Function and strain of the anterolateral ligament part II: reconstruction

Björn H Drews; Oliver Kessler; Wolfgang Franz; Maren Freutel; Lutz Dürselen

doi:10.1007/s00167-020-06137-8

Function and strain of the anterolateral ligament part II: reconstruction

Knee Surg Sports Traumatol Arthrosc. 2023 Feb;31(2):390-398. doi: 10.1007/s00167-020-06137-8. Epub 2020 Jul 25.

Authors

Björn H Drews^#¹, Oliver Kessler^#^{2

3}, Wolfgang Franz⁴, Maren Freutel⁵, Lutz Dürselen⁵

Affiliations

¹ St. Vinzenz Clinic Allgäu, Kirchenweg 15, 87459, Pfronten, Germany. bjoern.drews@vinzenz-klinik.de.
² Centre for Orthopaedics and Sports, Albisriederstrasse 243 A, 8047, Zürich, Switzerland.
³ University Hospital for Orthopaedic Surgery, Leipziger Str. 44, 39120, Magdeburg, Germany.
⁴ Lutrina Clinic, Pfaffplatz 10, 67655, Kaiserslautern, Germany.
⁵ Institute of Orthopaedic Research and Biomechanics, Trauma Research Centre, University of Ulm, Medical Centre, Helmholtzstraße 14, 89081, Ulm, Germany.

^# Contributed equally.

PMID: 32712685
DOI: 10.1007/s00167-020-06137-8

Abstract

Purpose: Anterolateral rotatory instability (ALRI) may result from isolated ruptures of the anterior cruciate ligament (ACL) or combined lesions with the anterolateral ligament (ALL). Biomechanical studies have demonstrated that the ALL contributes to the overall rotational stability of the knee. The purpose of this study was to investigate the biomechanical function of anatomic ALL reconstruction (ALL_rec) in the setting of a combined ACL and ALL injury and reconstruction. The hypothesis was that combined ACL reconstruction (ACL_rec) and ALL_rec (ACL/ALL_rec) significantly reduces internal rotation and shows load sharing between both reconstructions compared with isolated ACL_rec.

Methods: Eight fresh-frozen cadaveric knees were evaluated using a six degrees of freedom knee simulator. Continuous passive motion and external loads were tested. Kinematic differences between ACL_rec and combined ACL/ALL_rec were compared. Additionally, ACL graft tension and ALL graft strain were measured continuously throughout the testing protocol.

Results: Combined anatomic ACL/ALL_rec significantly improved the internal rotatory stability compared with isolated ACL_rec at 30°-90° under an internal rotation moment. During a static pivot-shift test, additional ALL_rec showed no significant reduction of ap-translation. ALL_rec resulted in an increase in ACL graft tension during continuous passive motion and with additional internal rotation moment.

Conclusion: In the case of a combined ACL and ALL deficiency, concurrent ACL_rec and ALL_rec significantly improved the rotatory stability of the knee compared with solely reconstructing the ACL at flexion angles ≥ 30°. Nevertheless, additional ALL_rec with fixation at 60° and with low tension could not restore extension-near rotatory stability. For that reason, ALL_rec with fixation at 60° flexion cannot be recommended in clinical application.

Keywords: ACL reconstruction; Anterolateral ligament; Biomechanics; Knee; Rotational knee instability.

MeSH terms

Anterior Cruciate Ligament / surgery
Anterior Cruciate Ligament Injuries* / surgery
Biomechanical Phenomena
Cadaver
Humans
Joint Instability* / surgery
Knee Joint / surgery
Range of Motion, Articular
Tibia / surgery

Abstract

MeSH terms

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