Kinematics of ACL and anterolateral ligament. Part I: Combined lesion

Bonanzinga, Tommaso; Signorelli, Cecilia; Grassi, Alberto; Lopomo, N.; Bragonzoni, Laura; Zaffagnini, Stefano; Marcacci, Maurilio

doi:10.1007/s00167-016-4259-y

Cited by 53 publications

(66 citation statements)

References 30 publications

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“…Despite recent improvements in surgical methods and understanding of ACL anatomy, it has been suggested that the normal rotational stability of the knee is not fully restored by reconstructive methods for ACL injuries [5,6]. Such abnormal biomechanics have led surgeons to focus more on anterolateral structures and, in the past few years, the ALL of the knee has been studied with regard to its anatomy and biomechanics [3,[7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Biomechanical function of the anterolateral ligament of the knee: a systematic review

Lee

Seo

Jeong

et al. 2020

Knee Surg & Relat Res

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Background: It has been suggested that the anterolateral ligament (ALL) is an important anterolateral stabilizer of the knee joint which functions to prevent anterolateral subluxation and anterior subluxation at certain flexion angles in the knee. Purpose: To analyze and systematically interpret the biomechanical function of the ALL. Methods: An online search was conducted for human cadaveric biomechanical studies that tested function of the ALL in resisting anterolateral subluxation and anterior subluxation of the knee. Two reviewers independently searched Medline, Embase, and the Cochrane Database of Systematic Reviews for studies up to 25 September 2018. Biomechanical studies not reporting the magnitude of anterior tibial translation or tibial internal rotation in relation to the function of the ALL were excluded. Results: Twelve biomechanical studies using human cadavers evaluating parameters including anterior tibial translation and/or internal tibial rotation in anterior cruciate ligament (ACL)-sectioned and ALL-sectioned knees were included in the review. Five studies reported a minor increase or no significant increase in anterior tibial translation and internal tibial rotation with further sectioning of the ALL in ACL-deficient knees. Five studies reported a significant increase in knee laxity in tibial internal rotation or pivot shift with addition of sectioning the ALL in ACL-deficient knees. Two studies reported a significant increase in both anterior tibial translation and internal tibial rotation during application of the anterior-drawer and pivot-shift tests after ALL sectioning. Conclusion: There was inconsistency in the biomechanical characteristics of the ALL of the knee in resisting anterolateral and anterior subluxation of the tibia.

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Section: Introductionmentioning

confidence: 99%

Biomechanical function of the anterolateral ligament of the knee: a systematic review

Lee

Seo

Jeong

et al. 2020

Knee Surg & Relat Res

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“…4–7,19,31,37,45 These discrepant anatomic findings are further magnified when we consider biomechanical studies of the ALL. While some study groups found this ligament to be an important restraint of internal tibial rotation, 1,26,27,30 others described the biomechanical role of the ALL to be negligible. 20,32,43 Considering the inconsistent terms and conflicting findings, it is crucial that the anterolateral knee structure is clearly defined and a consistent terminology is developed.…”

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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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“…Recent studies have further investigated the anatomy of the so called "antero-lateral ligament" (ALL) (7)(8)(9), that has been clearly identified as a distinct ligamentous structure in 83 to 100% of knees. Moreover, the role of the anterolateral structures in rotational control of the knee has been demonstrated recently by several robotic cadaveric studies where the effect of a lesion of the ALL-in addition to an ACL injury was evaluated (10). Despite this, the precise role of the ALL in eliminating the pivot shift remains controversial (11).…”

Section: Abstract Acl; Antero-lateral Ligament; Navigation; Pivot-shiftmentioning

confidence: 99%

“…ALL in a cadaveric model and the same navigation system of the present study and they concluded that lesion of the ALL in an ACL deficient knee significantly increases tibial rotation and is correlated to the clinical appearance of an explosive pivot-shift in most cases. Bonazinga et al (10) evaluated the effect of progressive lesions of ACL and ALL during pivot-shift test. They specifically evaluated acceleration during the pivot shift test.…”

Section: Navigator Evaluationmentioning

confidence: 99%

Repair of antero lateral ligament injuries in acute anterior cruciate ligament tears: an in vivo study using navigation

Monaco

Ponzo

Lupariello

et al. 2019

Muscle Ligaments and Tendons J

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Background. To evaluate the effect of antero-lateral ligament (ALL) repair on the anterior-tibial translation (ATT) and the axial-tibial rotation (ATR) during the pivot-shift test with a navigation system in patient undergoing acute anterior cruciate ligament (ACL) reconstruction of acute injuries of anterolateral compartment in cases of acute ACL tears. Methods. Ten consecutive patients operated for an acute ACL reconstruction were enrolled in this prospective study. The pivot-shift test was repeated after all three steps of the procedure with navigation system: preoperatively, after repair of the ALL and after ACL reconstruction. This system provided a real-time calculation of ATT and ATR during the pivot shift test. Results. The mean ATT during the dynamic pivot-shift test was 15mm±3mm before ACL reconstruction and ALL repair, 11mm±2mm after ALL repair and 6mm±3mm after ALL repair and ACL reconstruction. The mean ATR during the dynamic pivot-shift test was 22°±12° before ACL reconstruction and ALL repair, 16°±3° after ALL repair and 10°±4° after ALL repair and ACL reconstruction. Conclusion. The repair of the antero-lateral compartment had a statistically significant effect on ATR, with no effect on ATT. The addition of the ACL reconstruction produced a significant effect on ATT, but no effect on ATR.

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Kinematics of ACL and anterolateral ligament. Part I: Combined lesion

Cited by 53 publications

References 30 publications

Biomechanical function of the anterolateral ligament of the knee: a systematic review

Biomechanical function of the anterolateral ligament of the knee: a systematic review

The Anterolateral Complex of the Knee

Repair of antero lateral ligament injuries in acute anterior cruciate ligament tears: an in vivo study using navigation

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