Editorial Commentary: Anatomy of the Anterolateral Ligament of the Knee—The Science of Looking for Bigfoot

Grassbaugh, Jason A.; Turner, Eric K.

doi:10.1016/j.arthro.2018.11.031

Cited by 3 publications

(3 citation statements)

References 9 publications

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“…The ALL has been the source of much debate, and both its anatomic course and clinical significance are contested points of discussion [3, 4, 16, 21, 37]. Claes et al described the anatomical course as running from the lateral femoral epicondyle to the antero‐lateral tibia, located halfway between the tip of the fibular head and Gerdy’s tubercle [7].…”

Section: Discussionmentioning

confidence: 99%

There are differences in knee stability based on lateral extra-articular augmentation technique alongside anterior cruciate ligament reconstruction

Hurley

Bloom

Hoberman

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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PurposeThe purpose of the current study is to systematically review and network meta-analyze the current evidence in the literature to ascertain if there is a superior lateral extra-articular augmentation technique in conjunction with anterior cruciate ligament (ACL) reconstruction (ACL.R) with respect to knee stability, re-rupture rates and functional outcomes. Methods The literature search was performed based on the PRISMA guidelines. Cohort studies comparing ACL.R to ACL.R + lateral extra-articular augmentation were included. Lateral extra-articular techniques included were anterolateral ligament reconstruction (ALL.R), Cocker-Arnold, Lemaire, Losee, Maraccaci, and McIntosh. Clinical outcomes were compared between ACL.R alone and the diferent lateral extra-articular augmentation techniques using a frequentist approach to network meta-analysis, with statistical analysis performed using R. The treatment options were ranked using the P-Score. Results Twenty-eight studies with a total of 2990 patients were included. ACL.R + Cocker-Arnold technique had the highest P-Score for ACL re-ruptures and residual pivot-shift. ACL.R + Cocker-Arnold, Lemaire, and ALL.R all signiicantly reduced the rate of ACL re-rupture, and residual pivot-shift, compared to ACL.R alone. There was no signiicant diference between any of the lateral extra-articular augmentation techniques and ACL.R alone. ALL.R had the highest P-Score for return to play, and return to play at pre-injury level. Conclusion This study established that ACL.R + Cocker-Arnold, Lemaire and ALL.R resulted in signiicantly lower ipsilateral ACL re-ruptures, as well as reduced pivot-shift, compared to ACL.R alone. Whereas, the other lateral extra-articular augmentation techniques did not reduce pivot-shift and re-rupture. Additionally, functional outcomes and return to play were comparable between those who underwent ACL.R and lateral extra-articular augmentation and ACL.R alone. Level of evidence III.

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Section: Discussionmentioning

confidence: 99%

There are differences in knee stability based on lateral extra-articular augmentation technique alongside anterior cruciate ligament reconstruction

Hurley

Bloom

Hoberman

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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“…The ALL was recently “re‐discovered” by Claes et al in 2013, as Segond originally described the existence of a 'pearly, resistant, fibrous band' at the antero‐lateral aspect of the knee joint in 1879 [3]. The ALL has subsequently been the source of controversy as to its clinical significance and anatomical course [1, 2, 7, 8, 20]. Claes et al described it as running from the prominence of the lateral femoral epicondyle to the antero‐lateral tibia, midway between Gerdy’s tubercle and the tip of the fibular head [3].…”

Section: Discussionmentioning

confidence: 99%

Antero-lateral ligament reconstruction improves knee stability alongside anterior cruciate ligament reconstruction

Hurley

Fried

Kingery

et al. 2020

Knee Surg Sports Traumatol Arthrosc

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PurposeRecent evidence has found the antero‐lateral ligament (ALL) may play a role in stabilizing the knee, but its role in anterior cruciate ligament (ACL) reconstruction is controversial. The purpose of the current study is to systematically review and meta‐analyze the current evidence in the literature to ascertain whether ACL reconstruction combined with ALL reconstruction affects knee stability, re‐rupture rates and patient‐reported outcomes compared to ACL reconstructions performed alone. MethodsA literature search was performed based on the PRISMA guidelines. Cohort studies comparing ACL + ALL reconstruction and ACL reconstruction alone were included. ResultsSix clinical trials (LOE I: I, LOE II: 2, LOE III: 3) with 729 patients were included, with a mean follow‐up time of 34.2 (24–54.9) months. There was a significant difference in favor of combined ACL + ALL reconstruction for reduced re‐rupture rate (2.4% vs 7.3%, p < 0.01), residual positive pivot shift rate (33.3% vs 11.4%, p < 0.01), and reduced KT‐arthrometer evaluation (1.6 vs 2.6, p < 0.01). Combined ACL + ALL reconstruction resulted in improved IKDC scores (92.5 vs 87.8, p < 0.01), Lysholm scores (95.7 vs 91.2, p < 0.01) and Tegner scores (6.7 vs 5.7, p < 0.01). There was no significant difference in rate of return to play at the same level (54.3% vs 46.0%, n.s.). ConclusionThe current evidence suggests alongside soft tissue graft ACL reconstruction that concomitant ALL reconstruction improves clinical outcomes, with improved knee stability and lower re‐rupture rates. Level of evidenceIII.

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“…This increased interest has resulted in a plethora of publications on several aspects of the ALC, mainly addressing the ALL. However, contradictory data on the role and the necessity for an ALC repair/augmentation in the setting of primary ACL injured knees resulted in a divergent standpoint regarding this additional procedure in the Orthopaedic sports community [ 16 , 34 , 43 , 46 ]. This has been amplified by limited high-quality clinical research addressing the relevance and clinical outcomes of lateral augmentations (LA) as a whole [ 33 , 49 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical outcomes of contemporary lateral augmentation techniques in primary ACL reconstruction: a systematic review and meta-analysis

et al. 2021

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Purpose The purpose of this investigation was to systematically review the contemporary literature to determine if a lateral augmentation (LA) added to an Anterior Cruciate Ligament Reconstruction (ACLR) provides better clinical and patient reported outcomes compared to an isolated ACLR. Methods A systematic review and meta-analysis was performed according to the Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) criteria. Two authors independently conducted an electronic search using MEDLINE® and Embase® on February 6th, 2021 for level I-III randomized controlled trials (RCT) and prospective cohort studies without randomization, published after 2012 and with a minimum of two year follow-up. Publications were included when they reported on the objective knee stability examination, patient reported outcome scores, return to sports or graft rupture rate of any type of primary, isolated ACLR compared to ACLR combined with any type of LA. Results A total of 11 studies that reported on a combined total of 1892 unique patients were eligible for data extraction, including five RCTs and six prospective cohort studies. In 6 studies, an Anterolateral Ligament reconstruction (ALLR) was the LA of choice, while the 5 other publications used different types of Lateral Extra-articular Tenodesis (LET). A significant reduction in graft ruptures was found in patients treated with ACLR + LA (3%) compared to isolated ACLR (12%). Rotational laxity was significantly higher in isolated ACLR (14%) compared to ACLR + LA (6%). Addition of a LA reduced anterior translation when assessed via instrumented laxity testing. No significant difference was found in the patient reported outcome scores (IKDC and Tegner) between both patient groups, except for the Lysholm Score which was significant in favour of the ACLR + LA group. Conclusion Combination of a primary ACLR with a LA can significantly reduce the risk of graft rupture and provide better rotatory stability, without jeopardizing patient reported outcomes. Level of evidence Level III, Systematic Review of Level I, II and III studies.

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Editorial Commentary: Anatomy of the Anterolateral Ligament of the Knee—The Science of Looking for Bigfoot

Cited by 3 publications

References 9 publications

There are differences in knee stability based on lateral extra-articular augmentation technique alongside anterior cruciate ligament reconstruction

There are differences in knee stability based on lateral extra-articular augmentation technique alongside anterior cruciate ligament reconstruction

Antero-lateral ligament reconstruction improves knee stability alongside anterior cruciate ligament reconstruction

Clinical outcomes of contemporary lateral augmentation techniques in primary ACL reconstruction: a systematic review and meta-analysis

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