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Anterolateral Complex Reconstruction in the Multiple-Ligament Injured Knee

  • Ryan Wood
  • Robert Litchfield
  • Alan GetgoodEmail author
Chapter

Abstract

Structures within the anterolateral complex of the knee contribute, along with the ACL, towards rotational stability of the knee. Historically, extra-articular procedures were recognised to correct the pivot shift in the anterior cruciate ligament-deficient knee. A renaissance in the understanding of the anatomy of this region has lead to the development of additional techniques to reconstruct structures in the anterolateral complex. Biomechanical studies have shown that these techniques, in addition to anterior cruciate ligament reconstruction, can improve joint kinematics in the face of persistent rotatory laxity. Application of these techniques to the multiple-ligament injured knee depends on a number of factors, but clinical examination, the exact pattern of injury and surgical expertise remain the most important. Anterolateral complex reconstruction is rarely indicated in more severe injuries and should be reserved for specific cases.

Keywords

Knee Dislocation Ligament Anterior cruciate ligament ACL Anterolateral complex Anterolateral ligament Iliotibial band Rotatory laxity Pivot shift 

Abbreviations

ACL

Anterior cruciate ligament

ACLR

Anterior cruciate ligament reconstruction

ALC

Anterolateral corner

ALL

Anterolateral ligament

ALLR

Anterolateral ligament reconstruction

ALRI

Anterolateral rotatory instability

AMC

Anteromedial complex

BPTB

Bone–patellar tendon–bone

FCL

Fibular collateral ligament

MCL

Medial collateral ligament

MLIK

Multiple-ligament injured knee

PCL

Posterior cruciate ligament

PLC

Posterolateral corner

PMC

Posteromedial corner

Notes

Conflicts of Interest and Source of Funding

AG receives research funding from ISAKOS and Smith and Nephew Inc.

References

  1. 1.
    Rc S. A baker’s dozen of knee dislocations. Am J Knee Surg. 1994;7:117–24.Google Scholar
  2. 2.
    Galway HR, MacIntosh DL. The lateral pivot shift: a symptom and sign of anterior cruciate ligament insufficiency. Clin Orthop Relat Res. 1980;147:45–50.Google Scholar
  3. 3.
    Ellison AE. The pathogenesis and treatment of anterolateral rotatory instability. Clin Orthop Relat Res. 1980;147:51–5.Google Scholar
  4. 4.
    Seebacher JR, Inglis AE, Marshall JL, Warren RF. The structure of the posterolateral aspect of the knee. J Bone Joint Surg Am. 1982;64(4):536–41.CrossRefGoogle Scholar
  5. 5.
    Gerdy P. Trosiere monographie maladies des organs du movement os muscles. Paris: chez Victor Masson; 1855.Google Scholar
  6. 6.
    Terry GC, Hughston JC, Norwood LA. The anatomy of the iliopatellar band and iliotibial tract. Am J Sports Med. 1986;14(1):39–45.CrossRefGoogle Scholar
  7. 7.
    Vieira EL, Vieira EA, da Silva RT, Berlfein PA, Abdalla RJ, Cohen M. An anatomic study of the iliotibial tract. Arthroscopy. 2007;23(3):269–74.CrossRefGoogle Scholar
  8. 8.
    Godin JA, Chahla J, Moatshe G, Kruckeberg BM, Muckenhirn KJ, Vap AR, et al. A comprehensive reanalysis of the distal iliotibial band: quantitative anatomy, radiographic markers, and biomechanical properties. Am J Sports Med. 2017;45(11):2595–603.CrossRefGoogle Scholar
  9. 9.
    Lobenhoffer P, Posel P, Witt S, Piehler J, Wirth CJ. Distal femoral fixation of the iliotibial tract. Arch Orthop Trauma Surg. 1987;106(5):285–90.CrossRefGoogle Scholar
  10. 10.
    Müller W. Functional anatomy and clinical findings of the knee joint. Helv Chir Acta. 1984;51(5):505–14.PubMedGoogle Scholar
  11. 11.
    Claes S, Vereecke E, Maes M, Victor J, Verdonk P, Bellemans J. Anatomy of the anterolateral ligament of the knee. J Anat. 2013;223(4):321–8.CrossRefGoogle Scholar
  12. 12.
    Segond P. Paris 1879.Google Scholar
  13. 13.
    Hughston JC, Andrews JR, Cross MJ, Moschi A. Classification of knee ligament instabilities. Part II. The lateral compartment. J Bone Joint Surg Am. 1976;58(2):173–9.CrossRefGoogle Scholar
  14. 14.
    Johnson LL. Lateral capsualr ligament complex: anatomical and surgical considerations. Am J Sports Med. 1979;7(3):156–60.CrossRefGoogle Scholar
  15. 15.
    Campos JC, Chung CB, Lektrakul N, Pedowitz R, Trudell D, Yu J, et al. Pathogenesis of the Segond fracture: anatomic and MR imaging evidence of an iliotibial tract or anterior oblique band avulsion. Radiology. 2001;219(2):381–6.CrossRefGoogle Scholar
  16. 16.
    Musahl V, Herbst E, Burnham JM, Fu FH. The anterolateral complex and anterolateral ligament of the knee. J Am Acad Orthop Surg. 2018;26(8):261–7.CrossRefGoogle Scholar
  17. 17.
    Kennedy MI, Claes S, Fuso FA, Williams BT, Goldsmith MT, Turnbull TL, et al. The anterolateral ligament: an anatomic, radiographic, and biomechanical analysis. Am J Sports Med. 2015;43(7):1606–15.CrossRefGoogle Scholar
  18. 18.
    LaPrade RF, Ly TV, Wentorf FA, Engebretsen L. The posterolateral attachments of the knee: a qualitative and quantitative morphologic analysis of the fibular collateral ligament, popliteus tendon, popliteofibular ligament, and lateral gastrocnemius tendon. Am J Sports Med. 2003;31(6):854–60.CrossRefGoogle Scholar
  19. 19.
    Song YB, Watanabe K, Hogan E, D’Antoni AV, Dilandro AC, Apaydin N, et al. The fibular collateral ligament of the knee: a detailed review. Clin Anat. 2014;27(5):789–97.CrossRefGoogle Scholar
  20. 20.
    Spencer L, Burkhart TA, Tran MN, Rezansoff AJ, Deo S, Caterine S, et al. Biomechanical analysis of simulated clinical testing and reconstruction of the anterolateral ligament of the knee. Am J Sports Med. 2015;43(9):2189–97.CrossRefGoogle Scholar
  21. 21.
    Sonnery-Cottet B, Lutz C, Daggett M, Dalmay F, Freychet B, Niglis L, et al. The involvement of the anterolateral ligament in rotational control of the knee. Am J Sports Med. 2016;44(5):1209–14.CrossRefGoogle Scholar
  22. 22.
    Magnussen RA, Reinke EK, Huston LJ, Hewett TE, Spindler KP, Group M. Factors associated with high-grade lachman, pivot shift, and anterior drawer at the time of anterior cruciate ligament reconstruction. Arthroscopy. 2016;32(6):1080–5.CrossRefGoogle Scholar
  23. 23.
    Musahl V, Rahnemai-Azar AA, Costello J, Arner JW, Fu FH, Hoshino Y, et al. The influence of meniscal and anterolateral capsular injury on knee laxity in patients with anterior cruciate ligament injuries. Am J Sports Med. 2016;44(12):3126–31.CrossRefGoogle Scholar
  24. 24.
    Parsons EM, Gee AO, Charles Spiekerman C, Cavanagh PR. The biomechanical function of the anterolateral ligament of the knee. Am J Sports Med. 2015;43(3):669–74.CrossRefGoogle Scholar
  25. 25.
    Rasmussen MT, Nitri M, Williams BT, Moulton SG, Cruz RS, Dornan GJ, et al. An in vitro robotic assessment of the anterolateral ligament, part 1: secondary role of the anterolateral ligament in the setting of an anterior cruciate ligament injury. Am J Sports Med. 2016;44(3):585–92.CrossRefGoogle Scholar
  26. 26.
    Geeslin AG, Moatshe G, Chahla J, Kruckeberg BM, Muckenhirn KJ, Dornan GJ, et al. Anterolateral knee extra-articular stabilizers: a robotic study comparing anterolateral ligament reconstruction and modified lemaire lateral extra-articular tenodesis. Am J Sports Med. 2017:363546517745268.Google Scholar
  27. 27.
    Terry GC, Norwood LA, Hughston JC, Caldwell KM. How iliotibial tract injuries of the knee combine with acute anterior cruciate ligament tears to influence abnormal anterior tibial displacement. Am J Sports Med. 1993;21(1):55–60.CrossRefGoogle Scholar
  28. 28.
    Yamamoto Y, Hsu WH, Fisk JA, Van Scyoc AH, Miura K, Woo SL. Effect of the iliotibial band on knee biomechanics during a simulated pivot shift test. J Orthop Res. 2006;24(5):967–73.CrossRefGoogle Scholar
  29. 29.
    Lemaire M. Chronic knee instability. Technics and results of ligament plasty in sports injuries. J Chir (Paris). 1975;110(4):281–94.Google Scholar
  30. 30.
    MacIntosh D. Lateral substitution reconstruction. J Bone Joint Surg Br. 1976;58B(1):142.Google Scholar
  31. 31.
    Ellison AE. Distal iliotibial-band transfer for anterolateral rotatory instability of the knee. J Bone Joint Surg Am. 1979;61(3):330–7.CrossRefGoogle Scholar
  32. 32.
    Christel P, Djian P. Anterio-lateral extra-articular tenodesis of the knee using a short strip of fascia lata. Rev Chir Orthop Reparatrice Appar Mot. 2002;88(5):508–13.PubMedGoogle Scholar
  33. 33.
    DePhillipo NN, Cinque ME, Chahla J, Geeslin AG, LaPrade RF. Anterolateral ligament reconstruction techniques, biomechanics, and clinical outcomes: a systematic review. Arthroscopy. 2017;33(8):1575–83.CrossRefGoogle Scholar
  34. 34.
    MeC Ferreira, Zidan FF, Miduati FB, Fortuna CC, Mizutani BM, Abdalla RJ. Reconstruction of anterior cruciate ligament and anterolateral ligament using interlinked hamstrings—technical note. Rev Bras Ortop. 2016;51(4):466–70.CrossRefGoogle Scholar
  35. 35.
    Sonnery-Cottet B, Barbosa NC, Tuteja S, Daggett M, Kajetanek C, Thaunat M. Minimally invasive anterolateral ligament reconstruction in the setting of anterior cruciate ligament injury. Arthrosc Tech. 2016;5(1):e211–5.CrossRefGoogle Scholar
  36. 36.
    Helito CP, Bonadio MB, Gobbi RG, da Mota E, Albuquerque RF, Pécora JR, Camanho GL, et al. Combined intra- and extra-articular reconstruction of the anterior cruciate ligament: the reconstruction of the knee anterolateral ligament. Arthrosc Tech. 2015;4(3):e239–44.CrossRefGoogle Scholar
  37. 37.
    Smith JO, Yasen SK, Lord B, Wilson AJ. Combined anterolateral ligament and anatomic anterior cruciate ligament reconstruction of the knee. Knee Surg Sports Traumatol Arthrosc. 2015;23(11):3151–6.CrossRefGoogle Scholar
  38. 38.
    Wagih AM, Elguindy AM. Percutaneous reconstruction of the anterolateral ligament of the knee with a polyester tape. Arthrosc Tech. 2016;5(4):e691–7.CrossRefGoogle Scholar
  39. 39.
    Inderhaug E, Stephen JM, Williams A, Amis AA. Biomechanical comparison of anterolateral procedures combined with anterior cruciate ligament reconstruction. Am J Sports Med. 2017;45(2):347–54.CrossRefGoogle Scholar
  40. 40.
    Chahla J, Menge TJ, Mitchell JJ, Dean CS, LaPrade RF. Anterolateral ligament reconstruction technique: an anatomic-based approach. Arthrosc Tech. 2016;5(3):e453–7.CrossRefGoogle Scholar
  41. 41.
    Weber AE, Zuke W, Mayer EN, Forsythe B, Getgood A, Verma NN, et al. Lateral augmentation procedures in anterior cruciate ligament reconstruction: anatomic, biomechanical, imaging, and clinical evidence. Am J Sports Med. 2018:363546517751140.Google Scholar
  42. 42.
    Hewison CE, Tran MN, Kaniki N, Remtulla A, Bryant D, Getgood AM. Lateral extra-articular tenodesis reduces rotational laxity when combined with anterior cruciate ligament reconstruction: a systematic review of the literature. Arthroscopy. 2015;31(10):2022–34.CrossRefGoogle Scholar
  43. 43.
    Song GY, Hong L, Zhang H, Zhang J, Li Y, Feng H. Clinical outcomes of combined lateral extra-articular tenodesis and intra-articular anterior cruciate ligament reconstruction in addressing high-grade pivot-shift phenomenon. Arthroscopy. 2016;32(5):898–905.CrossRefGoogle Scholar
  44. 44.
    Rezende FC, de Moraes VY, Martimbianco AL, Luzo MV, da Silveira Franciozi CE, Belloti JC. Does combined intra- and extraarticular ACL reconstruction improve function and stability? A Meta-analysis. Clin Orthop Relat Res. 2015;473(8):2609–18.CrossRefGoogle Scholar
  45. 45.
    Devitt BM, Bell SW, Ardern CL, Hartwig T, Porter TJ, Feller JA, et al. The role of lateral extra-articular tenodesis in primary anterior cruciate ligament reconstruction: a systematic review with meta-analysis and best-evidence synthesis. Orthop J Sports Med. 2017;5(10):2325967117731767.CrossRefGoogle Scholar
  46. 46.
    Sonnery-Cottet B, Thaunat M, Freychet B, Pupim BH, Murphy CG, Claes S. Outcome of a combined anterior cruciate ligament and anterolateral ligament reconstruction technique with a minimum 2-year follow-up. Am J Sports Med. 2015;43(7):1598–605.CrossRefGoogle Scholar
  47. 47.
    Zhang Y, Xu C, Dong S, Shen P, Su W, Zhao J. Systemic review of anatomic single-versus double-bundle anterior cruciate ligament reconstruction: does femoral tunnel drilling technique matter? Arthroscopy. 2016;32(9):1887–904.CrossRefGoogle Scholar
  48. 48.
    Sonnery-Cottet B, Saithna A, Cavalier M, Kajetanek C, Temponi EF, Daggett M, et al. anterolateral ligament reconstruction is associated with significantly reduced ACL graft rupture rates at a minimum follow-up of 2 years: a prospective comparative study of 502 patients from the SANTI study group. Am J Sports Med. 2017;45(7):1547–57.CrossRefGoogle Scholar
  49. 49.
    Musahl V, Rahnemai-Azar AA, Costello J, Arner JW, Fu FH, Hoshino Y, et al. The influence of meniscal and anterolateral capsular injury on knee laxity in patients with anterior cruciate ligament injuries. Am J Sports Med. 2016;44(12):3126–31.CrossRefGoogle Scholar
  50. 50.
    Sonnery-Cottet B, Daggett M, Fayard JM, Ferretti A, Helito CP, Lind M, et al. Anterolateral ligament expert group consensus paper on the management of internal rotation and instability of the anterior cruciate ligament—deficient knee. J Orthop Traumatol. 2017;18(2):91–106.CrossRefGoogle Scholar
  51. 51.
    Shybut TB, Vega CE, Haddad J, Alexander JW, Gold JE, Noble PC, et al. Effect of lateral meniscal root tear on the stability of the anterior cruciate ligament-deficient knee. Am J Sports Med. 2015;43(4):905–11.CrossRefGoogle Scholar
  52. 52.
    Magnussen RA, Reinke EK, Huston LJ, Hewett TE, Spindler KP. Factors associated with high-grade lachman, pivot shift, and anterior drawer at the time of anterior cruciate ligament reconstruction. Arthroscopy. 2016;32(6):1080–5.CrossRefGoogle Scholar
  53. 53.
    Serra Cruz R, Mitchell JJ, Dean CS, Chahla J, Moatshe G, LaPrade RF. Anatomic posterolateral corner reconstruction. Arthrosc Tech. 2016;5(3):e563–72.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.The Fowler Kennedy Sport Medicine ClinicUniversity of Western OntarioLondonCanada
  2. 2.Orthopaedic Surgery, the Fowler Kennedy Sport Medicine ClinicUniversity of Western OntarioLondonCanada
  3. 3.Complex Knee Reconstruction, Orthopaedic Surgery, the Fowler Kennedy Sport Medicine ClinicUniversity of Western OntarioLondonCanada

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