Minimally Invasive Anterolateral Ligament Reconstruction in the Setting of Anterior Cruciate Ligament Injury

Sonnery‐Cottet, Bertrand; Barbosa, Nuno; Tuteja, Sanesh; Daggett, Matthew; Kajetanek, Charles; Thaunat, Mathieu

doi:10.1016/j.eats.2015.11.005

Cited by 65 publications

(57 citation statements)

References 15 publications

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“…Some laboratory results on various “modern” anatomic ALL reconstruction procedures may seem conflicting at first, and definitely, among the existing techniques [29, 43, 49, 83, 86], no one has been proven superior to others, but in order to compare ex vivo and in vivo outcomes of contemporary ALL reconstruction techniques, proper terminology should be used.…”

Section: Future Directions and Conclusionmentioning

confidence: 99%

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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Section: Future Directions and Conclusionmentioning

confidence: 99%

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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“…[9][10][11] Several techniques have been developed to try to anatomically address this structure in the setting of an ACL reconstruction. [12][13][14] The lead author (B.S-C.) has developed a simple anatomic technique to reconstruct the ACL and the ALL of the knee using hamstring tendons and keeping the semitendinosus inserted to preserve tendon vascularization (Video 1, Table 1). …”

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confidence: 99%

Combined Anterior Cruciate Ligament and Anterolateral Ligament Reconstruction

Sonnery‐Cottet

Daggett

Helito

et al. 2016

Arthroscopy Techniques

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Despite technologic advances in the surgical technique for anterior cruciate ligament (ACL) reconstruction, some patients continue to have rotational instability postoperatively. Recently, authors have reported the anatomic and functional characteristics of the anterolateral ligament (ALL), a structure that originates near the lateral epicondyle on the femur and inserts on the tibia between the Gerdy tubercle and the fibular head. Recent biomechanical studies have shown the ALL is an important stabilizer against anterolateral tibial rotation, and its reconstruction has shown excellent initial clinical results. Several techniques have been developed to try to anatomically address this structure in the setting of an ACL reconstruction. This article details a simple anatomic technique to reconstruct the ACL and the ALL of the knee using hamstring tendon autograft and maintaining the semitendinosus insertion.

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“…Более чем 130 лет эта анатомическая структура находилась в тени и ее роль была либо не очевидна, либо не-дооценивалась. поэтому алс не восстанавливали при хирургических вмешательствах по поводу разрыва передней крестообразной связки (пкс) до 2013 г. значимость данной структуры для реконструктивной хирургии возросла после того, как последующие исследования доказали участие алс в ротационной стабильности коленного сустава [12][13][14][15][16]. однако результаты топографо-анатомических исследований антеролатеральной связки коленного сустава во многом противоречивы и явно недостаточны [17], что требует ее дальнейшего изучения.…”

Section: рефератunclassified

Topographic and Anatomical Features of Anterolateral Ligament of the Knee

Goncharov¹,

Коваль²,

Krasnov³

et al. 2018

Traumatology and Orthopedics of Russia

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Background: anterolateral ligament (ALL) is known since it was found in 1879 by Paul Segond. During more than 130 years this anatomical structure was not popular, later it became especially relevant, when its involvement in knee joint rotational stability was demonstrated by different studies. However, data about anterolateral ligament in the knee joint is controversial and limited so further research is necessary.Purpose of the study: to investigate frequency of occurrence, severity and features of topography of anterolateral ligament of the knee joint in the context of stabilizing procedures on the knee joint.Materials and methods: the study included 60 samples of lower limbs obtained from 30 unfixed corpses of people who died at the age from 69 to 99 years. Topography-anatomical study was performed with knee bent at 90° with internal rotation of lower leg using basic surgical instruments set and precision preparation instruments set. When the ligament was identified, relationship with the lateral meniscus body was evaluated, relationship with peroneal collateral ligament (mainly by connective fibers) and the presence of lateral lower knee vessels (artery and veins) were evaluated. Also, the place of ligament attachment on lateral epicondyle of femur and lateral condyle of tibia were measured.Results: the incidence of ALL in studied age group is 56.6 percent. ALL was observed in both knee joints in 100% of cases. In women ALL was observed in 66.7% (24 joints out of 36), in men — 41.6% (10 joint out of 24). The average length of the ALL was 38.5±4.4 mm. The average width at the level of joint gap — 4.45±0.85 mm.The location of the attachment to the lateral epicondyle of the femur was represented in three anatomical variants: posterior and proximal to the lateral collateral ligament — 64.7%, anterior to the lateral collateral ligament — 23.5%, in the place of attachment of popliteal muscle tendon or next to it — 11.8%. The place of attachment on lateral condyle of the tibia is typical — approximately in the middle of the line from fibula head to Gerdy tubercle.Conclusion. Based on the authors’ findings and findings of foreign studies the optimal area for proximal channel formation is the posterior position and proximal to place of lateral collateral ligament beginning. Also, the anatomical regularity of lateral lower knee vessels is obtained, that allows to preserve one of the main blood supply sources of anterolateral area of the knee joint.

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Minimally Invasive Anterolateral Ligament Reconstruction in the Setting of Anterior Cruciate Ligament Injury

Cited by 65 publications

References 15 publications

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

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

Combined Anterior Cruciate Ligament and Anterolateral Ligament Reconstruction

Topographic and Anatomical Features of Anterolateral Ligament of the Knee

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