Cadaveric Study Comparing the Biomechanical Properties of Grafts Used for Knee Anterolateral Ligament Reconstruction

Wytrykowski, Karine; Swider, Pascal; Reina, Nicolas; Murgier, Jérôme; Laffosse, Jean Michel; Chiron, Philippe; Cavaignac, Étienne

doi:10.1016/j.arthro.2016.03.004

Cited by 54 publications

(42 citation statements)

References 39 publications

(54 reference statements)

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“…In order to assess the sensitivity of LER behavior to the four surgery settings, a total of 625 surgeries were simulated based upon five different variations of each of the following parameters: femoral attachment site, tibial attachment site, knee flexion angle at the time of fixation, and graft tension at the time of fixation. Each simulated surgery was performed using a single-strand gracilis graft with a stiffness of 65 N.mm (Wytrykowski et al, 2016).…”

Section: Simulated Lateral Extra-articular Reconstructionmentioning

confidence: 99%

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Technical considerations in lateral extra-articular reconstruction coupled with anterior cruciate ligament reconstruction: A simulation study evaluating the influence of surgical parameters on control of knee stability

Blache

Dumas

Guise

et al. 2019

Clinical Biomechanics

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Background: Surgical parameters such as the selection of tibial and femoral attachment site, graft tension, and knee flexion angle at the time of fixation may influence the control of knee stability after lateral extra-articular reconstruction. This study aimed to determine how sensitive is the control of knee rotation and translation, during simulated pivot-shift scenarios, to these four surgery settings. Methods: A computer model was used to simulate 625 lateral extra-articular reconstructions based upon five different variations of each of the following parameters: femoral and tibial attachment sites, knee flexion angle and graft tension at the time of fixation. For each simulated surgery, the lateral extra-articular reconstruction external rotation moment at the knee joint center was computed during simulated pivot-shift scenarios. The sensitivity of the control of knee rotation and translation to a given surgery setting was assessed by calculating the coefficient of variation of the lateral extra-articular reconstruction external rotation moment. Findings: Graft tension had minimal influence on the control of knee rotation and translation with less than 2.4% of variation across the scenarios tested. Control of knee rotation and translation was the least affected by the femoral attachment site if the knee was close to full extension at the time of graft fixation. The choice of the tibial attachment site was crucial when the femoral fixation was proximal and posterior to the femoral epicondyle since 15 to 67% of variation was observed in the control of knee rotation and translation. Interpretation: Femoral and tibial attachment sites as well as knee flexion angle at the time of fixation should be considered by surgeons when performing lateral extra-articular reconstruction. Variation in graft tension between the ranges 20-40 N has minimal influence on the control of knee rotation and translation.

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Section: Simulated Lateral Extra-articular Reconstructionmentioning

confidence: 99%

“…For each knee position and the 625 simulated surgeries, reconstructed LER length was calculated using the computer model. Based on LER length and its stiffness (Wytrykowski et al, 2016) (Fig. 1), the force produced by LER in the three dimensional directions was computed.…”

Section: Ler Moments and Forcesmentioning

confidence: 99%

Technical considerations in lateral extra-articular reconstruction coupled with anterior cruciate ligament reconstruction: A simulation study evaluating the influence of surgical parameters on control of knee stability

Blache

Dumas

Guise

et al. 2019

Clinical Biomechanics

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“…The maximum load to failure for the ALL was 141 N, 200.7 N for the duplicated gracilis, and 161.1 N for the ITB; the stiffness was 21 N mm -1 for the ALL,131.7 N mm -1 for the gracilis and 39.9 N mm -1 for the ITB; the elongation at failure was 6.2 mm for the ALL, 19.9 mm for the gracilis and 20.8 mm for the ITB. Therefore, the tendon of gracilis had the highest maximum load to failure, while the mechanical properties of the ITB most closely resemble those of the ALL 31 . We prefer to use a duplicate ipsilateral gracilis tendon because it does not weaken the iliotibial band, which represents another important anatomical structure of the anterolateral anatomy of the knee in controlling rotational stability.…”

Section: Surgical Proceduresmentioning

confidence: 94%

Minimally invasive anatomic reconstruction of the anterolateral ligament with ipsilateral gracilis tendon

Trinchese¹,

Oliva

Maffulli³

2017

MLTJ

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SummaryBackground: There has been much interest in understanding the anatomy and biomechanics of the anterolateral ligament (ALL). Several recon struction procedures have been proposed to correct rotatory instability after Anterior Cruciate Ligament (ACL) and anterolateral soft tissues injuries. Methods: We propose a new anatomic minimally invasive ALL reconstruction using the ipsilateral gracilis tendon. Through small skin incisions, the femoral attachment and the tibial insertion of the ALL can be identified, and half tunnels drilled. Then, the neo-ligament can be passed under the fascia lata into the tunnels. Fixation to the tibia is accomplished with a biotenodesis screw, and to the femur with a TightRope RT (Arthrex). Conclusion: This procedure allows to reconstruct in a minimally invasive fashion the ALL in selected patients with chronic anterolateral instability in ACL deficient knees. Level of evidence: V.

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“…Wytrykowski et al [38] performed a cadaveric study to compare the biomechanical properties of the ALL, gracilis, and IT band. The gracilis was found to have six times the stiffness of the ALL (131.7 vs. 21 N/mm) and had the highest maximum load to failure (200.7 vs. 141 N).…”

Section: Reconstruction 71 Graft Type and Preparationmentioning

confidence: 99%

Decision-Making for ALL Reconstruction and Surgical Techniques

Gürpınar¹

2020

Knee Surgery - Reconstruction and Replacement

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The anterolateral ligament (ALL), which was first described in 1879, was reintroduced in 2013 by Claes et al. It originates near the lateral epicondyle of the distal femur, runs along the lateral outer aspect of the knee, and inserts on the proximal tibia between Gerdy's tubercle and fibular head. The ALL tightens when the knee is internally rotated (twisted inwards), and in doing so, it is proposed to be a stabilizer to internal tibial rotation. Biomechanical studies showed that the ALL restrains internal rotation of the tibia and thus affects the pivot-shift phenomenon in the anterior cruciate ligament (ACL)-injured knee. Therefore, it is proposed that the deficient ALL can be a reason for persistent rotatory instability after ACL reconstruction. Furthermore, ALL reconstruction techniques have evolved and indications extended. Commonly accepted indications for concomitant ACL and ALL reconstruction are ACL revisions, high-grade pivot-shift test, chronic ACL rupture, and young patients and patients doing pivoting activities. Most surgeons perform an anatomic reconstruction technique with gracilis autograft. However, only few studies published reporting the outcomes of ALL reconstruction and more studies with longer follow-up times are, therefore, needed to provide the compelling clinical evidence for the efficacy of concomitant ACL and ALL procedures.

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Cadaveric Study Comparing the Biomechanical Properties of Grafts Used for Knee Anterolateral Ligament Reconstruction

Abstract: The biomechanical properties of each potential ALL graft can be factored in when deciding which type of graft to use.

Cited by 54 publications

References 39 publications

Technical considerations in lateral extra-articular reconstruction coupled with anterior cruciate ligament reconstruction: A simulation study evaluating the influence of surgical parameters on control of knee stability

Technical considerations in lateral extra-articular reconstruction coupled with anterior cruciate ligament reconstruction: A simulation study evaluating the influence of surgical parameters on control of knee stability

Minimally invasive anatomic reconstruction of the anterolateral ligament with ipsilateral gracilis tendon

Decision-Making for ALL Reconstruction and Surgical Techniques

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