Anterolateral Ligament Expert Group consensus paper on the management of internal rotation and instability of the anterior cruciate ligament - deficient knee

Journal of Orthopaedics and Traumatology - Tập 18 - Trang 91-106 - 2017
Bertrand Sonnery-Cottet1, Matthew Daggett2, Jean-Marie Fayard1, Andrea Ferretti3, Camilo Partezani Helito4, Martin Lind5, Edoardo Monaco3, Vitor Barion Castro de Pádua6, Mathieu Thaunat1, Adrian Wilson7, Stefano Zaffagnini8, Jacco Zijl9, Steven Claes10
1Centre Orthopédique Paul Santy, FIFA Medical Center of Excellence, Groupe Ramsay-Generale de Santé, Lyon, France
2Kansas City University, Kansas City, USA
3Orthopaedic Unit and Kirk Kilgour Sports Injury Center, Sant’Andrea University Hospital, “Sapienza” University of Rome, Rome, Italy
4Knee Surgery Division, University of São Paulo, São Paulo, Brazil
5Division of Sportstraumatology, Department of Orthopedics, Aarhus University Hospital, Aarhus C, Denmark
6Associação Beneficente Hospital Universitário de Marilia-SP Brazil, Cidade Universitária, Marilia, Brazil
7Department of Sport and Exercise, Sport and Exercise Research Centre, University of Winchester, Winchester, UK
8Dipartimento Rizzoli Sicilia, Ortopedia e Traumatologia, Università di Bologna, Bagheria, Italy
9St. Antonius Hospital, Utrecht, The Netherlands
10Department of Orthopaedic Surgery and Traumatology, AZ Herentals, Herentals, Belgium

Tóm tắt

Purpose of this paper is to provide an overview of the latest research on the anterolateral ligament (ALL) and present the consensus of the ALL Expert Group on the anatomy, radiographic landmarks, biomechanics, clinical and radiographic diagnosis, lesion classification, surgical technique and clinical outcomes. A consensus on controversial subjects surrounding the ALL and anterolateral knee instability has been established based on the opinion of experts, the latest publications on the subject and an exchange of experiences during the ALL Experts Meeting (November 2015, Lyon, France). The ALL is found deep to the iliotibial band. The femoral origin is just posterior and proximal to the lateral epicondyle; the tibial attachment is 21.6 mm posterior to Gerdy’s tubercle and 4–10 mm below the tibial joint line. On a lateral radiographic view the femoral origin is located in the postero-inferior quadrant and the tibial attachment is close to the centre of the proximal tibial plateau. Favourable isometry of an ALL reconstruction is seen when the femoral position is proximal and posterior to the lateral epicondyle, with the ALL being tight upon extension and lax upon flexion. The ALL can be visualised on ultrasound, or on T2-weighted coronal MRI scans with proton density fat-suppressed evaluation. The ALL injury is associated with a Segond fracture, and often occurs in conjunction with acute anterior cruciate ligament (ACL) injury. Recognition and repair of the ALL lesions should be considered to improve the control of rotational stability provided by ACL reconstruction. For high-risk patients, a combined ACL and ALL reconstruction improves rotational control and reduces the rate of re-rupture, without increased postoperative complication rates compared to ACL-only reconstruction. In conclusion this paper provides a contemporary consensus on all studied features of the ALL. The findings warrant future research in order to further test these early observations, with the ultimate goal of improving the long-term outcomes of ACL-injured patients. Level of evidence Level V—Expert opinion.

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Journal of Orthopaedics and Traumatology

Tập 18

91-106

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