Anterolateral Ligament and Iliotibial Band Control of Rotational Stability in the Anterior Cruciate Ligament–Intact Knee: Defined by Tibiofemoral Compartment Translations and Rotations

2017 ◽  
Vol 33 (3) ◽  
pp. 595-604 ◽  
Author(s):  
Lauren E. Huser ◽  
Frank R. Noyes ◽  
Darin Jurgensmeier ◽  
Martin S. Levy
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Anterolateral Ligament ◽  
Rotational Stability ◽  
Iliotibial Band ◽  
Anterior Cruciate ◽  
Intact Knee

scholarly journals MRI Evaluation of Anterolateral Ligament of the Knee: A CrossSectional Study in Malaysia

2020 ◽  
Vol 18 (2) ◽  
Author(s):  
Kow Ren Yi ◽  
Low Chooi Leng ◽  
Siti Nor Badriati Sheik Said
Keyword(s):  
Cruciate Ligament ◽  
Anterolateral Ligament ◽  
Rotational Stability ◽  
Iliotibial Band ◽  
Popliteus Tendon ◽  
Tibial Rotation ◽  
Mr Images ◽  
Acl Injuries ◽  
Genicular Artery ◽  
Anterior Cruciate

Introduction: Anterolateral ligament (ALL) of the knee has been demonstrated to be an important secondary restrainer in providing rotational stability to the knee. ALL stabilizes the internal tibial rotation with increasing knee flexion. ALL injuries with concomitant anterior cruciate ligament (ACL) injuries have a higher grade of pivot shift. Magnetic resonant (MR) studies on ALL have been performed but there is no such data among the Malaysian population. We aim to investigate the reproducibility of ALL identification on 1.5T MRI and the association with other ligamentous injuries. Materials and method: Magnetic resonant imaging of the knees with suspected ligamentous injuries from 1st January 2017 to 30th June 2017 were reviewed for suitability of this study. Post-operative MRI and MRI of patients with suspected tumour at the knee region were excluded. 1.5T MRI (Siemens Medical Solution) was used for assessment of all the knees. All MRIs were double read and approved by a consultant radiologist. Results: A total of 36 knee MR images were obtained from 31 patients during the study period. 5 patients were excluded (3 for suspected tumour and 2 for post-operative). Mean age of the patients was 29.44. All three components of ALL were identified in 20 MRIs (55.6%): femoral component (75%); meniscal (69.4%) and tibial (58.3%). There were 11 knees identified to have ALL injury, which was associated with ACL injury. Discussion: ALLs are best visualized on coronal views (PD, PD FS and T2) with lateral inferior genicular artery as a guide to locate the bifurcation of meniscal and tibial components. Delineation of ALLs from other surrounding structures such as lateral collateral ligaments, iliotibial band and popliteus tendon was done in both coronal and axial views. Conclusion: ALLs of the knees are delineated in more than half of the MR images. There is an association between ALL injuries and ACL injuries.

scholarly journals Combined Anterior Cruciate Ligament Repair and Anterolateral Ligament Internal Brace Augmentation: Minimum 2-Year Patient-Reported Outcome Measures

2020 ◽  
Vol 8 (12) ◽  
pp. 232596712096855
Author(s):  
Graeme P. Hopper ◽  
Joanna M.S. Aithie ◽  
Joanne M. Jenkins ◽  
William T. Wilson ◽  
Gordon M. Mackay
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Anterolateral Ligament ◽  
Rotational Stability ◽  
Acl Repair ◽  
Patient Reported ◽  
Internal Brace ◽  
The Mean ◽  
Anterior Cruciate

Background: The anterolateral ligament (ALL) contributes to anterolateral rotational stability of the knee. Internal bracing of the anterior cruciate ligament (ACL) and ALL reinforces the ligaments and encourages natural healing by protecting both during the healing phase and supporting early mobilization. Purpose/Hypothesis: To assess the 2-year patient-reported outcomes of combined ACL repair and ALL internal brace augmentation. We hypothesized that significant improvements in outcomes would be seen. Study Design: Case series; Level of evidence, 4. Methods: A total of 43 consecutive patients with acute proximal ACL ruptures were prospectively evaluated for a minimum of 2 years. The mean age at the time of surgery was 25.7 years (range, 13-56 years). Indications for the combined ACL/ALL procedure were associated Segond fractures, grade 3 pivot shift, or high levels of sporting activity. Patients with chronic ruptures or with multiligament injuries were excluded. The Knee injury and Osteoarthritis Outcome Score (KOOS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), visual analog scale (VAS) for pain, Veterans RAND 12-Item Health Survey (VR-12), and Marx activity scale were collected preoperatively and at 12 and 24 months postoperatively. Patients with any postoperative complications were identified at the time of this analysis. Results: The mean follow-up period was 44.8 months. Five patients were lost to follow-up, leaving 38 patients (88.4%) in the final analysis. The mean KOOS for Pain, Symptoms, Activities of Daily Living, Sport/Recreation, and Quality of Life improved from a respective 64.9, 58.6, 75.0, 33.7, and 28.9 preoperatively to 91.1, 81.8, 96.1, 82.8, and 74.3 at the 2-year follow-up ( P < .0001). The mean WOMAC scores for pain, stiffness, and function improved from 77.5, 65.3, and 75.0 preoperatively to 94.6, 88.6, and 96.0 at the 2-year follow-up ( P < .0001). The VAS pain score improved from 3.4 preoperatively to 0.7 at the 2-year follow-up, and the VR-12 physical score improved from 34.4 preoperatively to 52.7 at the 2-year follow-up ( P < .0001 for both ). However, the Marx activity score decreased from 13.3 preinjury to 10.6 at the 2-year follow-up ( P = .01). Two patients (5.3%) sustained a rerupture. Conclusion: Combined ACL repair and ALL internal brace augmentation demonstrated excellent outcomes in 94.7% of the study patients. Based on our experience with this cohort as well as our isolated ACL repair data, we suggest that high-risk patients with ACL ruptures have an additional ALL procedure to provide rotational stability.

Anterolateral Ligament Reconstruction Improves Anteroposterior Stability As Well As Rotational Stability in Revision Anterior Cruciate Ligament Reconstruction with High-Grade Pivot Shift

2020 ◽  
Author(s):  
Kyoung Ho Yoon ◽  
In Uk Hwang ◽  
Eung Ju Kim ◽  
Yoo Beom Kwon ◽  
Sang-Gyun Kim
Keyword(s):  
Anterior Cruciate Ligament ◽  
Ligament Reconstruction ◽  
Pivot Shift ◽  
Cruciate Ligament ◽  
Anterolateral Ligament ◽  
Rotational Stability ◽  
High Grade ◽  
Cruciate Ligament Reconstruction ◽  
Anterior Cruciate

AbstractThis study aimed to investigate the effect of anterolateral ligament reconstruction (ALLR) in revision anterior cruciate ligament reconstruction (ACLR) with high-grade pivot shift. The hypothesis was that revision ACLR combined with ALLR (RACLR with ALLR group) would show superior clinical outcomes to those of isolated revision ACLR. We retrospectively evaluated consecutive patients who underwent revision ACLR (RACLR) combined with ALLR between October 2015 and January 2017. The indication for combination of ALLR with revision ACLR was failed ACLR with ≥G2 pivot-shift instability. The control group included patients who underwent isolated revision ACLR (isolated RACLR group) for the same indication between July 2013 and September 2015. Exclusion criteria were ≤G1 pivot-shift instability, multiple ligament reconstruction, bilateral ligament injury, double-bundle reconstruction, insufficient medical records, postoperative infection, and follow-up loss at postoperative 2 years. Clinical scores, stability tests, and failure rates were compared between groups at the 2-year follow-up. The RACLR with ALLR group had 18 patients (mean age, 32.9 ± 10.8 years) and the RACLR group had 21 patients (mean age, 29.6 ± 10.2 years). Clinical scores at the 2-year follow-up showed no significant differences between groups. However, the RACLR with ALLR group showed better stability in the Lachman test (p = 0.005), pivot-shift test (p = 0.030), and side-to-side difference in stress radiographs (3.9 ± 3.0 mm vs. 5.9 ± 2.8 mm, p = 0.018) than the isolated RACLR group. The RACLR with ALLR group had two failures (11.1%), and the RACLR group had three failures (14.3%). In conclusion, ALLR in revision ACLR with high-grade pivot shift improves anteroposterior stability as well as rotational stability at 2-year follow-up. Therefore, ALLR is recommended with revision ACLR, especially in patients with high-grade pivot shift. This is a Level III, retrospective cohort review.

scholarly journals High Prevalence of Anterolateral Ligament Abnormalities on MRI in Knees With Acute Anterior Cruciate Ligament Injuries: A Case-Control Series From the SANTI Study Group

2019 ◽  
Vol 7 (6) ◽  
pp. 232596711985291 ◽  
Author(s):  
Andrea Ferretti ◽  
Edoardo Monaco ◽  
Andrea Redler ◽  
Giuseppe Argento ◽  
Angelo De Carli ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Clinical Decision Making ◽  
Cruciate Ligament ◽  
Anterolateral Ligament ◽  
Iliotibial Band ◽  
Level Of Evidence ◽  
Control Series ◽  
Anterior Cruciate ◽  
Injured Knee ◽  
Mri Evaluation

Background: Broad variation in the reported rate of magnetic resonance imaging (MRI)–detected abnormalities of the anterolateral structures of the anterior cruciate ligament (ACL)–injured knee suggests a lack of reliability that has limited the use of MRI in clinical decision making. Purpose/Hypothesis: The aim of this study was to use MRI to determine the prevalence and spectrum of abnormalities of the anterolateral structures in acute ACL-injured knees, using the contralateral uninjured knee as a reference. We hypothesized that MRI evaluation of the acutely injured knee (using the uninjured knee as a reference) would allow reliable identification of abnormalities of the anterolateral structures. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Patients with acute ACL injury underwent MRI scan of both knees. Images were evaluated by 3 observers. Inter- and intraobserver reliabilities were determined for MRI parameters of anterolateral ligament (ALL) injury by use of the kappa (κ) test. Univariate and multivariate analyses were conducted to test associations between ALL abnormality and associated injuries. Results: A total of 34 patients were evaluated. Of these, 30 patients (88.2%) had at least 1 ALL abnormality in the ACL-injured knee (increased signal: n = 27[79.4%]; increased thickness: n = 15[44.1%]; tapering: n = 7[20.6%]; irregularities in the path of the ALL fibers: n = 21[61.7%]). Asymmetries of the genicular vessels were observed in 21 patients (61.7%). ALL abnormality was significantly associated with lateral joint capsular tears ( P < .001). No correlation was found between ALL lesions and iliotibial band lesions ( P = .49). Inter- and intraobserver reliabilities were very good concerning ALL signal changes and femoral and tibial bone bruises (κ coefficient, 0.81-1). Conclusion: MRI evaluation of the ALL was associated with good and very good inter- and intraobserver reliabilities, and it demonstrated abnormalities of the ALL in the majority of acutely ACL-injured knees. The index of suspicion for ALL injury should be elevated by the presence of lesions of the lateral capsule. This suggests that the ALL is part of a wider area of the lateral capsule that is often injured simultaneously in an acute ACL tear.

scholarly journals Graft Preparation for Combined ACL and ALL Reconstruction With a Single Femoral Tunnel

2021 ◽  
Vol 1 (3) ◽  
pp. 263502542110045
Author(s):  
Camilo Partezani Helito ◽  
Tales Mollica Guimarães ◽  
Marcel Faraco Sobrado
Keyword(s):  
Anterior Cruciate Ligament ◽  
High Risk ◽  
Cruciate Ligament ◽  
Anterolateral Ligament ◽  
Anatomical Landmarks ◽  
High Risk Patients ◽  
Risk Patients ◽  
Anterior Cruciate ◽  
Semitendinosus Graft ◽  
Lemaire Procedure

Background: Combined reconstruction of the anterolateral ligament (ALL) and anterior cruciate ligament (ACL) has shown excellent results. It could potentially reduce graft failure and improve outcomes in high-risk patients. There are several surgical techniques described. Hamstrings are the most frequently used graft for ALL reconstruction. The distal portion of the iliotibial band is used for the modified Lemaire procedure. Indications: Anterior cruciate ligament reconstructions associated with the following risk factors: pivoting sports, high-demand athletes, high-grade pivot-shift, chronic ACL injury, lateral femoral condyle notch, Segond fractures, young patients (<20 years), ACL revision, generalized hyperlaxity, and Lachman >7 mm. Technique Description: Semitendinosus and gracilis tendons are harvested and their extremities are prepared with continuous suture. The semitendinosus graft is folded in 3 parts leaving the ends of the graft internalized. The triple semitendinosus will be the main component of the ACL and the single gracilis will be used for both ACL and ALL. Anterolateral ligament anatomical landmarks are proximal and posterior to the lateral epicondyle in the femur, and in the mid distance from the fibular head and the Gerdy tubercle in the tibia. The ALL is fixed in knee extension with interference screws. This video also includes a brief demonstration of graft preparation for the modified Lemaire procedure. Results: Results from our group using this technique have shown excellent clinical outcomes, minimal complications, and low failure rates in high-risk populations. This graft preparation shows excellent diameter and length for combined ACL and ALL reconstruction. Conclusion: This technique is easy to perform, with minimal complications, and should be considered in high-risk patients undergoing ACL reconstruction.

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