scholarly journals Anterolateral ligament as a main stabilizing structure оf rotational stability оf the knee joint

2019 ◽  
Vol 10 (1) ◽  
pp. 72-80
Author(s):  
Alena A. Epshtein ◽  
A. P. Prizov ◽  
F. L. Lazko ◽  
N. V. Zagorodniy ◽  
A. A. Akhpashev
Keyword(s):  
Knee Joint ◽  
Cruciate Ligament ◽  
Anterolateral Ligament ◽  
Rotational Stability ◽  
Histological Structure ◽  
Surgical Methods ◽  
Ligamentous Structure ◽  
Anterior Cruciate ◽  
Anterolateral Instability

Currently, anterior cruciate ligament grafting is one of the most popular operations on the knee joint, but despite the fact that the technique has been used for years, there is a high percentage of unsatisfactory long-term postoperative results, reaching 25%, according to various authors. The concern over this problem has led to an increase in the number of studies aimed at the understanding of the causes of these failures. Most researchers have concluded that the unsatisfactory results are associated with instability in the knee joint, which is caused by the damage of a ligamentous structure found in many dissections, namely, anterolateral ligament (ALL). In this literature review, we have analyzed the articles dedicated to the ALL, its anatomical and histological structure, its biomechanics, as well as its role in the anterolateral stability of the joint. Also in this review we consider the existing surgical methods for the correction of anterolateral instability associated with the ALL damage.

scholarly journals The anterolateral ligament of the knee joint: a review of the anatomy, biomechanics, and anterolateral ligament surgery

2019 ◽  
Vol 31 (1) ◽  
Author(s):  
Ji Hyun Ahn ◽  
Nilay A. Patel ◽  
Charles C. Lin ◽  
Thay Q. Lee
Keyword(s):  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Double Bundle ◽  
Anterolateral Ligament ◽  
Rotational Stability ◽  
Single Bundle ◽  
Graft Choice ◽  
Surgical Methods ◽  
Anterior Cruciate

AbstractResidual knee instability and low rates of return to previous sport are major concerns after anterior cruciate ligament (ACL) reconstruction. To improve outcomes, surgical methods, such as the anatomical single-bundle technique or the double-bundle technique, were developed. However, these reconstruction techniques failed to adequately overcome these problems, and, therefore, new potential answers continue to be of great interest. Based on recent anatomical and biomechanical studies emphasizing the role of the anterolateral ligament (ALL) in rotational stability, novel surgical methods including ALL reconstruction and anterolateral tenodesis have been introduced with the possibility of resolving residual instability after ACL reconstruction. However, there is still little consensus on many aspects of the ALL, including: several anatomical issues, appropriate indications for ALL surgery, and the optimal surgical method and graft choice for reconstruction surgery. Therefore, further studies are necessary to advance our knowledge of the ALL and its contribution to knee stability.

Deconstructing the Anterior Cruciate Ligament: What We Know and Do Not Know About Function, Material Properties, and Injury Mechanics

2015 ◽  
Vol 137 (2) ◽  
Author(s):  
Scott G. McLean ◽  
Kaitlyn F. Mallett ◽  
Ellen M. Arruda
Keyword(s):  
Anterior Cruciate Ligament ◽  
Knee Joint ◽  
Mechanical Response ◽  
Cruciate Ligament ◽  
Complex Structure ◽  
Acute Injury ◽  
Research Attention ◽  
Increased Risk ◽  
Anterior Cruciate

Anterior cruciate ligament (ACL) injury is a common and potentially catastrophic knee joint injury, afflicting a large number of males and particularly females annually. Apart from the obvious acute injury events, it also presents with significant long-term morbidities, in which osteoarthritis (OA) is a frequent and debilitative outcome. With these facts in mind, a vast amount of research has been undertaken over the past five decades geared toward characterizing the structural and mechanical behaviors of the native ACL tissue under various external load applications. While these efforts have afforded important insights, both in terms of understanding treating and rehabilitating ACL injuries; injury rates, their well-established sex-based disparity, and long-term sequelae have endured. In reviewing the expanse of literature conducted to date in this area, this paper identifies important knowledge gaps that contribute directly to this long-standing clinical dilemma. In particular, the following limitations remain. First, minimal data exist that accurately describe native ACL mechanics under the extreme loading rates synonymous with actual injury. Second, current ACL mechanical data are typically derived from isolated and oversimplified strain estimates that fail to adequately capture the true 3D mechanical response of this anatomically complex structure. Third, graft tissues commonly chosen to reconstruct the ruptured ACL are mechanically suboptimal, being overdesigned for stiffness compared to the native tissue. The net result is an increased risk of rerupture and a modified and potentially hazardous habitual joint contact profile. These major limitations appear to warrant explicit research attention moving forward in order to successfully maintain/restore optimal knee joint function and long-term life quality in a large number of otherwise healthy individuals.

scholarly journals Anterolateral Ligament (ALL) — Myth or Reality?

2017 ◽  
Vol 2 (s3) ◽  
pp. 12-16
Author(s):  
Mihai Roman ◽  
Octav Russu ◽  
Radu Prejbeanu ◽  
Adrian Todor ◽  
Vlad Predescu ◽  
...  
Keyword(s):  
Cruciate Ligament ◽  
Surgical Techniques ◽  
Anterolateral Ligament ◽  
Anterior Tibial Translation ◽  
Anterior Tibial ◽  
Long Time ◽  
Ligamentous Structure ◽  
Anterior Cruciate ◽  
Patient Selection Criteria ◽  
Tibial Translation

AbstractAlthough the anterolateral ligament (ALL) was described a long time ago, recent research shows a lot of interest regarding this structure. There is a high variability concerning its anatomy, especially its capsular/extracapsular situation and insertion sites. There is also some controversy about its ligamentous structure. It seems that it has a biomechanical role in restricting anterior tibial translation and internal rotation. The ALL complex seems to have a clinical significance, and a relationship with the pivot shift has been described. Although there are promising results recently, the surgical techniques of ALL reconstruction, in addition to anterior cruciate ligament reconstruction, have to be further investigated. A precise indication algorithm and patient selection criteria need to be established.

17-Year Results following Transepiphyseal Anterior Cruciate Ligament Reconstruction in Children and Adolescents

2021 ◽  
Author(s):  
Alexander Zimmerer ◽  
Marco M. Schneider ◽  
Carina Semann ◽  
Wolfgang Schopf ◽  
Christian Sobau ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Knee Joint ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Lysholm Score ◽  
Long Term Results ◽  
Childhood And Adolescence ◽  
The Mean ◽  
Anterior Cruciate

Abstract Objective Rupture of the anterior cruciate ligament (ACL) in childhood and adolescence is a serious injury. It is now known that conservative therapy of an unstable knee joint in childhood or adolescence under can lead to poor subjective and objective results. The aim of this study is to record long-term results after transepiphyseal ACL reconstruction using autologous hamstring tendons and extracortical fixation in childhood and adolescence with open physes – at least 15 years after surgery. Methods Our internal registry was used to identify all patients who received surgical treatment of an acl tear during childhood and adolescence by transepiphyseal acl reconstruction more than 15 years previously. In these patients, the International Knee Documentation Committee for Subjective Knee Form (IKDCsubj.), Knee Injury and Osteoarthritis Outcome Score (KOOS), Tegner Activity Score (TAS) and Lysholm Score were collected, and clinical and magnetic resonance imaging (MRI) examinations were performed. Results A total of 22 patients were identified, 5 of whom could not be contacted. The mean age at the time of surgery was 13.1 years, and the mean follow-up time was 17.4 years. In 3 patients, a traumatic tear was observed with subsequent reconstruction of the ACL. None of the included patients showed a growth disorder during the course of the study. The IKDCsubj. was 92.4 ± 14.7 (48 – 100), the Lysholm score was 87.9 ± 16.9 (34 – 100), the TAS was 5.7 ± 2.3 (3 – 9) and the pain level based on VAS was 3.5 ± 2.6 (1 – 8) points. The values showed subjective and objective deterioration compared to the 10-year results, with no statistical significance. The following subscores were reported for the KOOS: KOOSpain 90.9 ± 17.6 (28 – 100); KOOSsymptom 82.9 ± 22.6 (11 – 100); KOOOSADL 94.3 ± 13.7 (44 – 100); KOOSSport 80.3 ± 26.4 (15 – 100); KOOSQOL 80.9 ± 25.8 (0 – 100). 13 of the 17 patients could also be clinically and radiologically examined. In 92% of patients, an intact acl reconstruction was found without evidence of cartilage or meniscus damage. The mean lateral difference in the KT-1000 measurement was 1.5 mm. Conclusion ACL reconstruction in childhood and adolescence provides good functionality and stability of the knee joint over the long term. Secondary signs of osteoarthritis can only be detected in isolated cases by MRI. ACL reconstruction using the transepiphyseal technique can be considered the method of choice for open growth plate knee joints.

scholarly journals Ultrasonography of the Anterolateral Ligament of the Knee Joint. The State of the Art and the Perspectives

2021 ◽  
Vol 1 (56) ◽  
pp. 38-42
Author(s):  
Oleksandr Kostrub ◽  
◽  
Viktor Kotiuk ◽  
Roman Luchko ◽  
Roman Blonsky ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Knee Joint ◽  
State Of The Art ◽  
Cruciate Ligament ◽  
Lower Leg ◽  
Structure And Function ◽  
Anterolateral Ligament ◽  
Key Words Ultrasonography ◽  
Anterior Cruciate ◽  
And Function

The anterolateral ligament of the knee is an important stabilizer of the knee in relation to internal rotation of the lower leg. Ultrasonographic examination of the anterolateral ligament of the knee joint is a simple and affordable method for its study, it allows to evaluate the femoral and tibial portions, has prospects for improving and improving the understanding of its function. The indication for its implementation is suspicion or confirmed damage to the anterior cruciate ligament. Ultrasonographic studies of the anterolateral ligament are not only important from the perspective of diagnosing its damage, but have already supplemented our understanding of its structure and function. Key words: ultrasonography, anterolateral ligament, knee joint.

scholarly journals Comparison of tunnel expansion, isometric muscle strength and clinical condition after anterior cruciate ligament reconstruction with single- or dual-bundle

2017 ◽  
Vol 5 (2_suppl2) ◽  
pp. 2325967117S0004
Author(s):  
Salih Beyaz ◽  
Ümit Özgür Güler ◽  
Şenay Demir ◽  
Selcen Pehlivan ◽  
Bekir Murat Çınar ◽  
...  
Keyword(s):  
Knee Joint ◽  
Cruciate Ligament ◽  
Scoring Systems ◽  
Peak Torque ◽  
Double Bundle ◽  
Tunnel Widening ◽  
Single Bundle ◽  
Significant Difference ◽  
Anterior Cruciate

Thirty-one patients who suffered anterior cruciate ligament (ACL) injury and underwent ACL reconstruction (16 single-bundle, 15 double-bundle) with ENDOBUTTON between November 2007 and March 2008 were included in the study. Isokinetic and concentric strength measurements of the quadriceps and hamstring muscles at the 6th month and 8th year were made using a Biodex 3 device at angular velocities of 60°/sec, 120°/sec and 180°/sec. The peak torque and peak torque to body weight ratios were recorded. 3D-CT scans of the joints were performed on the 2nd, 3 rd and 6th month and 8th year. CT slices were divided into six equal parts marking the distance between the femoral and tibial tunnels with the most distant part of the knee joint as L1, and with the entry point on the knee joint as L6. The tunnel length was measured in millimeters and perpendicularly to the tibial axis in the sagittal and coronal planes. Tunnel cross-sectional areas were also measured in mm2 using the same device on axial reconstructions. Clinical evaluations on the 8th year were performed with the IKDC, Tegner and Lysholm knee scoring systems and laxity in the patients was evaluated with the anterior drawer test. Posterolateral tunnel widening was analyzed with the repeated measures ANOVA technique whereas two-way mixed ANOVA was employed in evaluating the anteromedial tunnel widening. Three-way ANOVA was used in assessing the Biodex results and comparison of the scoring systems results were done with the t-test. Results: No difference was found between the groups in terms of IKDC, Lysholm and Tegner scores and anterior drawer test results at the 8th year follow-up (p>0.05). Points where significant amounts of tunnel widening were observed are shown in Table 1 . On evaluation of the anteromedial bundles alone, it was observed that double-tunnel reconstruction led to greater widening. No significant difference was found between the groups in terms of muscle strength in the 8th year assessments, however, there was a statistically significant difference between the preoperative and 6th month results (p<0.05). Patients in both groups had better results at the 8th year follow-up when compared to their preoperative and 6th month results. The results of our study confirmed significant amounts of widening at parts of the femoral tunnel close to the knee joint in patients treated with single-bundle or double-bundle ACL reconstruction. However, there is no difference between the groups in terms of clinical results and isometric muscle strengths in the long term. [Table: see text] Discussion: It has been suggested that the tunnel widening will lead to failure of the reconstruction. It is hypothesized that, in double-bundle reconstruction, the tunnels will widen more and finally coalesce, which in turn, will result in failure of the reconstruction. In our study, we found no evidence pointing out to a coalescence of the tunnels in the long term. We believe the greater widening in the anteromedial bundle in the double-tunnel surgery vs. the single-tunnel method is due to the smaller diameter of the graft and its greater mobility

scholarly journals The effect of anterolateral ligament integrity on the tibia displacement and reaction forces of anterior cruciate ligament

2017 ◽  
Vol 5 (2_suppl2) ◽  
pp. 2325967117S0010
Author(s):  
Adem Aydın ◽  
Levent Uğur ◽  
Halil Atmaca
Keyword(s):  
Anterior Cruciate Ligament ◽  
Knee Joint ◽  
Internal Rotation ◽  
Knee Flexion ◽  
Cruciate Ligament ◽  
Anterolateral Ligament ◽  
Knee Flexion Angle ◽  
Anterior Drawer ◽  
Reaction Forces ◽  
Anterior Cruciate

Objective: Recent studies focused on rotational instability and remained positive pivot test in patients with anterior cruciate ligament (ACL) reconstruction. Clinical, radiological and biomechanical studies showed the importance of the anterolateral ligament (ALL) integrity. ALL is one of the stabilization structures against the internal rotation of the tibia under forces which was associated with Segond fracture previously. Even some authors claimed that ACL failure and risk of re-rupture increased if only ACL reconstruction performed in patients with simultaneous ALL injury. The aim of the study is to evaluate the importance of ALL on knee biomechanics during anterior drawer test and internal rotation forces with different flexion angles in terms of reaction forces on ACL and the amount of tibia displacement via finite element analysis. Methods: Three dimensional (3D) solid model of knee joint and ALL injured models were constructed based on DICOM formatted computed tomography (CT) images. 0°, 15°,30°,45°,60°,75° and 90° flexion angles were applied respectively to reference models. Then varied anterior drawer and internal rotational forces were used to investigate the effect of ALL. ANSYS ®Version 17 was used in analyses and same boundary conditions were used in all models. Results: In critical analyzing the all results; medial displacement and the amount of anterior drawer distance were increased in all ALL injured models when compared with references. Therewithal the rotational displacements were increased by increasing the knee flexion angle and rotational torque. But, it was not a significant change in the amount of displacement between the models with respect to anteroposterior displacement when the anterior drawer force was increased. Conclusion: ALL particular has an important role in the stability of the internal rotation occurs against the force and with increased contribution rate to the knee joint stability by increasing the knee flexion angle. But the reaction forces were not affected by ALL integrity. So this study do not support the previous studies which suggest simultaneously reconstruction of both ligaments to avoid re rupture of ACL in cases with ALL injured.

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