Skip to main content

Advertisement

Log in

The role of the anterolateral ligament in knee’s biomechanics: a case–control retrospective study

  • Original Article
  • Published:
European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

The aim of this study was to assess the functional and clinical results of patients who underwent ACL reconstruction surgery and were divided into subpopulations related to ACL-associated lesions and focused on ALL-associated lesion.

Methods

Our retrospective analysis included 62 patients who underwent standard ACL reconstruction surgery in our hospital from 2014 to 2016. The mean follow-up period was 21 months (range 11–35). We divided the sample into two subpopulations due to the presence or absence of ALL tear at the preoperative MRI. In 42 patients out of 62 (68%), ALL lesion was evident. We evaluated in both subpopulations the ACL failure rate, the functional outcomes rated with IKDC, KOOS, Lysholm scores and the clinical assessment of anteroposterior and rotatory instability with the Lachman test and pivot-shift test.

Results

The overall re-injury rate in our cohort of patients was 4.8% with a smaller but not a significant difference between the two groups. A statistically significant difference was observed for the three functional scores, favoring the isolated ACL-lesion group (p < 0.05). Similarly, a better Lachman score was observed in the isolated ACL-lesion group, without statistical significance (p = 0.77); overall, the rate of positive test was lower in the isolated ACL-lesion group. We observed a significant difference of residual rotatory instability (positive pivot-shift test) in the two subpopulations (p = 0.036), and 9% of patients in the ACL + ALL lesion group showed residual jerk or subluxation.

Conclusion

The additional ALL reconstruction/repair surgery should always be considered in patients with evident ALL tear at the preoperative MRI.

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

Access this article

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

Instant access to the full article PDF.

Fig.1

Similar content being viewed by others

References

  1. Amis AA, Scammell BE (1993) Biomechanics of intra-articular and extraarticular reconstruction of the anterior cruciate ligament. J Bone Joint Surg Br 75(5):812–817

    Article  CAS  Google Scholar 

  2. Bellier G, Christel P, Colombet P et al (2004) Double-stranded hamstring graft for the anterior cruciate ligament reconstruction. Arthroscopy 20:890–894

    Article  Google Scholar 

  3. Biau DJ, Tournoux C, Katsahian S et al (2007) ACL reconstruction: a meta-analysis of functional scores. Clin Orthop Relate Res 458:180–187

    Google Scholar 

  4. Brockmeyer M (2019) Editorial commentary: ligamentous hyperlaxity: a decisive factor for the indication of a combined anterior cruciate ligament and anterolateral ligament reconstruction? Arthroscopy 35(9):2655–2657

    Article  Google Scholar 

  5. Caterine S, Litchfield R, Johnson M, Chronik B, Getgood A (2015) A cadaveric study of the anterolateral ligament: re-introducing the lateral capsular ligament. Knee Surg Sports Traumatol Arthrosc 23(11):3186–3195

    Article  Google Scholar 

  6. Claes S, Bartholomeeusen S, Bellemans J (2014) High prevalence of antero-lateral ligament abnormalities in magnetic resonance images of anterior cruciate ligament-injured knees. Acta Orthop Belg 80(1):45–49

    PubMed  Google Scholar 

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

    Article  Google Scholar 

  8. Chambat P, Vargas R, Fayard JM, Lemaire B, Sonnery-Cottet B (2008) Résultat des reconstructions du ligament croisé antérieur sous contrôle arthroscopique avec un recul supérieur à 15 ans. In: Chambat P, Neyret P (éd) Le genou et le sport du ligament à la prothèse. Sauramps Médical, pp 147–152

  9. Chouliaras V, Ristanis S, Moraiti C et al (2007) Effectiveness of reconstruction of the anterior cruciate ligament with quadrupled hamstrings and bone-patellar tendon-bone autografts. An in vivo study comparing tibial internal-external rotation. Am J Sports Med 35:189–196

    Article  Google Scholar 

  10. DeLee JC, Riley MB, JrR RCA (1983) Acute posterolateral rotatory instability of the knee. Am J Sports Med 11:199–207

    Article  CAS  Google Scholar 

  11. George MS, Dunn WR, Spindler KP (2006) Current concepts review: revision anterior cruciate ligament reconstruction. Am J Sports Med 34:2026–2037

    Article  Google Scholar 

  12. Gillquist J, Messner K (1999) Anterior cruciate ligament reconstruction and the long-term incidence of gonarthrosis. Sports Med 27:143–156

    Article  CAS  Google Scholar 

  13. Hartigan DE, Carroll KW, Kosarek FJ, Piasecki DP, Fleischli JF, D'Alessandro DF (2016) Visibility of Anterolateral Ligament Tears in Anterior Cruciate Ligament-Deficient Knees With Standard 1.5-Tesla Magnetic Resonance Imaging. Arthroscopy 32(10) 2061–2065

  14. Helito CP, Bonadio MB, Rozas JS, Wey JMP, Pereira CAM, Cardoso TP, Pécora JR, Camanho GL, Kawamura DM (2016) Biomechanical study of strength and stiffness of the knee anterolateral ligament. BMC Musculoskeletal Disorders 30(17):193

    Article  Google Scholar 

  15. Helito CP, Demange MK, Bonadio MB, Tirico LEP, Gobbi RG, Pecora JR et al (2013) Anatomy and histology of the knee anterolateral ligament. Orthop J Sports Med 1(7):1–5

    Article  Google Scholar 

  16. Helito CP, Helito PVP, Costa HP, -Rodrigues M, Pecora JR, Camanho GL et al (2014) MRI evaluation of the anterolateral ligament of the knee: assessment in routine 1.5-T scans. Skeletal Radiol 43:1421–1427

    Article  Google Scholar 

  17. Hettrich CM, Dunn WR, Reinke EK, Spindler KP (2013) The rate of subsequent surgery and predictors after anterior cruciate ligament reconstruction: two- and 6-year follow-up results from a multicenter cohort. Am J Sports Med 41(7):1534–1540

    Article  Google Scholar 

  18. Hughston JC, Andrews JR, Cross MJ et al (1976) Classification of knee ligament instabilities. Part II. The lateral compartment. J Bone Joint Surg Am 58:173–179

    Article  CAS  Google Scholar 

  19. Inderhaug E, Stephen JM, Williams A, Amis AA (2017) Anterolateral tenodesis or anterolateral ligament complex reconstruction: effect of flexion angle at graft fixation when combined with ACL reconstruction. Am J Sports Med 45(13):3089–3097

    Article  Google Scholar 

  20. Inderhaug E, Stephen JM, Williams A, Amis AA (2017) Biomechanical comparison of anterolateral procedures combined with anterior cruciate ligament reconstruction. Am J Sports Med 45(2):347–354

    Article  Google Scholar 

  21. Ishibashi Y, Tsuda E, Fukuda A et al (2008) Intraoperative biomechanical evaluation of anatomic anterior cruciate ligament reconstruction using a navigation system. Comparison of hamstring tendon and bone-patellar tendon-bone graft. Am J Sports Med 36:1903–1912

    Article  Google Scholar 

  22. Kennedy MI, Claes S, Fuso FA, Williams BT, Goldsmith MT, Turnbull TL, Wijdicks CA, LaPrade RF (2015) The anterolateral ligament: an anatomic, radiographic, and biomechanical analysis. Am J Sports Med. 43(7):1606–1615

    Article  Google Scholar 

  23. Kocher MS, Steadman JR, Briggs KK et al (2004) Relationships between objective assessment of ligament stability and subjective assessment of symptoms and function after anterior cruciate ligament reconstruction. Am J Sports Med 32:629–634

    Article  Google Scholar 

  24. LaPrade RF, Gilbert TJ, Bollom TS, Wentorf F, Chaljub G (2000) The magnetic resonance imaging appearance of individual structures of the posterolateral knee. A prospective study of normal knees and knees with surgically verified grade III injuries. Am J Sports Med 28:191–199

    Article  CAS  Google Scholar 

  25. Mohtadi NG, Chan DS, Dainty KN, Whelan DB (2011) Patellar tendon versus hamstring tendon autograft for anterior cruciate ligament rupture in adults. Cochrane Database Syst Rev 7(9):CD005960

    Google Scholar 

  26. Monaco E, Ferretti A, Labianca L, Maestri B, Speranza A, Kelly MJ, D’Arrigo C (2012) Navigated knee kinematics after cutting of the ACL and its secondary restraint. Knee Surg Sports Traumatol Arthrosc 20(5):870–877

    Article  CAS  Google Scholar 

  27. Monaco E, Labianca L, Conteduca F, De Carli A, Ferretti A (2007) Double bundle or single bundle plus extraarticular tenodesis in ACL reconstruction? A CAOS study. Knee Surg Sports Traumatol Arthrosc 15(10):1168–1174

    Article  CAS  Google Scholar 

  28. Monaco E, Maestri B, Labianca L et al (2010) Navigated knee kinematics after tear of the ACL and its secondary restraints: preliminary results. Orthopedics 33(10 suppl):87–93

    Article  Google Scholar 

  29. Sonnery-Cottet B, Hager JP, Fournier Y, Chambat P (2008) Reconstruction double faisceau du ligament croise´ anterieur par tendons de la patte d’oie. In: Chambat P, Neyret P, (ed). Le genou et le sport du ligament a` la prothe`se. Sauramps Me´dical, pp 105–111.

  30. -Cottet B, Daggett M, Fayard JM, Ferretti A, Helito CP, Lind M, Monaco E, de Pádua VBC, Thaunat M, Wilson A, Zaffagnini S, Zijl J, Claes S (2017) Anterolateral Ligament Expert Group consensus paper on the management of internal rotation and instability of the anterior cruciate ligament - deficient knee. J Orthop Traumatol 18(2):91–106

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Enrico Ferranti Calderoni.

Ethics declarations

Conflict of interest

The author(s) declare that they have no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Castelli, A., Zanon, G., Jannelli, E. et al. The role of the anterolateral ligament in knee’s biomechanics: a case–control retrospective study. Eur J Orthop Surg Traumatol 30, 653–658 (2020). https://doi.org/10.1007/s00590-019-02607-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00590-019-02607-z

Navigation