Lateral tenodesis procedures increase lateral compartment pressures more than anterolateral ligament reconstruction, when performed in combination with ACL reconstruction: a pilot biomechanical study

Néri, Thomas; Cadman, Joseph; Beach, Aaron; Grasso, Samuel; Dabirrahmani, Danè; Putnis, Sven; Oshima, Takeshi; Devitt, Brian M.; Coolican, Myles; Fritsch, Brett; Appleyard, Richard; Parker, David

doi:10.1136/jisakos-2019-000368

Cited by 30 publications

(49 citation statements)

References 44 publications

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“…Neri et al 21 reported that all of the LEAPs they assessed (ALLR, modified Ellison, deep Lemaire, superficial Lemaire, modified MacIntosh) achieved rotational control; however, the deep and superficial Lemaire and the modified MacIntosh overconstrained internal rotation, leading to significantly shifted and different kinematics compared with the intact state. In a separate study, Neri et al 20 demonstrated that ALLR did not increase contact pressures in the lateral compartment but that the deep and superficial Lemaire procedures and the modified MacIntosh significantly increased contact pressures compared with isolated ACLR, particularly in internal rotation. We believe that ALLR avoids overconstraint because the procedure is anatomic and because grafts are fixed with the knee in full extension and neutral rotation.…”

Section: Discussionmentioning

confidence: 97%

Long-term Graft Rupture Rates After Combined ACL and Anterolateral Ligament Reconstruction Versus Isolated ACL Reconstruction: A Matched-Pair Analysis From the SANTI Study Group

et al. 2021

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Background: Clinical studies have demonstrated significant advantages of combined anterior cruciate ligament and anterolateral ligament reconstruction (ACL+ALLR) over isolated ACL reconstruction (ACLR) with respect to reduced graft rupture rates, a lower risk of reoperation for secondary meniscectomy, improved knee stability, and higher rates of return to sports. However, no long-term studies exist. Purpose/Hypothesis: The purpose of this study was to compare the outcomes of isolated ACLR versus ACL+ALLR at long-term follow-up. The hypothesis was that patients who underwent combined procedures would experience significantly lower rates of graft rupture. Study Design: Cohort study; Level of evidence, 3. Methods: Patients undergoing primary ACL+ALLR between January 2011 and March 2012 were propensity matched in a 1:1 ratio to patients who underwent isolated ACLR during the same period. A combination of face-to-face and telemedicine postoperative follow-up was undertaken. At the end of the study period (March 2020), medical notes and a final telemedicine interview were used to determine whether patients had experienced any complications or reoperations. The Knee injury and Osteoarthritis Outcome Score, International Knee Documentation Committee score, Lysholm score, and Tegner score were collected for all patients. Graft survivorship was assessed using Kaplan-Meier analysis. Logistic regression was performed to account for the potential effect of activity level on graft rupture rates. Results: A total of 86 matched pairs were included in the study. The mean ± SD age was 32.2 ± 8.8 years (range, 22-67 years) in the ACL+ALLR group and 34.7 ± 8.5 years (range, 21-61 years) in the isolated ACLR group. The mean duration of follow-up was 104.33 ± 3.74 months (range, 97-111 months). Patients who underwent combined ACL+ALLR versus isolated ACLR experienced significantly better ACL graft survivorship (96.5% vs 82.6%, respectively; P = .0027), lower overall rates of reoperation (15.3% vs 32.6%; P < .05), and lower rates of revision ACLR (3.5% vs 17.4%; P < .05). Patients undergoing isolated ACLR were at >5-fold greater risk of graft rupture (odds ratio, 5.549; 95% CI, 1.431-21.511; P = .0132), regardless of their preinjury activity level. There were no significant differences between groups with respect to other complications or any clinically important differences in patient-reported outcome measures. Conclusion: Patients who underwent combined ACL+ALLR experienced significantly better long-term ACL graft survivorship, lower overall rates of reoperation, and no increase in complications compared with patients who underwent isolated ACLR. Further, patients who underwent isolated ACLR had a >5-fold increased risk of undergoing revision surgery at a mean follow-up of 104.3 months.

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Section: Discussionmentioning

confidence: 97%

Long-term Graft Rupture Rates After Combined ACL and Anterolateral Ligament Reconstruction Versus Isolated ACL Reconstruction: A Matched-Pair Analysis From the SANTI Study Group

et al. 2021

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“…Neri et al, in a recent in vitro study, compared the ability of a variety of antero-lateral procedures [ 28 ] in association with ACL reconstruction, to restore the native knee kinematics. The authors tested the kinematic effects of the five different antero-lateral procedures in ten fresh-frozen cadavers using a motion analysis 3-D optoelectronic system, and distinguished two main kinds of extra-articular antero-lateral procedures: the antero-lateral ligament reconstruction and the lateral tenodesis using a section of ileo-tibial band (ITB).…”

Section: Resultsmentioning

confidence: 99%

“…Since the precursor of historical studies, in which this knee joint feature was described, among which the most famous and cited is the Paul Segond one [ 8 ], the analysis of the knee cadaveric specimen features and the assessment of the behaviour of the corpse joints and tissue in response to external mechanical input, represented a key tool to understanding the real structure and the function of the ALL. Furthermore, after the modern definition of this knee ligament [ 5 ], cadaver studies became one of the main ways to develop and test different kinds of surgical reconstruction of the ALL [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

The Cadaveric Studies and the Definition of the Antero-Lateral Ligament of the Knee: From the Anatomical Features to the Patient-Specific Reconstruction Surgical Techniques

Fabbro

Agostinone

Lucidi

et al. 2021

IJERPH

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Cadaver studies represented a milestone in surgical orthopaedic research, and still today they play a crucial role in the achievement of new knowledge about joint disease behaviour and treatment. In this review, an overview of the cadaver studies available in the literature about the anatomy, role, and treatment of the antero-lateral ligament (ALL) of the knee was performed. The aim of the review was to describe and gain more insight into the part of in vitro study in understanding knee joint anatomy and biomechanics, and in developing surgical reconstruction techniques. The findings of the review showed that cadaver studies had, and will continue to have, a key role in the research of knee joint biomechanics and surgical reconstruction. Moreover, they represent a powerful tool to develop and test new devices which could be useful in clinical and surgical practice.

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“…However, this study only includes four specimens which highly increases the risk of type II error,and this should be taken into account when interpreting their findings. In opposition to their findings, conflicting evidence 31 has shown no significant increase in the tibiofemoral compartment after ACL reconstruction with LEAT and, despite that the findings from Neri et al 4 that suggest an increased risk of knee overconstrain and subsequent risk of cartilage wear after ACL reconstruction with…”

mentioning

confidence: 86%

“…João Espregueira-Mendes 1,2,3,4,5 Since the publication of the 'discovery' of a new knee ligament in 2013, coined as anterolateral ligament (ALL), 1 the scientific research into this 'new' anatomical structure has grown exponentially in the past years. The Journal of ISAKOS (JISAKOS) publishes in this issue three studies on the anatomy of the anterolateral capsule (ALC) of the knee 2 and the biomechanics of the combined reconstruction of the anterior cruciate ligament (ACL) and the ALL.…”

mentioning

confidence: 99%

Is the anterolateral ligament the smoking gun to explain rotational knee laxity or just vaporware?

Espregueira-Mendes

2021

Journal of ISAKOS

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Lateral tenodesis procedures increase lateral compartment pressures more than anterolateral ligament reconstruction, when performed in combination with ACL reconstruction: a pilot biomechanical study

Cited by 30 publications

References 44 publications

Long-term Graft Rupture Rates After Combined ACL and Anterolateral Ligament Reconstruction Versus Isolated ACL Reconstruction: A Matched-Pair Analysis From the SANTI Study Group

Long-term Graft Rupture Rates After Combined ACL and Anterolateral Ligament Reconstruction Versus Isolated ACL Reconstruction: A Matched-Pair Analysis From the SANTI Study Group

The Cadaveric Studies and the Definition of the Antero-Lateral Ligament of the Knee: From the Anatomical Features to the Patient-Specific Reconstruction Surgical Techniques

Is the anterolateral ligament the smoking gun to explain rotational knee laxity or just vaporware?

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