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Biomechanics of Anterolateral Instability and Pivot Shift

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Anterolateral Rotatory Instability in ACL Deficient Knee

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Abstract

The biomechanics of anterolateral rotatory instability (ALRI) and of the pivot shift phenomenon are some of the most intriguing topics of modern knee ligament surgery. Our interest in this aspect was stimulated by the advent of surgical navigation. Thanks to some unique findings provided by the software specifically designed to investigate knee kinematics, we performed several cadaver studies aimed to investigate the role of the ACL and its secondary restraints on rotatory instabilities with a special focus on the anterolateral ligament (ALL). The effect of intra-articular ACL reconstructions (including the double bundle technique) and extra-articular reconstructions as stabilizing procedures in ACL-deficient knees were also analysed in other in vivo studies.

All our studies confirmed that the anterolateral ligament has an important role as a secondary restraint of the ACL in controlling tibial internal rotation and the pivot shift phenomenon; in fact, a severe pivot shift cannot be elicited unless the ALL is cut along with the ACL. Moreover, extra-articular reconstruction is more effective than the double bundle technique in restoring knee stability, with a specific effect on the rotational component of the pivot shift.

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Authors and Affiliations

  1. Orthopaedic Unit, Sant’Andrea University Hospital, La Sapienza University, Rome, Italy

    Andrea Ferretti & Susanna M. Pagnotta

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  1. Andrea Ferretti
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  2. Susanna M. Pagnotta
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Editors and Affiliations

  1. Department of Surgery and Translational Medicine, Sant'Andrea University Hospital, La Sapienza University, Rome, Italy

    Andrea Ferretti

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Ferretti, A., Pagnotta, S.M. (2022). Biomechanics of Anterolateral Instability and Pivot Shift. In: Ferretti, A. (eds) Anterolateral Rotatory Instability in ACL Deficient Knee. Springer, Cham. https://doi.org/10.1007/978-3-031-00115-4_3

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  • DOI: https://doi.org/10.1007/978-3-031-00115-4_3

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-00114-7

  • Online ISBN: 978-3-031-00115-4

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