MRI Assessment of Anterolateral Ligament Injury of Knee Joint

Background. Clinical diagnosis of the anterolateral ligament (ALL) insufficiency is rather complicated. Accordingly, it is necessary to use MRI for accurate diagnosis in patients with complex anterolateral instability of knee joint. The purpose of our work was to determine the possibilities of MRI in the diagnosis of anterolateral ligament lesions. Materials and methods. A retrospective analysis of 224 MRI studies of patients with ACL injuries was performed. 107 studies were performed on a 3.0 Tesla device and 117 studies were performed on a 1.5 Tesla device. Results. In 29 cases (13%), it was impossible to visualize ALL on MRI, so these patients were excluded from the study, while 195 patients (87%) remained in the study. 128 (65.6%) of the 195 remaining patients did not show signs of ALL rupture, while 67 patients (34.4%) had sings of rupture. In the group with ALL lesions, the femoral part was injured in 50.7% (34 patients), the tibial part in 19.4% (13 patients), and the middle part in 29.9% (20 patients). Conclusions. 1. In our study, we determined that the ALL was visualized in 87% of patients with ACL injury. 2. In our patients’ group, the frequency of a concomitant ALL lesion together with an ACL lesion was 34.4%, when an MRI study was performed up to 6 weeks from the moment of trauma.

Inestabilidad de la articulación tibio-peronea proximal como causa de dolor en artroplastia total de rodilla primaria.

The isolated instability of the proximal tibiofibular joint (PTFJ) as a cause of pain in a prosthetic knee is a very rare clinical entity, to date we have only found one reference in the bibliography of ATPP instability associated with total knee arthroplasty. We review the bibliography on the different forms of instability and their etiology, as well as the possibilities of conservative and surgical treatment. We present the case of a patient with anterolateral instability PTFJ associated with a primary postero-stabilized (PS) TKA with a mobile tibial polyethylene.

Lateral Extra-articular Tenodesis with Iliotibial Band Strip – a Solution for Anterolateral Instability?

It is widely acknowledged that anterior cruciate ligament (ACL) injury is the cause of anterolateral insta­bility, but in some cases not only the ACL ruptures, but also anterolateral structures (ALS), including the antero­lateral ligament. Their insufficiency may be the cause of residual instability after ACL reconstruction, which significantly increases the risk of graft rupture. In the past, anterolateral instability caused by ACL injury was treat­ed with extra-articular reconstructions, including lateral extra-articular tenodesis. Nowadays those techni­ques are used simultaneously in cases of complex anterolateral and rotational instability. This article briefly describes historical methods of lateral tenodesis and presents step-by-step two techniques used in our depart­ments involving two alternative graft femoral fixation methods.

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

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.

Lemaire extraarticular plasty in anterolateral knee instability

Anterolateral instability of the knee results from injury to the lateral capsular complex and the anterior cruciate ligament (ACL), and it should not be considered an isolated injury. Over the past years these structures have received renewed interest. The anterolateral ligament (ALL) recently described extends from the lateral side of the lateral femoral condyle to the antero-lateral edge of the tibia, and it is supposed to play a major role in anterolateral stability. ACL extra-articular tenodesis, initially developed as a single procedure, is now complementary to intra-articular plasty. Our indications are: pure rotational instability, symptomatic instability in non-athletes, and revision surgery. Lemaire-type plasty and post-opeartive care are described in detail. We suggest thorough patient history and clinical examination prior to surgical decision. Lemaire-type plasty effectively controls anterolateral instability.