An In Vitro Robotic Assessment of the Anterolateral Ligament, Part 1

Rasmussen, Matthew T.; Nitri, Marco; Williams, Brady T.; Moulton, Samuel G.; Cruz, Raphael Serra; Dornan, Grant J.; Goldsmith, Mary T.; LaPrade, Robert F.

doi:10.1177/0363546515618387

Cited by 230 publications

(102 citation statements)

References 34 publications

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“…18,27,34,36,42 Sonnery-Cottet et al 42 further demonstrated its significance in the presence of ACL injury. In their study, an isolated lesion of the ACL did not produce a pivot shift, which was instead only seen with a concurrent lesion of either the ALL or the ITB.…”

Section: Discussionmentioning

confidence: 96%

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The Anterolateral Ligament: An Anatomic Study on Sex-Based Differences

Daggett

Helito²,

Cullen

et al. 2017

Orthopaedic Journal of Sports Medicine

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Background:The anterolateral ligament (ALL) has been shown to have an important role in rotatory stability of the knee. While there is abundant research on sex-based differences related to anterior cruciate ligament (ACL) rupture, there is a paucity of literature related to such differences in the ALL.Purpose:To define any sex-based differences in the ALL with regard to length, width, and thickness.Study Design:Descriptive laboratory study.Methods:The ALL was initially evaluated in 165 unpaired knees (92 males and 65 females after exclusion criteria applied). The length, width, and thickness of the ALL were measured using a digital caliper. Width and thickness were measured at the joint line just superior to the lateral meniscus. The Mann-Whitney test and Student t tests were used to compare measurements between males and females. The Pearson product-moment correlation was subsequently used to determine the correlation between height and weight and the statistically different morphometric variables.Results:The mean (±SD) thickness of the ALL in males was 2.09 ± 0.56 mm, almost twice as thick as females (1.05 ± 0.49 mm; P = 8.8 × 10−20). There was also a statistically significant difference in ALL length (P = 3.8 × 10−7), but no significant difference was found for width. A moderate association was found between donor height and ALL thickness and length.Conclusion:The anatomic measurements of the ALL demonstrate a difference between sexes, and the ALL is significantly thicker in males than females.Clinical Relevance:As the role of the ALL in rotatory stability of the knee becomes better understood, the difference in the thickness of the ALL we have found between the sexes may be another factor why female athletes have an increased incidence of ACL rupture compared with males. This may also help explain why females have issues with knee laxity and rotatory instability.

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Section: Discussionmentioning

confidence: 96%

“…In a separate investigation, in vitro robotic assessment of the ALL provided further evidence of its role in rotatory stability when subjected to a simulated pivot-shift test. 36 Through this same modality it was shown that a combined ACL/ALL reconstruction provided better rotatory control than an ACL reconstruction alone. 32 …”

Section: Discussionmentioning

confidence: 99%

The Anterolateral Ligament: An Anatomic Study on Sex-Based Differences

Daggett

Helito²,

Cullen

et al. 2017

Orthopaedic Journal of Sports Medicine

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“…Despite these historical reports of the ALL, the most accurate anatomical description of the ALL has been provided by Claes et al [15], and its importance with regard to knee stability has been confirmed in numerous biomechanical studies [42, 53, 66, 71]. …”

Section: Historymentioning

confidence: 99%

“…The biomechanical properties of the ALL allow for internal rotation to be increased to over 30° of flexion; [71, 87] however, the pivot-shift seems to represent the most reliable test to evaluate ALL integrity. Monaco et al demonstrated that a grade III pivot shift is only seen in the absence of both the ACL and ALL in vitro [53].…”

Section: Clinical Diagnosismentioning

confidence: 99%

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Anterolateral Ligament Expert Group consensus paper on the management of internal rotation and instability of the anterior cruciate ligament - deficient knee

et al. 2017

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Purpose of this paper is to provide an overview of the latest research on the anterolateral ligament (ALL) and present the consensus of the ALL Expert Group on the anatomy, radiographic landmarks, biomechanics, clinical and radiographic diagnosis, lesion classification, surgical technique and clinical outcomes. A consensus on controversial subjects surrounding the ALL and anterolateral knee instability has been established based on the opinion of experts, the latest publications on the subject and an exchange of experiences during the ALL Experts Meeting (November 2015, Lyon, France). The ALL is found deep to the iliotibial band. The femoral origin is just posterior and proximal to the lateral epicondyle; the tibial attachment is 21.6 mm posterior to Gerdy’s tubercle and 4–10 mm below the tibial joint line. On a lateral radiographic view the femoral origin is located in the postero-inferior quadrant and the tibial attachment is close to the centre of the proximal tibial plateau. Favourable isometry of an ALL reconstruction is seen when the femoral position is proximal and posterior to the lateral epicondyle, with the ALL being tight upon extension and lax upon flexion. The ALL can be visualised on ultrasound, or on T2-weighted coronal MRI scans with proton density fat-suppressed evaluation. The ALL injury is associated with a Segond fracture, and often occurs in conjunction with acute anterior cruciate ligament (ACL) injury. Recognition and repair of the ALL lesions should be considered to improve the control of rotational stability provided by ACL reconstruction. For high-risk patients, a combined ACL and ALL reconstruction improves rotational control and reduces the rate of re-rupture, without increased postoperative complication rates compared to ACL-only reconstruction. In conclusion this paper provides a contemporary consensus on all studied features of the ALL. The findings warrant future research in order to further test these early observations, with the ultimate goal of improving the long-term outcomes of ACL-injured patients. Level of evidence Level V—Expert opinion.

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Lateral soft-tissue structures contribute to cruciate-retaining total knee arthroplasty stability

et al. 2016

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Little information is available to surgeons regarding how the lateral structures prevent instability in the replaced knee. The aim of this study was to quantify the lateral soft-tissue contributions to stability following cruciate-retaining total knee arthroplasty (CR TKA). Nine cadaveric knees were tested in a robotic system at full extension, 30°, 60°, and 90° flexion angles. In both native and CR implanted states, ±90 N anterior-posterior force, ±8 Nm varus-valgus, and ±5 Nm internal-external torque were applied. The anterolateral structures (ALS, including the iliotibial band), the lateral collateral ligament (LCL), the popliteus tendon complex (Pop T), and the posterior cruciate ligament (PCL) were transected and their relative contributions to stabilizing the applied loads were quantified. The LCL was found to be the primary restraint to varus laxity (an average 56% across all flexion angles), and was significant in internal-external rotational stability (28% and 26%, respectively) and anterior drawer (16%). The ALS restrained 25% of internal rotation, while the PCL was significant in posterior drawer only at 60° and 90° flexion. The Pop T was not found to be significant in any tests. Therefore, the LCL was confirmed as the major lateral structure in CR TKA stability throughout the arc of flexion and deficiency could present a complex rotational laxity that cannot be overcome by the other passive lateral structures or the PCL. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1902-1909, 2017.

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An In Vitro Robotic Assessment of the Anterolateral Ligament, Part 1

Abstract: Residual internal rotation and a positive pivot shift after ACL reconstruction may be attributed to ALL injury. For these patients, surgical treatment of an ALL tear may be considered.

Cited by 230 publications

References 34 publications

The Anterolateral Ligament: An Anatomic Study on Sex-Based Differences

The Anterolateral Ligament: An Anatomic Study on Sex-Based Differences

Anterolateral Ligament Expert Group consensus paper on the management of internal rotation and instability of the anterior cruciate ligament - deficient knee

Lateral soft-tissue structures contribute to cruciate-retaining total knee arthroplasty stability

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