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Anterolateral Ligament of the Knee: Back to the Future in Anterior Cruciate Ligament Reconstruction.

Bonasia DE, D'Amelio A, Pellegrino P, Rosso F, Rossi R - Orthop Rev (Pavia) (2015)

Bottom Line: Although the importance of the anterolateral stabilizing structures of the knee in the setting of anterior cruciate ligament (ACL) injuries has been recognized since many years, most of orthopedic surgeons do not take into consideration the anterolateral structures when performing an ACL reconstruction.For this reason, some researchers have turned again towards the anterolateral aspect of the knee and specifically the anterolateral ligament.The goal of this review is to summarize the existing knowledge regarding the anterolateral ligament of the knee, including anatomy, histology, biomechanics and imaging.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedics and Traumatology, CTO Hospital, University of Turin , Italy.

ABSTRACT
Although the importance of the anterolateral stabilizing structures of the knee in the setting of anterior cruciate ligament (ACL) injuries has been recognized since many years, most of orthopedic surgeons do not take into consideration the anterolateral structures when performing an ACL reconstruction. Anatomic single or double bundle ACL reconstruction will improve knee stability, but a small subset of patients may experience some residual anteroposterior and rotational instability. For this reason, some researchers have turned again towards the anterolateral aspect of the knee and specifically the anterolateral ligament. The goal of this review is to summarize the existing knowledge regarding the anterolateral ligament of the knee, including anatomy, histology, biomechanics and imaging. In addition, the most common anterolateral reconstruction/tenodesis techniques are described together with their respective clinical outcomes.

No MeSH data available.


Related in: MedlinePlus

Marcacci technique. A) The hamstrings are harvested, preserving the tibial insertion. B) An anatomic tibial tunnel is created and the graft is passed in an over the top position on the femur, through a lateral approach. C) The graft is fixed proximally with 2 staples. D) The remnant of the graft is then passed under the fascia lata and fixed to the anterolateral tibia with another staple.
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fig005: Marcacci technique. A) The hamstrings are harvested, preserving the tibial insertion. B) An anatomic tibial tunnel is created and the graft is passed in an over the top position on the femur, through a lateral approach. C) The graft is fixed proximally with 2 staples. D) The remnant of the graft is then passed under the fascia lata and fixed to the anterolateral tibia with another staple.

Mentions: This technique has been slightly modified by Arnold et al.,29 Losee et al.,30 Andrews and Sanders,31 Frank and Jackson,32 as well as Christel and Dijan.33 These variations mainly involve the femoral fixation of the ITB strip. According to Losee et al., the ITB is passed through an extrarticular femoral tunnel, through the lateral gastrocnemius tendon and under the LCL.30 Similarly to Losee et al., Frank and Jackson passed the ITB under the LCL, though the lateral gastrocnemius tendon and secured it with stitches to both structures (LCL and gastrocnemius).32 Andrews and Sanders described an isometric lateral plasty with two ITB strips (one tight in flexion, the other tight in extension), both fixed at the lateral femur.31 Christel and Dijan described the use of a short (12×75 mm) ITB strip left attached distally (Figure 4B).33 The strip was then twisted 180° and fixed with an interference screw in a femoral bone tunnel, drilled at the isometric point. Ellison described a dynamic lateral reconstruction with the ITB detached distally and preserved proximally.34 The strip was then passed under the LCL and fixed back to the anterolateral tibia. Ellison hypothesized that the contraction of the tensor fascia lata would stabilize the knee during activity. With the increasing renewed interest in anterolateral stabilizing structures, different authors recently described combined intra- and extra-articular reconstruction techniques.27,35-38 According to Marcacci et al. the gracilis and semitendinosus tendons are harvested preserving the distal insertion (Figure 5). The graft is then passed through a tibial tunnel and in an over the top position on the femoral side using a lateral incision to the distal femur. The graft is fixed proximally with 2 Richard’s staples, with the knee flexed at 90° and the foot externally rotated. The remnant of the graft is then passed under the iliotibial band and fixed with 1 staple at the level of the Gerdy’s tubercle (Figure 5).37


Anterolateral Ligament of the Knee: Back to the Future in Anterior Cruciate Ligament Reconstruction.

Bonasia DE, D'Amelio A, Pellegrino P, Rosso F, Rossi R - Orthop Rev (Pavia) (2015)

Marcacci technique. A) The hamstrings are harvested, preserving the tibial insertion. B) An anatomic tibial tunnel is created and the graft is passed in an over the top position on the femur, through a lateral approach. C) The graft is fixed proximally with 2 staples. D) The remnant of the graft is then passed under the fascia lata and fixed to the anterolateral tibia with another staple.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4508556&req=5

fig005: Marcacci technique. A) The hamstrings are harvested, preserving the tibial insertion. B) An anatomic tibial tunnel is created and the graft is passed in an over the top position on the femur, through a lateral approach. C) The graft is fixed proximally with 2 staples. D) The remnant of the graft is then passed under the fascia lata and fixed to the anterolateral tibia with another staple.
Mentions: This technique has been slightly modified by Arnold et al.,29 Losee et al.,30 Andrews and Sanders,31 Frank and Jackson,32 as well as Christel and Dijan.33 These variations mainly involve the femoral fixation of the ITB strip. According to Losee et al., the ITB is passed through an extrarticular femoral tunnel, through the lateral gastrocnemius tendon and under the LCL.30 Similarly to Losee et al., Frank and Jackson passed the ITB under the LCL, though the lateral gastrocnemius tendon and secured it with stitches to both structures (LCL and gastrocnemius).32 Andrews and Sanders described an isometric lateral plasty with two ITB strips (one tight in flexion, the other tight in extension), both fixed at the lateral femur.31 Christel and Dijan described the use of a short (12×75 mm) ITB strip left attached distally (Figure 4B).33 The strip was then twisted 180° and fixed with an interference screw in a femoral bone tunnel, drilled at the isometric point. Ellison described a dynamic lateral reconstruction with the ITB detached distally and preserved proximally.34 The strip was then passed under the LCL and fixed back to the anterolateral tibia. Ellison hypothesized that the contraction of the tensor fascia lata would stabilize the knee during activity. With the increasing renewed interest in anterolateral stabilizing structures, different authors recently described combined intra- and extra-articular reconstruction techniques.27,35-38 According to Marcacci et al. the gracilis and semitendinosus tendons are harvested preserving the distal insertion (Figure 5). The graft is then passed through a tibial tunnel and in an over the top position on the femoral side using a lateral incision to the distal femur. The graft is fixed proximally with 2 Richard’s staples, with the knee flexed at 90° and the foot externally rotated. The remnant of the graft is then passed under the iliotibial band and fixed with 1 staple at the level of the Gerdy’s tubercle (Figure 5).37

Bottom Line: Although the importance of the anterolateral stabilizing structures of the knee in the setting of anterior cruciate ligament (ACL) injuries has been recognized since many years, most of orthopedic surgeons do not take into consideration the anterolateral structures when performing an ACL reconstruction.For this reason, some researchers have turned again towards the anterolateral aspect of the knee and specifically the anterolateral ligament.The goal of this review is to summarize the existing knowledge regarding the anterolateral ligament of the knee, including anatomy, histology, biomechanics and imaging.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedics and Traumatology, CTO Hospital, University of Turin , Italy.

ABSTRACT
Although the importance of the anterolateral stabilizing structures of the knee in the setting of anterior cruciate ligament (ACL) injuries has been recognized since many years, most of orthopedic surgeons do not take into consideration the anterolateral structures when performing an ACL reconstruction. Anatomic single or double bundle ACL reconstruction will improve knee stability, but a small subset of patients may experience some residual anteroposterior and rotational instability. For this reason, some researchers have turned again towards the anterolateral aspect of the knee and specifically the anterolateral ligament. The goal of this review is to summarize the existing knowledge regarding the anterolateral ligament of the knee, including anatomy, histology, biomechanics and imaging. In addition, the most common anterolateral reconstruction/tenodesis techniques are described together with their respective clinical outcomes.

No MeSH data available.


Related in: MedlinePlus