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Function and strain of the anterolateral ligament part I: biomechanical analysis

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Because reconstruction of the anterior cruciate ligament (ACL) in a double-bundle technique did not solve the problem of persistent rotatory laxity after surgery, new potential answers to this issue are of great interest. One of these is an extraarticular stabilization based on the rediscovery of the anterolateral ligament (ALL). Knowledge about its biomechanical function and benchmark data for an optimal reconstruction remain lacking. Therefore, the purpose of this study was to assess the function of the ALL under passive motion, anterior tibial translation and tibial rotational moments.

Methods

Continuous passive motion (0°–120° flexion), ap-translation and static pivot shift tests were performed on eight cadaveric knees. The knees were measured in intact, ACL-resected (ACLres) and ACL + ALL-resected (ALLres) conditions. Ap-translation and static pivot shift under 134 N anterior shear load were determined at 0°, 30°, 60° and 90° flexion. Strain of the ALL was recorded in intact and ACLres conditions.

Results

During continuous passive motion under unloaded conditions, no significant difference in internal rotation between ACLres and ALLres was observed. With an additional internal tibial torque of 1–4 Nm, internal rotation increased significantly between 60° and 120° after resection of the ALL (p ≤ 0.05). Anterior tibial translation was significantly higher at 30° in ALLres (p = 0.01) and for a simulated pivot shift at 60° and 90° in ACLres (p ≤ 0.01). The ALL was not strained under unloaded passive motion. Adding different internal tibial torques led to strain starting at 60° flexion (1 N m internal torque) and 15° flexion (4 N m internal torque) in intact ligaments. In ACLres, significantly greater ALL strains under lower flexion angles were seen for each condition (p ≤ 0.05).

Conclusions

This study demonstrated the ALL to be without function under passive motion and with no influence on tibial rotation. On application of extrinsic loads, the ALL had a low but significant stabilizing effect against anterior tibial shear load at low flexion angles. For this reason, it can be concluded that the ALL is supporting the ACL against internal tibial loads to a minor degree. A relationship between the ALL and the pivot shift cannot be concluded. With these results ALL-reconstruction cannot be recommended at the moment without further biomechanical investigations.

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Acknowledgements

This study was funded by the Alwin-Jäger-Foundation. The instruments for the surgical preparation were sponsored by Arthrex (München, Germany). W.F. is Consultant to Arthrex and Corin and gets Royalties from Arthrex. M.F. is an employee to CeramTec. No author has received any financial benefit from research in this study.

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    Authors and Affiliations

    1. Center of Surgery, Department for Orthopedic Trauma, Hand and Reconstructive Surgery, University of Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany

      Björn Holger Drews

    2. Center for Orthopedics and Sports, Albisriederstrasse 243 A, 8047, Zurich, Switzerland

      Oliver Kessler

    3. Lutrina Clinic, Pfaffplatz 10, 67655, Kaiserslautern, Germany

      Wolfgang Franz

    4. Institute of Orthopedic Research and Biomechanics, Trauma Research Center, University of Ulm-Medical Center, Helmholtzstraße 14, 89081, Ulm, Germany

      Lutz Dürselen & Maren Freutel

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    1. Björn Holger Drews
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    Correspondence to Björn Holger Drews.

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    The Institutional Review Board of the University of Ulm approved this study (approval number 51/15).

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    B.H. Drews and O. Kessler contributed equally to this work.

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    Drews, B.H., Kessler, O., Franz, W. et al. Function and strain of the anterolateral ligament part I: biomechanical analysis. Knee Surg Sports Traumatol Arthrosc 25, 1132–1139 (2017). https://doi.org/10.1007/s00167-017-4472-3

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