practice Patterns Across the United States

The Fascia Lata Anterolateral Tenodesis Technique

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