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Anterolateral ligament of the knee

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
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
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
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
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
Volker Musahl, Ata A Rahnemai-Azar, Joanna Costello, Justin W Arner, Freddie H Fu, Yuichi Hoshino, Nicola Lopomo, Kristian Samuelsson, James J Irrgang
BACKGROUND: The role of the anterolateral capsule (ALC) as a secondary restraint to quantitative rotatory laxity of patients with an anterior cruciate ligament (ACL) injury is currently debated. PURPOSE/HYPOTHESIS: The purpose was to determine the influence of concomitant ALC injuries as well as injuries to other soft tissue structures on rotatory knee laxity in patients with an ACL injury. It was hypothesized that a concomitant ALC injury would be associated with increased rotatory knee laxity as measured during a quantitative pivot-shift test...
August 9, 2016: American Journal of Sports Medicine
Jun Watanabe, Daisuke Suzuki, Shougo Mizoguchi, Shigemitsu Yoshida, Mineko Fujimiya
BACKGROUND: The anterolateral ligament of the knee (ALL) has been attracting research attention as the ligament related to the Segond fracture. In this study, we investigated the prevalence and morphological variation of the ALL and developed a classification for the ALL in Japanese people. METHODS: A total of 94 knees of 54 room cadavers of Japanese people were examined (24 male, 30 female; age range 70-103 years; average age: 85.6 years). Knees with damaged ligaments, such as ACL rupture, and with bony abnormalities were excluded...
September 2016: Journal of Orthopaedic Science: Official Journal of the Japanese Orthopaedic Association
Jason M Schon, Gilbert Moatshe, Alex W Brady, Raphael Serra Cruz, Jorge Chahla, Grant J Dornan, Travis Lee Turnbull, Lars Engebretsen, Robert F LaPrade
BACKGROUND: Anterior cruciate ligament (ACL) tears are one of the most common injuries among athletes. However, the ability to fully restore rotational stability with ACL reconstruction (ACLR) remains a challenge, as evidenced by the persistence of rotational instability in up to 25% of patients after surgery. Advocacy for reconstruction of the anterolateral ligament (ALL) is rapidly increasing because some biomechanical studies have reported that the ALL is a significant contributor to internal rotational stability of the knee...
July 12, 2016: American Journal of Sports Medicine
Christian Lutz, Bertrand Sonnery-Cottet, Pierre Imbert, Nuno Camelo Barbosa, Sanesh Tuteja, Jean-Henri Jaeger
Interest and knowledge on the anatomy, function, and biomechanical properties of the anterolateral ligament has led to the recognition of the importance of this structure in rotational control of the knee. This article describes a technique that allows for a combined anterior cruciate ligament (ACL) and anterolateral reconstruction, using an Iliotibial band (ITB) autograft. The graft is detached from the vastus lateralis from proximal to distal, at the center portion from ITB, preserving its distal insertion on the Gerdy tubercle...
April 2016: Arthroscopy Techniques
Jason Capo, Daniel J Kaplan, David J Fralinger, Ronald S Adler, Kirk A Campbell, Laith M Jazrawi, Michael J Alaia
PURPOSE: Injury to the anterolateral ligament (ALL) of the knee has recently received attention as a potential risk factor for failure of anterior cruciate ligament reconstruction. However, evaluation of the anterolateral ligament is currently difficult, and radiologic data are sparse with regard to the normal appearance of this ligament. The purpose of the present study was to determine whether the ALL could be identified and visualized using ultrasonography. METHODS: Ten non-paired, fresh-frozen cadaveric knees underwent ultrasound by an experienced musculoskeletal radiologist using a Siemens S2000 Acuson Ultrasound machine with a 14-MHz linear transducer...
June 25, 2016: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
Samuel K Van de Velde, William A Kernkamp, Ali Hosseini, Robert F LaPrade, Ewoud R van Arkel, Guoan Li
BACKGROUND: Both anatomic anterolateral ligament (ALL) and nonanatomic anterolateral reconstructions are performed to improve the stability of anterior cruciate ligament (ACL)-deficient patients. However, the in vivo length change patterns and isometry of these anterolateral reconstructions are unknown. PURPOSE: To measure the theoretical length change patterns of the ALL and various anterolateral extra-articular reconstructions in healthy and ACL-deficient knees during in vivo weightbearing flexion...
June 23, 2016: American Journal of Sports Medicine
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