The Effects of Knee Reconstruction on Combined Anterior Cruciate Ligament and Anterolateral Capsular Deficiencies

Abstract

We tested the effect of intraarticular reconstructions of the anterior cruciate ligament alone and in combination with extraarticular reconstructions in 10 cadaveric knees. These knees had anterior cruciate ligament deficiency alone or in combination with anterolateral capsuloligamentous deficiencies. In the knees with combined injury, intraarticular reconstruction returned anterior stability to levels not significantly different from levels found for the knees deficient in the anterior cruciate ligament alone and treated with this procedure. After intraarticular reconstruction, rotational stability of the knee with combined injuries failed to return to the levels seen in the knee with isolated anterior cruciate ligament deficiencies that underwent the same treatment. When a tenodesis with either 0 N or 22 N of tension was added to the intraarticular reconstruction in the knee with combined injuries, we found that excessive internal rotation significantly decreased at all angles of flexion, except at full extension with 0 N of tension. In addition, the extraarticular reconstruction with 22 N of tension in the tenodesis overconstrained the knee in internal rotation between 30 degrees and 90 degrees of knee flexion. The tenodesis with 0 N of tension overconstrained the knee at only 60 degrees and 90 degrees of flexion. These results suggest extraarticular reconstruction as an adjunct to the intraarticular operation for the knee with anterior cruciate ligament and anterolateral structural injuries. The results also suggest that the surgeon can affect anterior and rotational laxity by adjusting the tension in the tenodesis.

Biomechanical Results of Lateral Extra-articular Tenodesis Procedures of the Knee: A Systematic Review

“…Application of the inclusion and exclusion criteria yielded 10 full-text articles for inclusion in the review. [16][17][18][19][20][21][22][23][24][25] …”

“…[17][18][19][20][21]24,25 In addition, whereas isolated LET procedures did not return normal anterior stability to the ACL-deficient knee, they did significantly reduce anterior tibial translation and the forces on an intra-articular graft during the application of an anteriorly directed load. These findings verify the conclusions of previous studies that asserted that the ACL and anterolateral structures collectively inhibit anterolateral rotatory instability in the intact knee.…”

“…The 10 studies included in this systematic review showed significant variability with respect to the surgical technique used for the LET procedure. [16][17][18][19][20][21][22][23][24][25] Despite variability in the surgical approaches, most studies exhibited similar biomechanical results, bringing previous concerns about the efficacy of LET procedures to the forefront. Previous studies documenting LET procedures recommended fixing the graft with the tibia maintained in an externally rotated position.…”

“…21 Of the 8 studies in this review that analyzed rotatory movement, 7 showed joint over-constraint, indicated by a significant reduction in internal rotatory movement relative to that of the native knee joint. [17][18][19][20][21]24,25 Previous studies have reported that over-constraint of the knee may cause abnormal joint kinematics, leading to the development of premature osteoarthritis. 18,20,21,24,25 In addition, joint over-constraint has been theorized to result in graft elongation and eventual graft failure.…”

“…[17][18][19][20][21]24,25 Previous studies have reported that over-constraint of the knee may cause abnormal joint kinematics, leading to the development of premature osteoarthritis. 18,20,21,24,25 In addition, joint over-constraint has been theorized to result in graft elongation and eventual graft failure. 21 As discussed previously, the studies included in this systematic review reported significant variability in the anatomic attachment points and course of the LET graft used.…”