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Plantaris tendon: a novel graft for anterolateral ligament reconstruction and additional reinforcement for anterior cruciate ligament autografts in combined reconstructive procedures

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Abstract

The anterolateral ligament is recently recognized as an important structure in restoring rotational stability of the anterior cruciate ligament-deficient knee. Biomechanical and clinical studies confirmed the benefits of concurrent anterior cruciate ligament and anterolateral ligament reconstruction. However, present techniques mostly use hamstring tendons autografts and therefore additionally disrupt the knee biomechanics. The plantaris tendon is a well known and accessible graft and has excellent biomechanical properties for anterolateral ligament reconstruction. The present paper describes a new combined anterior cruciate ligament and anterolateral ligament reconstruction technique using plantaris tendon and semitendinosus tendon.

Level of evidence V (Case report).

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Fig. 1
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Abbreviations

2PL:

Double plantaris tendon

3STT:

Triple semitendinosus tendon

ACL:

Anterior cruciate ligament

ALL:

Anterolateral ligament

FH:

Fibular head

GT:

Gracilis tendon

GTB:

Gerdy's tubercle

LE:

Lateral epicondyle

PL:

Plantaris tendon

STT:

Semitendinosus tendon

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Funding

There is not funding source.

Author information

M Josipovic designed the described technique and performed the surgery. He wrote the manuscript and contributed to analysis and interpretation of the data. He approved the final version of the manuscript to be submitted, and agreed to be accountable for all aspects of the work. JV participated in the conception and design of the described technique. He contributed to analysis and interpretation of the data. He approved the final version of the manuscript to be submitted, and agreed to be accountable for all aspects of the work. JS participated in performing the surgery. He contributed to analysis and interpretation of the data. He approved the final version of the manuscript to be submitted, and agreed to be accountable for all aspects of the work. MS performed the magnetic resonance images analysis. He contributed to analysis and interpretation of the data and drafting of the manuscript. He approved the final version of the manuscript to be submitted, and agreed to be accountable for all aspects of the work. DN performed the magnetic resonance images analysis. He contributed to analysis and interpretation of the data and drafting of the manuscript. He approved the final version of the manuscript to be submitted, and agreed to be accountable for all aspects of the work. ZS participated in the biomechanical evaluation of the described technique. He critically revised the manuscript for important intellectual content. He approved the final version of the manuscript to be submitted, and agreed to be accountable for all aspects of the work. IB participated in the design of the described technique. He contributed to analysis and interpretation of the data. He approved the final version of the manuscript to be submitted, and agreed to be accountable for all aspects of the work. M Jelic came up with the idea to use plantaris tendon for ALL reconstruction and participated in performing the surgery. He critically revised the manuscript for important intellectual content. He approved the final version of the manuscript to be submitted, and agreed to be accountable for all aspects of the work.

Correspondence to Mislav Jelić.

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The authors declare that they have no competing interests.

Ethics approval

The local Institutional review board (IRB) at the University Hospital Centre Zagreb was consulted prior to undertaking this surgery.

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This manuscript has the consent of the patient for the use of her data and images. The authors obtained the written consent of the patient for the publication of the data and images that appear in the article.

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Josipović, M., Vlaić, J., Serdar, J. et al. Plantaris tendon: a novel graft for anterolateral ligament reconstruction and additional reinforcement for anterior cruciate ligament autografts in combined reconstructive procedures. Knee Surg Sports Traumatol Arthrosc (2020). https://doi.org/10.1007/s00167-020-05885-x

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Keywords

  • Anterolateral ligament
  • Plantaris tendon
  • Anterior cruciate ligament
  • Arthroscopy
  • Hamstring sparing