Sonographic Evaluation of the Anterolateral Ligament of the Knee: A Cadaveric Study

Zappia, Marcello; Oliva, Francesco; Chianca, Vito; Pietto, Francesco Di; Maffulli, Nicola

doi:10.1055/s-0038-1655763

Cited by 7 publications

(5 citation statements)

References 25 publications

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“…The authors reported that the ALL could be identified as a distinct, distinguishable structure in all 10 specimens using the MRI [ 17 ]. In another cadaver study, Zappia et al performed a high resolution, real time ultrasonography evaluation of the ALL in eight specimens [ 20 ]; the results of the latter study showed that the ALL was distinguished in all eight cadaver limbs, and that the ultrasound examination was a useful tool to investigate the ALL features and its injuries.…”

Section: Resultsmentioning

confidence: 99%

The Cadaveric Studies and the Definition of the Antero-Lateral Ligament of the Knee: From the Anatomical Features to the Patient-Specific Reconstruction Surgical Techniques

Fabbro

Agostinone

Lucidi

et al. 2021

IJERPH

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Cadaver studies represented a milestone in surgical orthopaedic research, and still today they play a crucial role in the achievement of new knowledge about joint disease behaviour and treatment. In this review, an overview of the cadaver studies available in the literature about the anatomy, role, and treatment of the antero-lateral ligament (ALL) of the knee was performed. The aim of the review was to describe and gain more insight into the part of in vitro study in understanding knee joint anatomy and biomechanics, and in developing surgical reconstruction techniques. The findings of the review showed that cadaver studies had, and will continue to have, a key role in the research of knee joint biomechanics and surgical reconstruction. Moreover, they represent a powerful tool to develop and test new devices which could be useful in clinical and surgical practice.

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Section: Resultsmentioning

confidence: 99%

The Cadaveric Studies and the Definition of the Antero-Lateral Ligament of the Knee: From the Anatomical Features to the Patient-Specific Reconstruction Surgical Techniques

Fabbro

Agostinone

Lucidi

et al. 2021

IJERPH

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“…They concluded that the US is an adequate tool for identifying the ligament. Likewise, Zappia et al 20 in an anatomical study with cadavers concluded that ultrasound is useful for assessing ALL but emphasized the importance of studies evaluating its visualization in the knees of patients with ACL injuries.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the anterolateral ligament of the knee with high resolution ultrasound

Bettencourt Nunes,

Mendonça,

de Souza Tedrus

et al. 2023

MOJOR

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Objectives: To determine whether high-resolution ultrasound is an exam that contributes to the identification and assessment of the integrity of the anterolateral ligament of the knee in patients with anterior cruciate ligament injury. Methods: 41 patients, 16 to 55 years old, with primary lesion of the anterior cruciate ligament were evaluated. Demographic data were collected, and a Pivot Shift test was performed. An ultrasound examination was performed, with a high- resolution probe, on both patients' knees, initially, seeking the visualization of the anterolateral ligament in all its extension and later assessing its integrity, ending with an assessment of the lateral meniscus. Results: 100% of the evaluated cases, it was possible to visualize the anterolateral ligament through ultrasound with 46.3% of injuries, with the tibial portion being the most injured. 19 patients (46.3%) had anterolateral ligament injury on the same side as the anterior cruciate ligament injury, while in 19 cases (46.3%) no anterolateral ligament injury was observed on either side. 5 patients had a pivot shift test considered positive with 80% of associated anterolateral ligament injury. 31 patients had lateral meniscus injury by magnetic resonance imaging. Of the 31 patients, 25 were confirmed by ultrasound. Of the 11 patients without lesion of the lateral meniscus by MRI, none had an ultrasound lesion. Adding these two groups, 92.6% of results favorable to ultrasound, (p <0.001). Conclusion: The data obtained suggest that ultrasound contributes to the identification and assessment of the integrity of the knee anterolateral ligament in patients with anterior cruciate ligament injury. Level of Evidence IV.

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“…All US examinations were performed to detect the anatomical landmarks (Gerdy’s tubercle, Lateral collateral ligament (LCL), iliotibial band, popliteus tendon, and ALL) with the knee flexed at 10° and 10° of internal rotation to give some tension to the ALL. Thus, the ALL was first assessed distally by identifying Gerdy’s tubercle and looking for a ligamentous structure beginning posterior to the tubercle with directionality pointing toward the footprint of the LCL on the lateral femoral condyle, as described in literature [ 41 ].…”

Section: Methodsmentioning

confidence: 99%

Minimally invasive anatomic reconstruction of the anterolateral ligament with ipsilateral gracilis tendon: a kinematic in-vitro study

et al. 2022

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Purpose The anterolateral ligament (ALL) has been defined as a key stabilizer of internal tibial rotation at 35° or more of knee flexion, with a minimal primary or secondary stabilizing role in the AP direction. This study aimed to demonstrate that anatomical reconstruction of the ALL confers rotational stability equal to that of the uninjured knee. Hypothesis: anteroposterior (AP) and rotatory laxity will significantly vary after ALL tenotomy and ALL reconstruction with the author’s previously described technique. Methods After ultrasound (US) ALL identification, different kinematic measurements were performed with an image-less Computer-Assisted Navigation System with dedicated software for Laxity Analysis in 5 knee specimens. Anteroposterior (AP) translations and varus/valgus (VV) and Internal-External (IE) rotations were evaluated by two trained orthopedic surgeons before ALL section, after ALL section, and after ALL anatomical reconstruction with doubled ipsilateral autologous gracilis tendon. Results ALL resection significantly increased laxity in IE rotations with knee 90° flexed (IE90) and AP translation with tibia internally rotated and the knee 30° flexed (APlat) (p < 0.05). ALL reconstruction significantly reduced laxity in IE90 and APlat (p < 0.05) and reduced VV rotations at 30° of flexion (VV30) (p < 0.05). There were no statistically significant elongation differences between native ALL and reconstructed ALL (graft) during laxity tests. The inter-operator repeatability of the tests was excellent for each measurement. Conclusions ALL acted as an important internal tibial rotation restrain at 90° and a significant (secondary) AP stabilizer at 30° of knee flexion. The presented ALL reconstruction technique significantly restored the increase of knee laxity produced by the ALL section. Scientific level Case-Controlled Laboratory Study, Level III.

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Sonographic Evaluation of the Anterolateral Ligament of the Knee: A Cadaveric Study

Cited by 7 publications

References 25 publications

The Cadaveric Studies and the Definition of the Antero-Lateral Ligament of the Knee: From the Anatomical Features to the Patient-Specific Reconstruction Surgical Techniques

The Cadaveric Studies and the Definition of the Antero-Lateral Ligament of the Knee: From the Anatomical Features to the Patient-Specific Reconstruction Surgical Techniques

Evaluation of the anterolateral ligament of the knee with high resolution ultrasound

Minimally invasive anatomic reconstruction of the anterolateral ligament with ipsilateral gracilis tendon: a kinematic in-vitro study

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