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Anterolateral ligament

Brett D Steineman, Samuel G Moulton, Tammy L Haut Donahue, Cristián A Fontboté, Christopher M LaPrade, Tyler R Cram, Chase S Dean, Robert F LaPrade
BACKGROUND: The anterolateral meniscal root (ALMR) has been reported to intricately insert underneath the tibial insertion of the anterior cruciate ligament (ACL). Previous studies have begun to evaluate the relationship between the insertion areas and the risk of iatrogenic injuries; however, the overlap of the insertions has yet to be quantified in the sagittal and coronal planes. PURPOSE: To investigate the insertions of the human tibial ACL and ALMR using scanning electron microscopy (SEM) and to quantify the overlap of the ALMR insertion in the coronal and sagittal planes...
October 11, 2016: American Journal of Sports Medicine
Robert Petretta, Vipul Mandalia
The use of an accessory posteromedial portal for posterior cruciate ligament reconstruction in bicruciate knee ligament reconstruction has often been described. However, the use of a posteromedial portal can be time consuming and has some inherent risks including injury to the saphenous vein or nerve. We describe our bicruciate knee ligament reconstruction using 4 exclusively anterior portals including a high anteromedial, high anterolateral, low anteromedial, and low anterolateral portals. Arthroscopy is performed using a combination of 30° and 70° arthroscopes...
August 2016: Arthroscopy Techniques
Tun Hing Lui
The open anatomic repair of the anterior talofibular and calcaneofibular ligaments (modified Brostrom procedure) is widely accepted as the standard surgical stabilization procedure for lateral ankle instability that does not respond to conservative measures. Arthroscopic Brostrom procedures with a suture anchor have been reported to achieve both anatomic repair of the lateral ankle ligaments and management of the associated intra-articular lesions. However, the complication rates are higher than open Brostom procedures...
August 2016: Arthroscopy Techniques
Pinkawas Kongmalai, Bancha Chernchujit
A posterior horn of medial meniscal peripheral capsular is usually associated with the anterior cruciate ligament injury. The conventional repair technique with the camera in the anterolateral portal cannot precisely restore the slope capsular synovium to the original attachment point. We present the arthroscopic technique for improving the accuracy and quality of the repair by working in the posterior compartment. When the posterolateral portal is used as the viewing portal, the accuracy of repair is improved because we can assess the full extent of the lesion and lift the sagging peripheral tissue to the more central part...
August 2016: Arthroscopy Techniques
Ahmad M Wagih, Ahmed M F Elguindy
Recent advances in surgeons' understanding of the anatomic, biomechanical, and radiologic features of the anterolateral ligament (ALL) of the knee have led to an increased interest in reconstruction of this structure as part of the management of knee instability. Even without any technical flaws and proper positioning of the bone tunnels, there is a small subset of patients, approximately 7% of all patients, who experience some residual anterolateral rotational instability after anterior cruciate ligament reconstruction...
August 2016: Arthroscopy Techniques
Jon O Wright, Nathan W Skelley, Reid P Schur, Ryan M Castile, Spencer P Lake, Robert H Brophy
BACKGROUND: The microstructural organization (collagen fiber alignment) of the posterior cruciate ligament (PCL), which likely corresponds with its functional properties, has only been described qualitatively in the literature, to our knowledge. The goal of this study was to quantify the tensile mechanical and microstructural properties of the PCL and compare these qualities between the anterolateral and posteromedial bundles. METHODS: Twenty-two knee specimens from 13 donors (8 male and 5 female; mean age [and standard deviation] at the time of death, 43...
October 5, 2016: Journal of Bone and Joint Surgery. American Volume
Etienne Cavaignac, David Ancelin, Philippe Chiron, Jean-Louis Tricoire, Karine Wytrykowski, Marie Faruch, Elodie Chantalat
: There is a lively debate about the existence, origins and discoverer of the anterolateral ligament of the knee. The complex anatomy of the lateral aspect of the knee has made it difficult to differentiate between various structures such as the iliotibial band, capsulo-osseous layer, Kaplan's fibres and the anterolateral capsule. The "discovery" of a new anterolateral structure in 2013 was the culmination of many historical studies. In 1879, Paul Ferdinand Segond described a tibial plateau fracture in which he noted a pearly band reinforcing the joint capsule...
October 3, 2016: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
Michael J Rossi
Evidence is building to support consideration of anterolateral knee reconstruction in the anterior cruciate ligament-deficient knee with a high-grade pivot shift or participation in a high-risk sport. As the pendulum swings back to the future with the extra-articular augmentation, our anticipation should be tempered by cautious interpretation of the results as the controversy unfolds.
October 2016: Arthroscopy: the Journal of Arthroscopic & related Surgery
Shinichi Yoshiya
When considering the femoral attachment location for an anterolateral ligament reconstruction, the femoral attachment site should be positioned proximally and posteriorly to the lateral epicondyle to restore the physiologic length change of the native ligament. However, the clinical significance of the anterolateral ligament in patients having anterior cruciate ligament reconstructive surgery remains controversial.
October 2016: Arthroscopy: the Journal of Arthroscopic & related Surgery
Willem A Kernkamp, Samuel K Van de Velde, Ali Hosseini, Tsung-Yuan Tsai, Jing-Sheng Li, Ewoud R A van Arkel, Guoan Li
PURPOSE: To measure the in vivo anterolateral ligament (ALL) length change in healthy knees during step-up and sit-to-stand motions. METHODS: Eighteen healthy knees were imaged using magnetic resonance and dual fluoroscopic imaging techniques during a step-up and sit-to-stand motion. The ALL length change was measured using the shortest three-dimensional wrapping path, with its femoral attachment located slightly anterior-distal (ALL-Claes) or posterior-proximal (ALL-Kennedy) to the fibular collateral ligament attachment...
September 20, 2016: Arthroscopy: the Journal of Arthroscopic & related Surgery
Dyan V Flores, Edward Smitaman, Brady K Huang, Donald L Resnick
OBJECTIVE: To re-evaluate the Segond fragment emphasizing those structures that attach to the fragment in patients with reported acute/subacute anterior cruciate ligament (ACL) injuries, and to clarify the nomenclature used to describe these structures. MATERIALS AND METHODS: A search of databases of knee MR examinations over 4.5 years with reported ACL tears yielded 19,726 studies. Using strict exclusion criteria, a total of 146 MR studies with acute/subacute ACL tears were re-assessed with respect to the Segond fragment's size, shape, orientation, location, displacement, attaching soft tissue structures, and associated osseous and/or soft tissue injuries...
September 24, 2016: Skeletal Radiology
Stacey M Cornelson, Alicia M Yochum, Norman W Kettner
OBJECTIVE: This case report describes magnetic resonance imaging (MRI) and diagnostic ultrasound (US) findings for a patient with arthrofibrosis related to a complication of anterior cruciate ligament (ACL) reconstruction. CLINICAL FEATURES: A 25-year old man presented with right knee pain and loss of extension 5 years after ACL reconstruction. MRI and sonographic examination revealed a soft tissue mass anterolateral to the ACL graft consistent with a cyclops lesion...
September 2016: Journal of Chiropractic Medicine
T Bonanzinga, C Signorelli, A Grassi, N Lopomo, L Bragonzoni, S Zaffagnini, M Marcacci
PURPOSE: To quantify the influence of ALL lesions on static and dynamic laxity in ACL-deficient knee. METHODS: The study was performed in 10 fresh-frozen knees. The joints were analysed in the following conditions: intact, ACL resection and ACL + ALL resection. Testing parameters were defined as: anterior displacement at 30° and 90° of flexion (AP30, AP90) applying a manual-maximum load; internal rotation at 30° and 90° of flexion (INT30, INT90) applying a 5 N m torque and internal rotation and acceleration during manual pivot-shift (PS) test...
September 8, 2016: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
Bo Zhang, Cheng-Kung Cheng, Tie-Bing Qu, Yong Hai, Yuan Lin, Jiang Pan, Zhi-Wei Wang, Liang Wen
OBJECTIVE: Whether the entire posterior cruciate ligament (PCL) should be retained during cruciate-retaining total knee arthroplasty (CR TKA) is controversial. The goal of this study was to compare the early clinical outcomes of partial versus intact PCL-retaining TKA. METHODS: Ninety-two patients who had undergone unilateral CR TKA from March 2012 to June 2013 were enrolled in this study. Forty-six of these patients were randomly selected to undergo intact PCL-retaining TKA (intact group), whereas the remaining 46 patients underwent tibial osteotomy together with anterolateral bundle and bone island resection (partial group)...
August 2016: Orthopaedic Surgery
Camilo Partezani Helito, Julio Augusto do Prado Torres, Marcelo Batista Bonadio, José Aderval Aragão, Lucas Nogueira de Oliveira, Renato José Mendonça Natalino, José Ricardo Pécora, Gilberto Luis Camanho, Marco Kawamura Demange
BACKGROUND: The anterolateral ligament (ALL) of the knee has recently been described in detail. Most studies of the ALL have been conducted in adults; therefore, little is known about the anatomy and histology of the ALL in younger patients, and nothing is known about the fetal presence of the ALL. PURPOSE: To evaluate the ALL in human fetuses to determine its presence or absence and to describe its microscopic anatomy and histological features compared with the findings of studies conducted in adults...
September 13, 2016: American Journal of Sports Medicine
Ronald G Ray
There are a number of variations in the intra-articular anatomy of the ankle which should not be considered pathological under all circumstances. The anteromedial corner of the tibial plafond (between the anterior edge of the tibial plafond and the medial malleolus) can have a notch, void of cartilage and bone. This area can appear degenerative arthroscopically; it is actually a normal variant of the articular surface. The anterior inferior tibiofibular ligament (AITF) can possess a lower, accessory band which can impinge on the anterolateral edge of the talar dome...
October 2016: Clinics in Podiatric Medicine and Surgery
Young-Mo Kim, Yong-Bum Joo, Kyu-Woong Yeon, Ki-Young Lee
Anatomical variations of the meniscus are a common anomaly that knee surgeons frequently encounter. However, anomalies of the anterior horn of the lateral meniscus (AHLM) are extremely rare. In this report, we present a newly discovered anomaly of the AHML: an anterolateral meniscofemoral ligament is described with clinical features and radiographic and arthroscopic findings.
September 2016: Knee Surgery & related Research
Andrew D Franklin, G Bennett Cierny, Twila R Luckett
Meralgia paresthetica is a chronic pain syndrome that is extremely rare in the pediatric population. It is manifested by hypesthesia or pain in the distribution of the lateral femoral cutaneous nerve (LFCN) and is typically caused by entrapment as the nerve passes deep to the inguinal ligament. This sensory mononeuropathy is rare in children and diagnosis is typically delayed, often leading to prolonged functional impairment and unnecessary medical testing. A 9-year-old girl presented to the pain clinic with a 6-week history of right anterolateral thigh pain first noticed after a nontraumatic cheerleading practice...
September 2016: Journal of Clinical Anesthesia
Marcio de Castro Ferreira, Flavio Ferreira Zidan, Francini Belluci Miduati, Caio Cesar Fortuna, Bruno Moreira Mizutani, Rene Jorge Abdalla
Recent anatomical and biomechanical studies on the anterolateral ligament (ALL) of the knee have shown that this structure has an important function in relation to joint stability, especially when associated with anterior cruciate ligament (ACL) injury. However, the criteria for its reconstruction have not yet been fully established and the surgical techniques that have been described present variations regarding anatomical points and fixation materials. This study presents a reproducible technique for ALL and ACL reconstruction using hamstring tendons, in which three interference screws are used for fixation...
July 2016: Revista Brasileira de Ortopedia
Marcus Vinicius Malheiros Luzo, Carlos Eduardo da Silveira Franciozi, Fernando Cury Rezende, Guilherme Conforto Gracitelli, Pedro Debieux, Moisés Cohen
This updating article on the anterior cruciate ligament (ACL) has the aim of addressing some of the most interesting current topics in this field. Within this stratified approach, it contains the following sections: ACL remnant; anterolateral ligament and combined intra and extra-articular reconstruction; fixation devices; and ACL femoral tunnel creation techniques.
July 2016: Revista Brasileira de Ortopedia
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