Biomechanical study of strength and stiffness of the knee anterolateral ligament

Abstract

BackgroundRecent studies clearly characterize the anatomical parameters of the knee anterolateral ligament (ALL). The potential clinical importance of this ligament is exemplified by some patients with possible combined Anterior Cruciate Ligament (ACL) and ALL rupture who do not progress satisfactorily following isolated ACL reconstruction. Previous biomechanical studies have assessed the resistance parameters of the ALL in order to address potential reconstruction strategies; however, these have reported conflicting results. Thus, this study aimed to evaluate the linear resistance of the ALL by means of a biomechanical study in cadaveric knees.MethodsFourteen cadaveric knees were used. The ALL was dissected, and all structures that connect the femur and the tibia, except for the ALL, were sectioned. The ALL was subjected to a tensile test with the knee around 30 to 40 degrees, in a way that the ALL was aligned with the machine. The strength at the maximum resistance limit, deformation and stiffness of the ALL were evaluated.ResultsThe mean maximum strength of the ALL was 204.8 +/- 114.9 N. The stiffness was 41.9 +/- 25.7 N/mm and the deformation 10.3 +/- 3.5 mm.ConclusionThe ALL has a mean ultimate tensile strength of 204.8 N. This suggests that simple bands of all autologous or homologous grafts commonly used in clinical practice for ligament reconstruction around the knee possess the required biomechanical resistance characteristics for ALL reconstruction.

The Anterolateral Ligament: An Anatomic Study on Sex-Based Differences

“…18,27,34,36,42 Sonnery-Cottet et al 42 further demonstrated its significance in the presence of ACL injury. In their study, an isolated lesion of the ACL did not produce a pivot shift, which was instead only seen with a concurrent lesion of either the ALL or the ITB.…”

Revisión sistemática: ligamento anterolateral de la rodilla

“…Con respecto al tipo de injerto utilizado para la reconstrucción, la banda iliotibial tiene mejores propiedades biomecánicas en comparación con el tendón del gracilis (102,103) . Estudios recientes demuestran una disminución del pivot shift asociando esta reconstrucción del LAL a la cirugía del LCA (104)(105)(106) .…”

Kinematic outcomes following ACL reconstruction

“…Inconsistent findings of the proposed ligament [101][102][103][104] and a varying range of reported anatomic insertion sites [105] have led to a controversial discussion about its existence and function. Contradicting results of biomechanical tensile testing of the proposed anterolateral ligament, reporting an ultimate load to failure of 49.9 N (±14.6 N) [106] and 204.8 N (±114.9 N) [107], further complicate any conclusions. Without discovering a discrete ligamentous structure, a recent study evaluated the macroscopic, microscopic, and radiologic anatomy of the anterolateral aspect of the knee and discovered a discrete thickening of 2-4 mm in the anterolateral capsule in 30 % of the specimens.…”