Lateral Extra-articular Tenodesis Has No Effect in Knees With Isolated Anterior Cruciate Ligament Injury

Herbst, Elmar; Arilla, Fabio V.; Guenther, Daniel; Yacuzzi, Carlos; Rahnemai-Azar, Ata A.; Fu, Freddie H.; Debski, Richard E.; Musahl, Volker

doi:10.1016/j.arthro.2017.08.258

Cited by 58 publications

(48 citation statements)

References 39 publications

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“…Similarly, Herbst at el. investigated the role of LET in both an isolated ACL injury and ACL plus ALC injury [19]. These researchers concluded that the addition of an LET had no additional benefit to knee stability in the isolated ACL deficient knee when an ACL reconstruction was performed.…”

Section: Biomechanics Of Lateralmentioning

confidence: 99%

The anterolateral complex of the knee: results from the International ALC Consensus Group Meeting

Getgood

Brown²,

Lording

et al. 2018

Knee Surg Sports Traumatol Arthrosc

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The structure and function of the anterolateral complex (ALC) of the knee has created much controversy since the 're-discovery' of the anterolateral ligament (ALL) and its proposed role in aiding control of anterolateral rotatory laxity in the anterior cruciate ligament (ACL) injured knee. A group of surgeons and researchers prominent in the field gathered to produce consensus as to the anatomy and biomechanical properties of the ALC. The evidence for and against utilisation of ALC reconstruction was also discussed, generating a number of consensus statements by following a modified Delphi process. Key points include that the ALC consists of the superficial and deep aspects of the iliotibial tract with its Kaplan fibre attachments on the distal femur, along with the ALL, a capsular structure within the anterolateral capsule. A number of structures attach to the area of the Segond fracture including the capsule-osseous layer of the iliotibial band, the ALL and the anterior arm of the short head of biceps, and hence it is not clear which is responsible for this lesion. The ALC functions to provide anterolateral rotatory stability as a secondary stabiliser to the ACL. Whilst biomechanical studies have shown that these structures play an important role in controlling stability at the time of ACL reconstruction, the optimal surgical procedure has not yet been defined clinically. Concern remains that these procedures may cause constraint of motion, yet no clinical studies have demonstrated an increased risk of osteoarthritis development. Furthermore, clinical evidence is currently lacking to support clear indications for lateral extra-articular procedures as an augmentation to ACL reconstruction. The resulting statements and scientific rationale aim to inform readers on the most current thinking and identify areas of needed basic science and clinical research to help improve patient outcomes following ACL injury and subsequent reconstruction. Level of evidence V.

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Section: Biomechanics Of Lateralmentioning

confidence: 99%

The anterolateral complex of the knee: results from the International ALC Consensus Group Meeting

Getgood

Brown²,

Lording

et al. 2018

Knee Surg Sports Traumatol Arthrosc

Self Cite

293

265

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“…The indication should not be too broad, as there is a risk of excessive pressure in the lateral compartment. In addition, unphysiological kinematics may develop in the knee joint [62,63].…”

Section: Anterolateral Instabilitymentioning

confidence: 99%

Update on Failure Analysis of Implants in ACL Surgery: Technical Failure or Fate?

et al. 2019

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ZusammenfassungDie Ursachen für das Versagen von Rekonstruktionen des vorderen Kreuzbandes (VKB) sind vielfältig und erfordern einen multifaktoriellen Erklärungsansatz. Neben technischen operativen Fehlern müssen bei der Versagensanalyse auch die vielen für eine erneute VKB-Verletzung prädisponierenden Risikofaktoren berücksichtigt werden. Technische Fehler beinhalten vor allem die nicht anatomische Platzierung der tibialen und femoralen Bohrkanäle. Eine anatomische Position des femoralen Tunnels kann nur durch eine vom tibialen Bohrkanal unabhängige Anlagetechnik erreicht werden. Bei den Risikofaktoren lassen sich nicht modifizierbare und modifizierbare Risikofaktoren unterscheiden, wobei eine Kombination von mehr als einem Risikofaktor das Verletzungsrisiko erheblich steigert. Zu den nicht modifizierbaren Faktoren gehören die genetische Prädisposition, weibliches Geschlecht, junges Alter und eine allgemeine Hyperlaxität. Ein junges Patientenalter bei erstmaliger Verletzung stellt vor allem in Zusammenhang mit Hochrisikosportarten einen wesentlichen Risikofaktor für ein Transplantatversagen dar. Zu den modifizierbaren Faktoren gehören ein hoher Body-Mass-Index, Defizite im Sprunglandungsmechanismus, ein steiler posteriorer tibialer Slope und eine schmale Notchweite. Diese lassen sich durch neuromuskuläres Training oder zusätzliche operative Eingriffe verändern, sodass das Risiko einer weiteren Verletzung reduziert werden kann. Das operative Verfahren der Wahl zur Reduktion des tibialen Slopes ist die hohe tibiale Osteotomie. Hierdurch kann die anteriore Tibiatranslation verringert werden. Bei einem tibialen Slope von über 12° sollte ein derartiges Verfahren in Betracht gezogen werden. Eine zusätzliche laterale extraartikuläre Stabilisierung sollte vor allem bei Revisionsplastiken des VKB mit einer verbliebenen anterolateralen Rotationsstabilität erwogen werden. Auch bei Patienten, die durch Risikosportarten, begleitende Hyperlaxität oder zusätzliche Beteiligung der peripheren Strukturen bei VKB-Insuffizienz zur Hochrisikogruppe gezählt werden, sollte ein derartiger Eingriff diskutiert werden. Zudem kann der Belag des Sportfeldes modifiziert und somit Einfluss auf das Verletzungsrisiko genommen werden. Zusammenfassend kann man sagen, dass nicht nur im Falle einer VKB-Reruptur eine fundierte Versagensanalyse erfolgen muss, sondern die genannten Faktoren schon bei der Risikoabschätzung in der Patientenaufklärung berücksichtigt werden sollten. Nur so kann eine gezielte und individualisierte Therapie durchgeführt werden.

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“…4 In this issue of Arthroscopy, Herbst and his coauthors Arilla, Guenther, Yacuzzi, Rahnemai-Azar, Fu, Debski and Musahl, in their cadaveric study titled "Lateral Extra-articular Tenodesis Has No Effect in Knees With Isolated Anterior Cruciate Ligament Injury," reported knee kinematics in response to physical examinations in ACL-deficient and reconstructed knees with and without anterolateral capsule injury and LET. 5 The purpose of the study is of high clinical interest, and I commend the authors for pursuing this topic. This study is based on physical examination for the pivot shift in a cadaveric model performed by 2 experienced orthopaedic surgeons.…”

Section: See Related Article On Page 251mentioning

confidence: 99%

“…anterolateral capsule injury (P < .001) led to a significant increase of this translation." 5 Providing correlation with the degree of the pivot shift clinical grade related to an ACL tear only versus a combined ACL/ALL injury would have been good information from the study.…”

Section: Columbia Missourimentioning

confidence: 99%

Editorial Commentary: Filling the Void in Translational Research for Lateral Extra-articular Tenodesis for Anterior Cruciate Ligament Reconstruction: Are We Saturated With Biomechanical Studies?

Smith

2018

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Anterior cruciate ligament (ACL) graft failure rates remain unacceptably high in certain populations, and researchers are examining the effect that the anterolateral ligament (ALL) has on knee stability following ACL reconstruction. Currently, most available research examining the ALL has focused on cadaveric biomechanical kinematic studies, including the effect of surgical techniques for ALL reconstruction/lateral extra-articular tenodesis (LET). However, it is critical for ongoing and future research to focus on clinical outcome measures relating to individuals who have had ALL reconstruction or LET along with their ACL reconstructions. This is what will benefit clinicians most as to the appropriate indications for when to perform an extra-articular stabilization procedure in combination with ACL reconstruction.

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Lateral Extra-articular Tenodesis Has No Effect in Knees With Isolated Anterior Cruciate Ligament Injury

Cited by 58 publications

References 39 publications

The anterolateral complex of the knee: results from the International ALC Consensus Group Meeting

The anterolateral complex of the knee: results from the International ALC Consensus Group Meeting

Update on Failure Analysis of Implants in ACL Surgery: Technical Failure or Fate?

Editorial Commentary: Filling the Void in Translational Research for Lateral Extra-articular Tenodesis for Anterior Cruciate Ligament Reconstruction: Are We Saturated With Biomechanical Studies?

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