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Reconstructing the anterolateral ligament does not decrease rotational knee laxity in ACL-reconstructed knees

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

Abstract

Purpose

Little is known about the anterolateral ligament’s (ALL) influence on knee laxity. The purpose of this study was to investigate rotational knee laxity against a pure axial rotational stress using radiostereometric analysis (RSA) after cutting and reconstructing both the anterior cruciate ligament (ACL) and the ALL.

Methods

Eight human donor legs were positioned and stereoradiographically recorded at 0°, 30° and 60° of knee flexion using a motorised fixture, while an internally rotating force of 4 Nm was applied to the foot. Anterior–posterior and rotational laxity were investigated for knees with intact ligaments and compared with those observed after successive ACL and ALL resection and reconstruction.

Results

After cutting the ALL in ACL-deficient knees, the internal rotation was increased in all three knee flexion angles, 0° (p = 0.04), 30° (p = 0.03) and 60° (p < 0.01) by 1.0°, 1.6° and 2.5°, respectively. However, no decrease in laxity was found after reconstructing the ALL in ACL-reconstructed knees.

Conclusions

The ALL was confirmed as a stabiliser of internal rotation in ACL-deficient knees. However, reconstructing the ALL using a gracilis autograft tendon did not decrease the internal rotation laxity in the ACL-reconstructed knee. Based on the results of this study, we do not recommend reconstructing the ALL in ACL-reconstructed knees to decrease internal knee laxity.

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Acknowledgements

We thank the Department of Radiology at Aarhus University Hospital for their support, and especially Lars Lindgren and Mark Jensen for their help with recording the radiographs. Further, we thank the Department of Biomedicine at Aarhus University for providing the donor specimens. Also, we would like to thank Smith and Nephew Denmark for making the instruments for surgery and the arthroscopic hardware available.

Author contributions

KS-O, ETN, SR, PBJ, OGS, BK, KS and MS made a substantial contribution to the research design, data acquisition and interpretation and critical revisions of the manuscript.

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Authors and Affiliations

  1. Orthopedic Research Unit, Aarhus University Hospital, Tage Hansens Gade 2, 8000, Aarhus C, Denmark

    Kasper Stentz-Olesen, Sepp de Raedt, Peter Bo Jørgensen, Ole Gade Sørensen, Kjeld Søballe & Maiken Stilling

  2. Department of Health Science and Technology, Aalborg University, Fredrik Bajers Vej 7 D2, 9220, Aalborg East, Denmark

    Emil Toft Nielsen

  3. Biomechanics and Imaging Group, Department of Orthopedic Surgery, Leiden University Medical Center, Albinusdreef 2, 2333, ZA Leiden, The Netherlands

    Bart Kaptein

  4. Department of Clinical Medicine, University of Aarhus, Aarhus C, Denmark

    Maiken Stilling

  5. Nordisk Røntgen Teknik, Birkegaardsvej 16, 8361, Hasselager, Denmark

    Sepp de Raedt

Authors
  1. Kasper Stentz-Olesen
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  2. Emil Toft Nielsen
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  3. Sepp de Raedt
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  4. Peter Bo Jørgensen
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  5. Ole Gade Sørensen
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  6. Bart Kaptein
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  7. Kjeld Søballe
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  8. Maiken Stilling
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Corresponding author

Correspondence to Kasper Stentz-Olesen.

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Conflict of interest

The author(s) declare that they have no conflict of interest.

Funding

This work was supported by six funds: (1) Innovation Fund Grant 69-2013-1 - Transforming radiological technology for assessment of implant fixation: from research tool to clinical application, (2) Civilingeniør Frode V. Nyegaard og Hustrus fond, (3) Ortopædkirurgisk forskningsfond Aarhus, (4) A.P. Møller Fund, (5) Grosserer L. F. Foghts Fond, (6) Helga og Peter Kornings Fond.

Ethical approval

The study was reviewed by the Central Denmark Region Committees on Health Research Ethics, and according to the Act on Research Ethics Review of Health Research Projects, Act number 593 of 14 July 2011 section 14, no IRB approval was required. Case number 1-10-72-6-16 issued on February 24th, 2016.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Stentz-Olesen, K., Nielsen, E.T., de Raedt, S. et al. Reconstructing the anterolateral ligament does not decrease rotational knee laxity in ACL-reconstructed knees. Knee Surg Sports Traumatol Arthrosc 25, 1125–1131 (2017). https://doi.org/10.1007/s00167-017-4500-3

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  • DOI: https://doi.org/10.1007/s00167-017-4500-3

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