Biomechanical Evaluation of Pediatric Anterior Cruciate Ligament (ACL) Reconstruction Techniques With and Without the Anterolateral Ligament (ALL)

Trentacosta, Natasha; Pace, J. Lee; Metzger, Melodie F.; Michalski, Max; Nelson, Trevor; Polakof, Landon S.; Mandelbaum, Bert R.

doi:10.1097/bpo.0000000000001078

Cited by 22 publications

(31 citation statements)

References 37 publications

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“… 11 In a biomechanical study, Trentacosta et al. 30 compared stability after performing all-epiphyseal ACL reconstruction with ALLR with that after the modified Macintosh procedure. The modified Macintosh procedure restored rotational stability closer to normal values at most flexion angles, whereas the all-epiphyseal ACL reconstruction with ALLR improved rotational stability at lower flexion angles, but not at 60° and 90°.…”

Section: Discussionmentioning

confidence: 99%

Combined Anterolateral Ligament Reconstruction and Capsular Reinforcement in the Skeletally Immature Knee

Patel

Talathi

2020

Arthroscopy Techniques

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Graft failure after anterior cruciate ligament reconstruction remains a challenging complication in the pediatric population. The anterolateral ligament (ALL) contributes to rotational stability, and early evidence in adults suggests that ALL reconstruction may lower the risk of anterior cruciate ligament graft rupture. We present a technique for combined ALL reconstruction and anterolateral capsular reinforcement using iliotibial band autograft in skeletally immature patients. This procedure seeks to provide additional rotational stability in varying degrees of flexion while avoiding the physes and eliminating the need for implants.

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Section: Discussionmentioning

confidence: 99%

Combined Anterolateral Ligament Reconstruction and Capsular Reinforcement in the Skeletally Immature Knee

Patel

Talathi

2020

Arthroscopy Techniques

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“…32 Other biomechanical studies have reported opposite results when comparing traditional LEAT techniques and ALLR. 33 34 Inderhaug et al 33 showed that while deep Lemaire and MacIntosh procedures restored native rotational kinematics, the ALLR failed to restore normal internal rotation and underconstrained the knee. Trentacosta et al 34 also showed that the LEAT technique using the iliotibial band better restored the intact kinematics as compared with ALLR.…”

Section: Editorialmentioning

confidence: 99%

“…33 34 Inderhaug et al 33 showed that while deep Lemaire and MacIntosh procedures restored native rotational kinematics, the ALLR failed to restore normal internal rotation and underconstrained the knee. 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.…”

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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“…In 1879, Paul Segond initially described a pathognomonic anterolateral tibial avulsion fracture associated with anterior cruciate ligament (ACL) tears. 2 , 35 Since then, multiple studies 1 , 22 , 35 , 37 have described an anterolateral ligament (ALL) with varying terminology and anatomic findings. Histologically, the ALL has been noted as compact collagen fibers in parallel orientation consistent with a ligamentous and tendinous structure.…”

mentioning

confidence: 99%

Biomechanical Effects of Combined Anterior Cruciate Ligament Reconstruction and Anterolateral Ligament Reconstruction: A Systematic Review and Meta-analysis

Kelly

Cutter

Huish

2021

Orthopaedic Journal of Sports Medicine

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Background: Combined anterior cruciate ligament (ACL) reconstruction (ACLR) and anterolateral ligament reconstruction (ALLR) are performed with the intention to restore native knee kinematics after ACL tears. There continue to be varying results as to the difference in kinematics between combined and isolated procedures, including anterior tibial translation (ATT) and internal tibial rotation (IR). Purpose: To perform a systematic review and meta-analysis to evaluate the kinematic changes of a combined ACLR/ALLR versus isolated ACLR and to assess the effects of different fixation techniques. Study Design: Systematic review. Methods: We conducted a systematic review and meta-analysis of 15 human cadaveric biomechanical studies evaluating combined ACLR/ALLR versus isolated ACLR and their effects on ATT and IR in 149 specimens. The primary outcomes were ATT and IR. Secondary outcomes included graft type and size as well as fixation methods such as type, angle, tension, and position of fixation. Meta-regression was used to examine the effect of various cofactors on the resulting measures. Results: Compared with isolated ACLR, combined ACLR/ALLR decreased ATT and IR by 0.01 mm (95% CI, –0.059 to 0.079 mm; P = .777) and 1.64° (95% CI, 1.30°-1.98°; P < .001), respectively. Regarding ACLR/ALLR, increasing the knee flexion angle and applied IR force led to a significant reduction in IR ( P < .001 and P = .044, respectively). There was also a significant reduction in IR in combined procedures with semitendinosus ALL graft, higher flexion fixation angles, and tension but no change in IR with differing femoral fixation points ( P < .001, P < .001, and P = .268, respectively). Multivariate meta-regression showed that the use of tibial-sided suture anchor fixation significantly reduced IR ( P < .001). Conclusion: These results suggest that a combined ACLR/ALLR procedure significantly decreases IR compared with isolated ACLR, especially at higher knee flexion angles. Semitendinosus ALL graft, fixation at higher knee flexion, increased tensioning, and tibial-sided interference screw fixation in ALLR may help to further reduce IR.

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Biomechanical Evaluation of Pediatric Anterior Cruciate Ligament (ACL) Reconstruction Techniques With and Without the Anterolateral Ligament (ALL)

Abstract: Cadaveric Laboratory Study. The ITB ACLR seems to be the biomechanically superior pediatric ACLR technique to regain translational and rotational stability.

Cited by 22 publications

References 37 publications

Combined Anterolateral Ligament Reconstruction and Capsular Reinforcement in the Skeletally Immature Knee

Combined Anterolateral Ligament Reconstruction and Capsular Reinforcement in the Skeletally Immature Knee

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

Biomechanical Effects of Combined Anterior Cruciate Ligament Reconstruction and Anterolateral Ligament Reconstruction: A Systematic Review and Meta-analysis

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