Sectioning the anterolateral ligament did not increase tibiofemoral translation or rotation in an ACL-deficient cadaveric model

Saiegh, Yousif Al; Suero, Eduardo M.; Guenther, Daniel; Hawi, Nael; Decker, Sebastian; Krettek, Christian; Citak, Musa; Omar, Mohamed

doi:10.1007/s00167-015-3787-1

Cited by 75 publications

(71 citation statements)

References 32 publications

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“…These papers showed clearly that cutting the ALL led to significant increases in tibial internal rotation laxity, which means that the ALL must act to resist tibial internal rotation. In contrast to these studies, it has also been reported that adding an ALL lesion to an ACL-deficient knee did not lead to measureable increases in either anterior translation or internal rotation during clinical testing of whole cadavers [50]. …”

Section: Anterior–posterior and Internal–external Rotation Laxity Of mentioning

confidence: 99%

Anterolateral knee biomechanics

Amis

2017

Knee Surg Sports Traumatol Arthrosc

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This article reviews the evidence for the roles of the anterolateral soft-tissue structures in rotatory stability of the knee, including their structural properties, isometry, and contributions to resisting tibial internal rotation. These data then lead to a biomechanical demonstration that the ilio-tibial band is the most important structure for the restraint of anterolateral rotatory instability. Level of evidence V.

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Section: Anterior–posterior and Internal–external Rotation Laxity Of mentioning

confidence: 99%

Anterolateral knee biomechanics

Amis

2017

Knee Surg Sports Traumatol Arthrosc

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“…While some study groups found this ligament to be an important restraint of internal tibial rotation, 1,26,27,30 others described the biomechanical role of the ALL to be negligible. 20,32,43 Considering the inconsistent terms and conflicting findings, it is crucial that the anterolateral knee structure is clearly defined and a consistent terminology is developed. A thorough appreciation of the anatomic characteristics will clarify the role of the lateral extra-articular structures as well as the indications for lateral-side extra-articular procedures.…”

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confidence: 99%

The Anterolateral Complex of the Knee

Herbst

Albers

Burnham

et al. 2017

Orthopaedic Journal of Sports Medicine

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Background:Significant controversy exists regarding the anterolateral structures of the knee.Purpose:To determine the layer-by-layer anatomic structure of the anterolateral complex of the knee.Study Design:Descriptive laboratory study.Methods:Twenty fresh-frozen cadaveric knees (age range, 38-56 years) underwent a layer-by-layer dissection to systematically expose and identify the various structures of the anterolateral complex. Quantitative measurements were performed, and each layer was documented with high-resolution digital imaging.Results:The anterolateral complex of the knee consisted of different distinct layers, with the superficial and deep iliotibial band (ITB) representing layer 1. The superficial ITB had a distinct connection to the distal femoral metaphysis and femoral condyle (Kaplan fibers), and the deep layers of the ITB were identified originating at the level of the Kaplan fibers proximally. This functional unit, consisting of the superficial and deep ITB, was reinforced by the capsulo-osseous layer of the ITB, which was continuous with the fascia of the lateral gastrocnemius and biceps femoris muscles. These 3 components of the ITB became confluent distally, and the insertion spanned from the Gerdy tubercle anteriorly to the lateral tibia posteriorly on a small tubercle (lateral tibial tuberosity). Layer 3 consisted of the anterolateral capsule, in which 35% (7/20) of specimens had a discreet mid-third capsular ligament.Conclusion:The anterolateral complex consists of the superficial and deep ITB, the capsulo-osseous layer of the ITB, and the anterolateral capsule. The anterolateral complex is defined by the part of the ITB between the Kaplan fibers proximally and its tibial insertion, which forms a functional unit. A discrete anterolateral ligament was not observed; however, the anterolateral ligament described in recent studies likely refers to the capsulo-osseous layer or the mid-third capsular ligament.Clinical Relevance:The anterolateral knee structures form a complex functional unit. Surgeons should use caution when attempting to restore this intricate structure with extra-articular procedures designed to re-create a single discreet ligament.

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“…Parsons et al 28 demonstrated that the ALL was an important stabiliser of internal rotation at flexion angles great than 35°. In contrast, Saiegh et al 29 found that isolated sectioning of the ALL in an ACL deficient knee did not increase tibiofemoral instability in their cadaver model. Kittl et al 30 found that the ALL and anterolateral capsule played only minor roles in restraining internal rotation.…”

Section: Biomechanicsmentioning

confidence: 81%