Skip to main content
SpringerLink
Log in

Is it safe to reconstruct the knee Anterolateral Ligament with a femoral tunnel? Frequency of Lateral Collateral Ligament and Popliteus Tendon injury

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

This study sought to determine the safety limits for performing a femoral bone tunnel to reconstruct the knee anterolateral ligament (ALL) by establishing its distance from the lateral collateral ligament (LCL) and the popliteus muscle tendon (PT) on the lateral femoral condyle.

Methods

Anatomic study on 48 knee cadaveric specimens. The femoral attachments of the studied structures were isolated, and the distance between them was measured. For each cadaver, the percentage of cases in which at least 50 % of the LCL and PT would be injured when using 4- to 12-mm-diameter drills in an ALL reconstruction procedure was evaluated.

Results

The LCL and PT were 3.8 mm and 10.2 mm distant from the ALL, respectively. A 4-mm tunnel would cause LCL injury in 8.3 % of cases, with increasing incidence of injury up to 87.5 % with a 12-mm drill. Injury to the PT would start with the 10-mm drill, causing injury in 2.0 % of cases.

Conclusions

Performing a tunnel in the center of the ALL may cause an iatrogenic injury to the LCL origin. No cases of PT injury are expected to occur with drills smaller than 10 mm.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Segond P (1879) Recherches cliniques et expérimentales sur les épanchements sanguins du genou par entorse. Aux Bureaux du Progrès medical, Versailles

  2. Vincent JP, Magnussen RA, Gezmez F et al (2012) The anterolateral ligament of the human knee: an anatomic and histologic study. Knee Surg Sports Traumatol Arthrosc 20:147–152

    Article  PubMed  Google Scholar 

  3. Caterine S, Litchfield R, Johnson M, Chronik B, Getgood A (2014) A cadaveric study of the anterolateral ligament: re-introducing the lateral capsular ligament. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-014-3117-z

  4. Claes S, Vereecke E, Maes M, Victor J, Verdonk P, Bellemans J (2013) Anatomy of the anterolateral ligament of the knee. J Anat 223:321–328

    Article  PubMed  PubMed Central  Google Scholar 

  5. Helito CP, Demange MK, Bonadio MB et al (2013) Anatomy and histology of the knee anterolateral ligament. OJSM 1:2325967113513546. doi:10.1177/2325967113513546

    PubMed  PubMed Central  Google Scholar 

  6. Dodds AL, Halewood C, Gupte CM, Williams A, Amis AA (2014) The anterolateral ligament: anatomy, length changes and association with the Segond fracture. Bone Joint J 96-B:325–331

    Article  CAS  PubMed  Google Scholar 

  7. Wroble RR, Grood ES, Cummings JS, Henderson JM, Noyes FR (1993) The role of lateral extraarticular restraints in the anterior cruciate ligament-deficient knee. Am J Sports Med 21:257–262

    Article  CAS  PubMed  Google Scholar 

  8. Terry GC, Norwood LA, Hughston JC, Caldwell KM (1993) How iliotibial tract injuries of the knee combine with acute anterior cruciate ligament tears to influence abnormal anterior tibial displacement. Am J Sports Med 21:55–60

    Article  CAS  PubMed  Google Scholar 

  9. Samuelson M, Draganich LF, Zhou X, Krumins P, Reider B (1996) The effects of knee reconstruction on combined anterior cruciate ligament and anterolateral capsular deficiencies. Am J Sports Med 24:492–497

    Article  CAS  PubMed  Google Scholar 

  10. Monaco E, Ferretti A, Labianca L et al (2012) Navigated knee kinematics after cutting of the ACL and its secondary restraint. Knee Surg Sports Traumatol Arthrosc 20:870–877

    Article  CAS  PubMed  Google Scholar 

  11. Claes S, Bartholomeeusen S, Bellemans J (2014) High prevalence of anterolateral ligament abnormalities in magnetic resonance images of anterior cruciate ligament-injured knees. Acta Orthop Belg 80:45–49

    PubMed  Google Scholar 

  12. De Maeseneer M, Boulet C, Willekens I et al (2014) Segond fracture: involvement of the iliotibial band, anterolateral ligament, and anterior arm of the biceps femoris in knee trauma. Skeletal Radiol 44:413-421

  13. Helito CP, Helito PV, Costa HP et al (2014) MRI evaluation of the anterolateral ligament of the knee: assessment in routine 1.5T scans. Skeletal Radiol 43:1421–1427

    Article  PubMed  Google Scholar 

  14. Cianca J, John J, Pandit S, Chiou-Tan FY (2014) Musculoskeletal ultrasound imaging of the recently described anterolateral ligament of the knee. Am J Phys Med Rehabil 93:186

    Article  PubMed  Google Scholar 

  15. Helito CP, Demange MK, Bonadio MD et al (2014) Radiographic landmarks for locating the femoral origin and the tibial insertion of the knee anterolateral ligament. Am J Sports Med 42:2356-2362

  16. Rezansoff AJ, Caterine S, Spencer L, Tran MN, Litchfield RB, Getgood AM (2014) Radiographic landmarks for surgical reconstruction of the anterolateral ligament of the knee. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-014-3126-y

  17. Archibald JD, Baer GS (2012) Complications of anterior cruciate ligament reconstruction. In: Scott WN, Scuderi G (eds) Insall and Scott Surgery of the knee, 5th edn. Elsevier, Philadelphia, pp 428–434

    Chapter  Google Scholar 

  18. Hussein M, van Eck CF, Cretnik A, Dinevski D, Fu FH (2012) Prospective randomized clinical evaluation of conventional single-bundle, anatomic single-bundle, and anatomic double-bundle anterior cruciate ligament reconstruction: 281 cases with 3- to 5-year follow-up. Am J Sports Med 40:512–520

    Article  PubMed  Google Scholar 

  19. Piefer JW, Pflugner TR, Hwang MD, Lubowitz JH (2012) Anterior cruciate ligament femoral footprint anatomy: systematic review of the 21st century literature. Arthroscopy 28:872–881

    Article  PubMed  Google Scholar 

  20. Scheffel PT, Henninger HB, Burks RT (2013) Relationship of the intercondylar roof and the tibial footprint of the ACL: implications for ACL reconstruction. Am J Sports Med 41:396–401

    Article  PubMed  Google Scholar 

  21. Kamath GV, Redfern JC, Burks RT (2010) Femoral radiographic landmarks for lateral collateral ligament reconstruction and repair: a new method of reference. Am J Sports Med 38:570–574

    Article  PubMed  Google Scholar 

  22. Marcacci M, Zaffagnini S, Giordano G, Iacono F, Presti ML (2009) Anterior cruciate ligament reconstruction associated with extra-articular tenodesis: a prospective clinical and radiographic evaluation with 10- to 13-year follow-up. Am J Sports Med 37:707–714

  23. Edwards DJ, Brown JN, Roberts SN, Paterson RS. Long-term results of anterior cruciate ligament reconstruction using ilio-tibial tract and semitendinosis tendon. Knee 7:87–93.

  24. Trichine F, Alsaati M, Chouteau J, Moyen B, Bouzitouna M, Maza R. Patellar tendon autograft reconstruction of the anterior cruciate ligament with and without lateral plasty in advanced-stage chronic laxity. A clinical, prospective, randomized, single-blind study using passive dynamic X-rays. Knee 21:58–65

  25. Chambat P, Guier C, Sonnery-Cottet B, Fayard JM, Thaunat M (2013) The evolution of ACL reconstruction over the last fifty years. Int Orthop 37:181–186. doi:10.1007/s00264-012-1759-3

    Article  PubMed  PubMed Central  Google Scholar 

  26. Vadalà AP, Iorio R, De Carli A, Bonifazi A, Iorio C, Gatti A, Rossi C, Ferretti A (2013) An extra-articular procedure improves the clinical outcome in anterior cruciate ligament reconstruction with hamstrings in female athletes. Int Orthop 37:187–192. doi:10.1007/s00264-012-1571-0

    Article  PubMed  PubMed Central  Google Scholar 

  27. Dejour D, Vanconcelos W, Bonin N, Saggin PR (2013) Comparative study between mono-bundle bone-patellar tendon-bone, double-bundle hamstring and mono-bundle bone-patellar tendon-bone combined with a modified Lemaire extra-articular procedure in anterior cruciate ligament reconstruction. Int Orthop 37:193–199. doi:10.1007/s00264-012-1718-z

    Article  PubMed  PubMed Central  Google Scholar 

  28. Camanho GL, Bitar AC, Hernandez AJ, Olivi R. Medial patellofemoral ligament reconstruction: a novel technique using the patellar ligament. Arthroscopy;23:108.e1-4

  29. Witoński D, Kęska R, Synder M, Sibiński M (2013) An isolated medial patellofemoral ligament reconstruction with patellar tendon autograft. Biomed Res Int 2013:637678

  30. Angelini FJ, Helito CP, Tozi MR et al (2013) Combined reconstruction of the anterior cruciate ligament and posterolateral corner with a single femoral tunnel. Arthrosc Tech 2:e285–e288

    Article  PubMed  PubMed Central  Google Scholar 

  31. Wahl CJ, Nicandri G (2008) Single-Achilles allograft posterior cruciate ligament and medial collateral ligament reconstruction: a technique to avoid osseous tunnel intersection, improve construct stiffness, and save on allograft utilization. Arthroscopy 24:486–489

    Article  PubMed  Google Scholar 

  32. Zaffagnini S, Marcheggiani Muccioli GM, Marcacci M (2011) Combined posterior cruciate ligament and superficial medial collateral ligament reconstruction using hamstrings autograft: technical note with a case report. Musculoskelet Surg 95:135–139

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

The authors declare that they have no conflicts of interest.

Author information

Authors and Affiliations

  1. University of São Paulo, São Paulo, Brazil

    Camilo Partezani Helito, Marcelo Batista Bonadio, Riccardo Gomes Gobbi, Roberto Freire da Mota e Albuquerque, José Ricardo Pécora, Gilberto Luis Camanho & Marco Kawamura Demange

Authors
  1. Camilo Partezani Helito
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marcelo Batista Bonadio
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Riccardo Gomes Gobbi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Roberto Freire da Mota e Albuquerque
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. José Ricardo Pécora
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Gilberto Luis Camanho
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Marco Kawamura Demange
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Camilo Partezani Helito.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Helito, C.P., Bonadio, M.B., Gobbi, R.G. et al. Is it safe to reconstruct the knee Anterolateral Ligament with a femoral tunnel? Frequency of Lateral Collateral Ligament and Popliteus Tendon injury. International Orthopaedics (SICOT) 40, 821–825 (2016). https://doi.org/10.1007/s00264-015-2888-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-015-2888-2

Keywords

Search

Navigation