Anatomy, Biomechanics, and Reconstruction of the Anterolateral Ligament of the Knee Joint

Park, Jun-Gu; Han, Seung-Beom; Lee, Chul-Soo; Jeon, Ok Hee; Jang, Ki-Mo

doi:10.3390/medicina58060786

Cited by 11 publications

(6 citation statements)

References 58 publications

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“…The importance of ensuring knee stability in the structures analysed (MCL, POL, ALL and medial meniscus) in our study has been widely reported and analysed in the literature; in fact, several biomechanical studies have demonstrated that the ALL acts as a secondary stabilizer of anterolateral rotatory instability [18].…”

Section: Discussionmentioning

confidence: 99%

“…RAMP lesions are associated with notable augmentation of anterior translational mobility and external rotational instability of the tibia [19]. During clinical examination, both types of damage cause an augmentation in motion when the subject is doing the pivot-shift test [6,18,19]. In individuals diagnosed with an ACL injury and accompanying ALL tear or RAMP lesion, complete restoration of knee joint stability is frequently not achieved via ACL reconstruction alone [6,22,24].…”

Section: Introductionmentioning

confidence: 99%

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High incidence of RAMP lesions and a nonnegligible incidence of anterolateral ligament and posterior oblique ligament rupture in acute ACL injury

D'Ambrosi,

Sconfienza,

Albano

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeThe purpose of this study was to assess the frequency of medial collateral ligament (MCL), posterior oblique ligament (POL) and anterolateral ligament (ALL) tears and different types of RAMP lesions of patients with verified acute anterior cruciate ligament (ACL) tears by magnetic resonance imaging (MRI).MethodsMRI was performed on patients with a clinical diagnosis of acute ACL injury. Patients were eligible for inclusion if they had an initially clinically noted ACL tear confirmed on MRI within 30 days of trauma.ResultsA total of 146 patients were included in the study, 42 (28.8%) females and 104 (71.2%) males. The mean age at MRI was 27.2 ± 9.4 years, and the mean time from injury to MRI was 15.7 ± 7.8 days. Thirty‐four (23.3%) patients had a complete MCL lesion, 32 (21.9%) had a complete POL lesion and 28 (19.2%) had a complete ALL lesion. One hundred and fourteen patients (78.1%) presented with RAMP lesions, while 20 (13.7%) patients reported other meniscal lesions. The mean medial and lateral tibial slopes were 4.0° ± 2.7° and 4.0° ± 3.1°, respectively. Only 10 (6.8%) patients reported no lesions associated with ACL rupture. The most common injuries were isolated RAMP type 3 (18–12.3%) and isolated RAMP type 1 (17–11.6%). Thirteen (8.9%) patients had a combination of MCL, POL and ALL rupture.ConclusionsIsolated lesions of the ACL are extremely rare. In most cases, a single RAMP lesion should be investigated. In the presence of MCL injury, POL injury should always be suspected as well, while nearly 20% of patients present a rupture of the ALL. About one in 10 patients had three lesions (MCL, ALL and POL), and most of them had a combined RAMP lesion.Level of EvidenceLevel IV.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

High incidence of RAMP lesions and a nonnegligible incidence of anterolateral ligament and posterior oblique ligament rupture in acute ACL injury

D'Ambrosi,

Sconfienza,

Albano

et al. 2024

Knee surg. sports traumatol. arthrosc.

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“…Several variable surgical techniques have been developed with promising short-term prognoses [ 1 , 23 , 24 ]. However, some systemic reviews revealed variation in the anatomic footprint and heterogeneous biomechanical results, and the objective measurement of the surgical outcome also varied [ 25 , 26 ]. DePhillipo et al found there was more variability in the femoral tunnel location than in the tibial tunnel.…”

Section: Discussionmentioning

confidence: 99%

“…They noted average comparability for the KT1000 and GNRB and poor comparability for the others. Hence, they concluded that the devices were not comparable [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Combined Anterior Cruciate Ligament and Anterolateral Ligament Reconstruction According to GNRB Arthrometer Measurement

et al. 2023

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Background and Objectives: To investigate the prognosis of combined anterior cruciate ligament (ACL) and anterolateral ligament (ALL) reconstruction, we used a GNRB (Genourob, Laval, France) arthrometer to measure surgical outcomes. Materials and Methods: This retrospective study reviewed patients who underwent combined ACL and ALL reconstruction and had a minimum follow-up of 2 years. Subjective outcomes, namely the International Knee Documentation Committee (IKDC) evaluation form scale scores and Lysholm scores, were evaluated preoperatively and postoperatively. We used a GNRB arthrometer to test the side-to-side laxity under pressures of 134 and 200 N, and we calculated the differential of the slope of the curves. We also recorded complications. Results: Our study examined 18 patients (mean age: 30.56 ± 8.9 years, range: 19–53) with a mean follow-up of 27.37 ± 3.4 months (range: 24–36). Both Lysholm and IKDC scores were significantly improved following the operation. The GNRB arthrometer measured mean anteroposterior laxity side-to-side as 0.76 ± 0.78 mm and 0.82 ± 0.8 mm under pressures of 134 and 200 N, respectively. The mean side-to-side differential slope under 200 N was 3.52 ± 2.17 μm/N. These values indicated that patients displayed no graft tear or low functional knee instability. All patients had a grade 3 pivot shift preoperatively; only two patients had a grade 1 pivot shift postoperatively, with the rest having a negative pivot shift. Conclusions: Our study revealed that combined ACL and ALL reconstruction has an excellent prognosis. GNRB measurement demonstrated excellent stability, and most patients had no residual pivot shift.

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“…ACL reconstruction (ACLR) is, therefore, one of the most common procedures performed in orthopaedic surgery [26].…”

Section: Introductionmentioning

confidence: 99%

A fast, easy and reliable method for hamstrings graft size prediction in anterior cruciate ligament reconstruction

Minoli,

Travi,

Monti

et al. 2023

Knee surg. sports traumatol. arthrosc.

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Purpose The aim of this study is to describe and validate a simple and reliable method to pre-operatively predict the size of the ACL graft in the double strand technique with autologous semitendinosus–gracilis tendons on the same MRI used for ACL rupture diagnosis. Methods The study included 92 patients, with a median age of 31 years (IQR 26–41 years), 73/92 (79%) of whom were males. All patients that underwent an ACL reconstruction with doubled ST + GT between 2017 and 2022 were counted in the study. Results Overall, the median predicted graft diameter from MR imaging was similar to the actual graft diameter with no significant differences (n.s.). Regarding the comparison between predicted and actual graft size, concordance was 78/92 (85%, 95% CI 76–91%), with κ = 0.797 which corresponds to a level of agreement defined as “Strong”. Tendon sizes calculated on pre-operative MRI were evaluated both with intra-observer and inter-observer reliability demonstrating a statistically reproducible method. The predicted graft was then compared to the reported one with a statistically significant reliability found. Conclusion This study can help the surgeons to perform a fast pre-operative planning of an ACL reconstruction for graft selection. If the planned graft with ST and GT is smaller than 8 mm, the clinician can decide to switch to a different type of graft or plan a different graft preparing technique and, therefore, reduce the risk of post-operative ligament re-rupture. The method proposed is reliable and reproducible. The major strength of the planning technique proposed is that it relies on data that are already available for the clinician before surgery, without the need of further analysis. Level of evidence IV.

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Anatomy, Biomechanics, and Reconstruction of the Anterolateral Ligament of the Knee Joint

Cited by 11 publications

References 58 publications

High incidence of RAMP lesions and a nonnegligible incidence of anterolateral ligament and posterior oblique ligament rupture in acute ACL injury

High incidence of RAMP lesions and a nonnegligible incidence of anterolateral ligament and posterior oblique ligament rupture in acute ACL injury

Outcomes of Combined Anterior Cruciate Ligament and Anterolateral Ligament Reconstruction According to GNRB Arthrometer Measurement

A fast, easy and reliable method for hamstrings graft size prediction in anterior cruciate ligament reconstruction

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