Increased lateral tibial slope predicts high-grade rotatory knee laxity pre-operatively in ACL reconstruction

Rahnemai-Azar, Ata A.; Abebe, Ermias; Johnson, Paul J.; Labrum, Joseph T.; Fu, Freddie H.; Irrgang, James J.; Samuelsson, Kristian; Musahl, Volker

doi:10.1007/s00167-016-4157-3

Cited by 90 publications

(83 citation statements)

References 28 publications

(42 reference statements)

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“…In fact, unaddressed meniscal tears, underappreciated meniscocapsular injuries, increased posterior tibial slope, and anterolateral capsular injuries have all been demonstrated to play a role in rotatory knee stability. 3,10,23–28,30,38 …”

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confidence: 99%

The Anterolateral Complex of the Knee

Herbst

Albers

Burnham

et al. 2017

Orthopaedic Journal of Sports Medicine

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Background:Significant controversy exists regarding the anterolateral structures of the knee.Purpose:To determine the layer-by-layer anatomic structure of the anterolateral complex of the knee.Study Design:Descriptive laboratory study.Methods:Twenty fresh-frozen cadaveric knees (age range, 38-56 years) underwent a layer-by-layer dissection to systematically expose and identify the various structures of the anterolateral complex. Quantitative measurements were performed, and each layer was documented with high-resolution digital imaging.Results:The anterolateral complex of the knee consisted of different distinct layers, with the superficial and deep iliotibial band (ITB) representing layer 1. The superficial ITB had a distinct connection to the distal femoral metaphysis and femoral condyle (Kaplan fibers), and the deep layers of the ITB were identified originating at the level of the Kaplan fibers proximally. This functional unit, consisting of the superficial and deep ITB, was reinforced by the capsulo-osseous layer of the ITB, which was continuous with the fascia of the lateral gastrocnemius and biceps femoris muscles. These 3 components of the ITB became confluent distally, and the insertion spanned from the Gerdy tubercle anteriorly to the lateral tibia posteriorly on a small tubercle (lateral tibial tuberosity). Layer 3 consisted of the anterolateral capsule, in which 35% (7/20) of specimens had a discreet mid-third capsular ligament.Conclusion:The anterolateral complex consists of the superficial and deep ITB, the capsulo-osseous layer of the ITB, and the anterolateral capsule. The anterolateral complex is defined by the part of the ITB between the Kaplan fibers proximally and its tibial insertion, which forms a functional unit. A discrete anterolateral ligament was not observed; however, the anterolateral ligament described in recent studies likely refers to the capsulo-osseous layer or the mid-third capsular ligament.Clinical Relevance:The anterolateral knee structures form a complex functional unit. Surgeons should use caution when attempting to restore this intricate structure with extra-articular procedures designed to re-create a single discreet ligament.

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confidence: 99%

The Anterolateral Complex of the Knee

Herbst

Albers

Burnham

et al. 2017

Orthopaedic Journal of Sports Medicine

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“…Bony features such as increased posterior tibial slope and a deep lateral femoral notch have been associated with increased ACL injury risk and rotatory knee instability. 57–61, 23 In addition, stereo fluoroscopy at our institution has demonstrated that posterior tibial slope correlates with knee kinematics in ACL reconstructed patients (Figure 5). 23 In cases of excessive posterior tibial slope, an anterior closing wedge tibial osteotomy may be indicated.…”

Section: Technical Considerations For Revision Acl Reconstruction Surmentioning

confidence: 92%

“…57–61, 23 In addition, stereo fluoroscopy at our institution has demonstrated that posterior tibial slope correlates with knee kinematics in ACL reconstructed patients (Figure 5). 23 In cases of excessive posterior tibial slope, an anterior closing wedge tibial osteotomy may be indicated. Similarly, patients with excessive varus malalignment may experience greater in-situ graft forces, 62 and concomitant proximal tibial osteotomy may be needed.…”

Section: Technical Considerations For Revision Acl Reconstruction Surmentioning

confidence: 92%

“…19, 12, 20–22, 16, 15, 9, 23, 24 Understanding the causes of primary ACL reconstruction is necessary to perform successful revision surgery. Chen et al reported that the most common reason for failure in ACL reconstruction cases requiring a single revision was due to the patient sustaining some type of traumatic event leading to graft tear.…”

Section: Factors Contributing To Primary Acl Reconstruction Failurementioning

confidence: 99%

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Technical Considerations in Revision Anterior Cruciate Ligament Reconstruction for Operative Techniques in Orthopaedics

Burnham

Herbst

Pauyo

et al. 2017

Operative Techniques in Orthopaedics

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As the incidence of anterior cruciate ligament (ACL) reconstruction continues to increase, the rate of revision surgery continues to climb. Revision surgery has inherent challenges that must be addressed in order to achieve successful results. The cause of the primary ACL reconstruction failure should be determined, and careful preoperative planning should be performed to address the cause(s) of failure. Each patient undergoing revision surgery should undergo a thorough history and physical examination, receive full length alignment radiographs, lateral radiographs, 45-degree flexion weight-bearing postero-anterior radiographs, and patellofemoral radiographs. 3-dimensional computed topography (CT) scan should be performed to assess tunnel position and widening. Magnetic resonance imaging (MRI) should be used to assess for intra-articular soft tissue pathology. Meniscal tears, meniscal deficiency, anterolateral capsule injuries, bony morphology, age, activity level, connective tissue diseases, infection, graft choice, and tunnel position can all impact the success of ACL reconstruction surgery. Meniscal lesions should be repaired, and in cases of persistent rotatory instability, extra-articular procedures may be indicated. Furthermore, osteotomies may be needed to correct malalignment or excess posterior tibial slope. Depending on the placement and condition of the original femoral and tibial tunnels, revision surgery may be performed in a single procedure or in a staged manner. In most cases, the surgery can be performed in one procedure. Regardless, the surgeon must communicate with the patient openly regarding the implications of revision ACL surgery and the treatment plan should be developed in a shared fashion between the surgeon and the patient.

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“…Os dados obtidos após a análise dos valores do "slope" lateral estão de acordo com a maioria dos trabalhos publicados recentemente (BEYNNON et al, 2014;FEUCHT et al, 2013;HOHMANN et al, 2011;RAHNEMAI-AZAR et al, 2017;ZENG et al, 2014). O compartimento lateral é mais móvel e tem maior efeito sobre a estabilidade rotacional no joelho.…”

Section: Método De Medição Do "Slope" Tibialunclassified

A influência do \"slope\" tibial no risco de falha da reconstrução do ligamento cruzado anterior

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Increased lateral tibial slope predicts high-grade rotatory knee laxity pre-operatively in ACL reconstruction

Abstract: Prospective diagnostic study, Level II.

Cited by 90 publications

References 28 publications

The Anterolateral Complex of the Knee

The Anterolateral Complex of the Knee

Technical Considerations in Revision Anterior Cruciate Ligament Reconstruction for Operative Techniques in Orthopaedics

A influência do \"slope\" tibial no risco de falha da reconstrução do ligamento cruzado anterior

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