The Role of the Anterolateral Structures and the ACL in Controlling Laxity of the Intact and ACL-Deficient Knee: Response

Kittl, Christoph; El-Daou, Hadi; Athwal, Kiron K.; Gupte, Chinmay; Weiler, Andreas; Williams, Andy; Amis, Andrew A.

doi:10.1177/0363546516638070

Cited by 37 publications

(33 citation statements)

References 16 publications

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“… 4 – 8 In addition to the ALL, the Kaplan fibers of the iliotibial band (ITB) have been reported to provide significant restraint against internal rotation of the tibia. 6 , 9 , 10 Foundational quantitative anatomic characterization of the Kaplan fibers was recently performed by Godin et al, 11 supporting future studies to characterize a potential individual role for these structures (Fig. 1 ).…”

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confidence: 63%

An Overview of Clinically Relevant Biomechanics of the Anterolateral Structures of the Knee

Kennedy

LaPrade

Geeslin

et al. 2018

Techniques in Orthopaedics

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Residual anterolateral rotatory laxity following injury and reconstruction of the anterior cruciate ligament (ACL) has become a popular topic and has generated interest in characterizing the relative contribution from the anterolateral structures of the knee. Studies have reported on the anatomic and biomechanical features of the anterolateral ligament (ALL), revealing a role in restraining internal tibial rotation in both ACL-intact and ACL-deficient knees. The Kaplan fibers of the iliotibial band have also been reported to provide significant restraint to internal tibial rotation. The ACL is the primary restraint to anterior tibial translation, and both the proximal and distal bundles of the iliotibial band, with a divergent orientation, also provide significant static restraint against internal tibial rotation, and each bundle may have a distinct individual role. In the setting of ACL deficiency, subsequent sectioning of the ALL and Kaplan fibers led to further increases in anterior tibial translation. Residual rotatory laxity that may be seen clinically following ACL reconstruction may be attributable to an associated anterolateral structure injury even in the setting of an anatomic ACLR, leading to consideration for a concomitant anterolateral structure reconstruction. Studies evaluating the kinematic influence of anatomic ALL reconstruction or lateral extra-articular tenodesis have focused on internal rotation, axial plane translation, and anterior tibial translation, with variable results having been reported. Further, despite the long history of anterolateral structure reconstruction, most commonly with a lateral extra-articular tenodesis, the clinical use of these combined techniques is still in its relative infancy, and long-term patient outcomes have yet to be published for relative comparisons.

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confidence: 63%

An Overview of Clinically Relevant Biomechanics of the Anterolateral Structures of the Knee

Kennedy

LaPrade

Geeslin

et al. 2018

Techniques in Orthopaedics

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“…Our findings also demonstrate a wide connective matrix of the ITB, as it gives rise to connections to the patella and patellar tendon, previously referred to as the IPB. Structures previously referred to as the deep ITT layer, also called Kaplan fibers, 24 , 47 attached to the lateral intermuscular septum and the lateral retinaculum 8 but appeared macroscopically as part of the ITB and as part of the deep fascia of layer 3. One distinct difference between the ITB and the ALL concerned the tibial attachments.…”

Section: Discussionmentioning

confidence: 99%

Anatomic and Histological Study of the Anterolateral Aspect of the Knee: A SANTI Group Investigation

Daggett

Stephenson

Dobson

et al. 2018

Orthopaedic Journal of Sports Medicine

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Background:The structure and function of the anterolateral aspect of the knee have been significantly debated, with renewed interest in this topic since the description of the anterolateral ligament (ALL).Purpose:To define and describe the distinct structures of the lateral knee and to correlate the macroscopic and histologic anatomic features.Study Design:Descriptive laboratory study.Methods:Twelve fresh-frozen human cadavers were used for anatomic analysis. In the left knee, a layer-by-layer dissection and macroscopic analysis were performed. In the right knee, an en bloc specimen was obtained encompassing an area from the Gerdy tubercle to the posterior fibular head and extending proximally from the anterior aspect to the posterior aspect of the lateral femoral epicondyle. The en bloc resection was then frozen, sliced at the level of the joint line, and reviewed by a musculoskeletal pathologist.Results:Macroscopically, the lateral knee has 4 main layers overlying the capsule of the knee: the aponeurotic layer, the superficial layer including the iliotibial band (ITB), the deep fascial layer, and the ALL. Histologically, 8 of 12 specimens demonstrated 4 consistent, distinct structures: the ITB, the ALL, the lateral collateral ligament, and the meniscus.Conclusion:The lateral knee has a complex orientation of layers and fibers. The ALL is a distinct structure from the ITB and is synonymous to the previously described capsulo-osseous layer of the ITB.Clinical Relevance:Increasingly, lateral extra-articular procedures are performed at the time of anterior cruciate ligament reconstruction. Understanding the anatomic features of the anterolateral aspect of the knee is necessary to understand the biomechanics and function of the structures present and allows surgeons to attempt to replicate those anatomic characteristics when performing extra-articular reconstruction.

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“…Several biomechanical studies have reported that the ALL is important in controlling internal tibial rotation in ACL-deficient knees. 11,27,28 However, Kittl et al 29 reported that the ALL had only a minor role in controlling internal rotation in ACL-deficient knees. The role of the ALL seems to be most important at knee flexion angles Z301-351.…”

Section: Biomechanical Role Of Key Anterolateral Structuresmentioning

confidence: 99%

Biomechanical Role of Lateral Structures in Controlling Anterolateral Rotatory Laxity: The Anterolateral Ligament

Chahla

Moatshe

Geeslin

et al. 2017

Operative Techniques in Orthopaedics

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The Role of the Anterolateral Structures and the ACL in Controlling Laxity of the Intact and ACL-Deficient Knee: Response

Cited by 37 publications

References 16 publications

An Overview of Clinically Relevant Biomechanics of the Anterolateral Structures of the Knee

An Overview of Clinically Relevant Biomechanics of the Anterolateral Structures of the Knee

Anatomic and Histological Study of the Anterolateral Aspect of the Knee: A SANTI Group Investigation

Biomechanical Role of Lateral Structures in Controlling Anterolateral Rotatory Laxity: The Anterolateral Ligament

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