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Editorial Commentary| Volume 35, ISSUE 5, P1614-1617, May 2019

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Editorial Commentary: Magnetic Resonance Imaging of the Knee Anterolateral Ligament: Does It Really Matter?

DOI:https://doi.org/10.1016/j.arthro.2019.02.015
Editorial Commentary: Magnetic Resonance Imaging of the Knee Anterolateral Ligament: Does It Really Matter?
Previous ArticleIdentification of Normal and Injured Anterolateral Ligaments of the Knee: A Systematic Review of Magnetic Resonance Imaging Studies
Next ArticleSystematic Review of Medial Patellofemoral Ligament Reconstruction Techniques: Comparison of Patellar Bone Socket and Cortical Surface Fixation Techniques

      Abstract

      Great interest remains in the structures of the knee anterolateral complex and how they work synergistically with the anterior cruciate ligament to control anterolateral rotatory laxity. Many studies have now used magnetic resonance imaging to assess the degree of damage to the anterolateral ligament. The systematic review described in this commentary rigorously highlights the many deficiencies that exist within our current understanding of the imaging analysis of these structures. Marked variability in the definition of anterolateral ligament injury, significant methodological differences, and the lack of a gold standard reference make it very challenging to translate the findings of these imaging studies into clinical practice. More information is required to fully understand the injury pattern, and then clinical studies are needed to guide treatment. Hopefully we will then have the ability to better treat our patients with these challenging complex laxity patterns that exist over and above an isolated anterior cruciate ligament injury.
      There is no doubt that the greatest controversy in the past 5 years in regard to anterior cruciate ligament (ACL) treatment has been the introduction of the anterolateral ligament (ALL) as being an important secondary stabilizer of anterolateral rotation and hence control of the pivot shift. The anatomic study by Claes et al.
      • Claes S.
      • Vereecke E.
      • Maes M.
      • Victor J.
      • Verdonk P.
      • Bellemans J.
      Anatomy of the anterolateral ligament of the knee.
      J Anatomy. 2013; 223: 321-328
      in 2013 has had a dramatic impact on how we, as clinicians and researchers, think about the ACL-deficient knee and how best to treat it.
      However, there have been multiple opinions as to the significance of this structure, with many articles supporting its presence,
      • Caterine S.
      • Litchfield R.
      • Johnson M.
      • Chronik B.
      • Getgood A.
      A cadaveric study of the anterolateral ligament: Re-introducing the lateral capsular ligament.
      Knee Surg Sports Traumatol Arthrosc. 2015; 23: 3186-3195
      , 
      • Daggett M.
      • Busch K.
      • Sonnery-Cottet B.
      Surgical dissection of the anterolateral ligament.
      Arthrosc Tech. 2016; 5: e185-e188
      , 
      • Dodds A.L.
      • Halewood C.
      • Gupte C.M.
      • Williams A.
      • Amis A.A.
      The anterolateral ligament: Anatomy, length changes and association with the Segond fracture.
      Bone Joint J. 2014; 96-B: 325-331
      , 
      • Helito C.P.
      • do Prado Torres J.A.
      • Bonadio M.B.
      • et al.
      Anterolateral ligament of the fetal knee: An anatomic and histological study.
      Am J Sports Med. 2017; 45: 91-96
      , 
      • Kennedy M.I.
      • Claes S.
      • Fuso F.A.
      • et al.
      The anterolateral ligament: An anatomic, radiographic, and biomechanical analysis.
      Am J Sports Med. 2015; 43: 1606-1615
      some refuting,
      • Herbst E.
      • Albers M.
      • Burnham J.M.
      • et al.
      The anterolateral complex of the knee: A pictorial essay.
      Knee Surg Sports Traumatol Arthrosc. 2017; 25: 1009-1014
      , 
      • Musahl V.
      • Rahnemai-Azar A.A.
      • van Eck C.F.
      • Guenther D.
      • Fu F.H.
      Anterolateral ligament of the knee, fact or fiction?.
      Knee Surg Sports Traumatol Arthrosc. 2016; 24: 2-3
      others determining its importance in knee kinematics,
      • Monaco E.
      • Fabbri M.
      • Mazza D.
      • et al.
      The effect of sequential tearing of the anterior cruciate and anterolateral ligament on anterior translation and the pivot-shift phenomenon: A cadaveric study using navigation.
      Arthroscopy. 2018; 34: 1009-1014
      , 
      • Monaco E.
      • Ferretti A.
      • Labianca L.
      • et al.
      Navigated knee kinematics after cutting of the ACL and its secondary restraint.
      Knee Surg Sports Traumatol Arthrosc. 2012; 20: 870-877
      , 
      • Imbert P.
      • Lutz C.
      • Daggett M.
      • et al.
      Isometric characteristics of the anterolateral ligament of the knee: A cadaveric navigation study.
      Arthroscopy. 2016; 32: 2017-2024
      , 
      • Sonnery-Cottet B.
      • Lutz C.
      • Daggett M.
      • et al.
      The involvement of the anterolateral ligament in rotational control of the knee.
      Am J Sports Med. 2016; 44: 1209-1214
      and many suggesting it having a lesser role.
      • Geeslin A.G.
      • Chahla J.
      • Moatshe G.
      • et al.
      Anterolateral knee extra-articular stabilizers: A robotic sectioning study of the anterolateral ligament and distal iliotibial band Kaplan fibers.
      Am J Sports Med. 2018; 46: 1352-1361
      , 
      • Guenther D.
      • Rahnemai-Azar A.A.
      • Bell K.M.
      • et al.
      The anterolateral capsule of the knee behaves like a sheet of fibrous tissue.
      Am J Sports Med. 2017; 45: 849-855
      , 
      • Kittl C.
      • El-Daou H.
      • Athwal K.K.
      • et al.
      The role of the anterolateral structures and the ACL in controlling laxity of the intact and ACL-deficient knee.
      Am J Sports Med. 2016; 44: 345-354
      , 
      • Spencer L.
      • Burkhart T.A.
      • Tran M.N.
      • et al.
      Biomechanical analysis of simulated clinical testing and reconstruction of the anterolateral ligament of the knee.
      Am J Sports Med. 2015; 43: 2189-2197
      This has led to significant confusion in the literature and hence spurred the creation of a consensus paper from a group of clinician researchers who are prominent in this field.
      • Getgood A.
      • Brown C.
      • Lording T.
      • et al.
      for the ALC Consensus Group
      The anterolateral complex of the knee: Results from the International ALC Consensus Group Meeting.
      Knee Surg Sports Traumatol Arthrosc. 2018; https://doi.org/10.1007/s00167-018-5072-6
      Importantly, following much debate and detailed review of historical papers, we were able to better define the nomenclature used to describe the structures within the anterolateral complex (ALC). These include
      • 1.
        Superficial iliotibial (IT) band and iliopatellar band
      • 2.
        Deep IT band incorporating the
        • •
          Kaplan fiber system
        • •
          Proximal and distal supracondylar attachments
        • •
          Retrograde (Condylar) attachment continuous with the capsule-osseous layer (COL) of the IT band
      • 3.
        ALL and capsule
      Importantly, we concluded that the ALL did exist from an anatomical point of view, as part of Seebacher's layer 3 of the anterolateral capsule, as opposed to a distinct ligamentous structure like the fibular collateral ligament. But ultimately, when focusing on the sole structure of the ALL, as opposed to the complex of structures of the ALC, the most important question is, does this specific structure have any bearing on the ACL-injured knee, and if addressed clinically via repair or reconstruction, can we improve patient outcomes? Alternatively, is some sort of anterolateral procedure that addresses the whole complex a more relevant operation to address the complex injury pattern?
      LaPrade has described the hierarchy of translational studies, starting from the anatomy of the structure in mind, determining its role in knee kinematics, and establishing the best method to reconstruct it, followed by clinical studies to determine clinical outcome. Within those studies, it is vitally important to determine what the in vivo injury pattern is, as only then can the preclinical studies be translated appropriately. As such, multiple papers have now been published on magnetic resonance imaging (MRI) of the anterolateral side of the knee, in both the normal and ACL-injured states, mostly focusing on the identification of the ALL. With so many studies come many different methodologies, and hence the ability to synthesize the reported information is vital.
      I therefore wish to congratulate authors Andrade, Marques, Bastos, Zaffagnini, Seil, Ayeni, and Espregueira-Mendes
      • Andrade R.
      • Marques A.
      • Bastos R.
      • et al.
      Identification of normal and injured anterolateral ligaments of the knee: A systematic review of magnetic resonance imaging studies.
      Arthroscopy. 2019; 35: 1594-1613
      on their systematic review of the published literature of MRI identification of the ALL in ACL-intact and -deficient knees titled “Identification of Normal and Injured Anterolateral Ligaments of the Knee: A Systematic Review of Magnetic Resonance Imaging Studies.” In performing this review of 24 published studies, using a rigorous search methodology and assessment criteria, they have been able to highlight the many deficiencies within the current literature in terms of MRI identification of the ALL. It is clear that while there are many publications, the variability in methodology, lack of standardized MRI sequences, and lack of repeatability testing make the results somewhat challenging to clearly determine the pattern of ALL injury and hence translate into routine clinical practice.
      Differences in angles of knee flexion, extremely variable reliability rates (0.04-1.0 intraobserver; 0.14-1.0 interobserver), and marked heterogeneity of descriptions of ALL identification were reported. Some describe the ALL as being present only if all 3 sections (femoral, meniscal, and tibial) can be visualized, others suggesting visibility from origin to insertion and distinction from the lateral capsule or a linear low-signal-intensity band of fibrous tissue. This therefore goes some way toward explaining why a rate of identification in the range of 51% to 100% and a 11% to 98% rate of injury were reported in these studies.
      And here lies the major problem. There has been no reference standard to determine exactly what these imaging studies are looking at. Independent gross anatomic studies of the anterolateral side of the knee have struggled to form a clear consensus on the anatomical composition of this region, let alone MRI analysis. This is mainly because of the overlap in tissue planes of the structures in question, differences in nomenclature describing these structures, and the coexisting interpretations of historic literature, something that we hope in some way was addressed by the recent consensus paper.
      • Getgood A.
      • Brown C.
      • Lording T.
      • et al.
      for the ALC Consensus Group
      The anterolateral complex of the knee: Results from the International ALC Consensus Group Meeting.
      Knee Surg Sports Traumatol Arthrosc. 2018; https://doi.org/10.1007/s00167-018-5072-6
      So even with all of these studies, we are still left wondering what the key injury pattern of this structure is. Is it a clear isolated ALL injury in the proximal, mid, or distal substance? The Segond injury has been demonstrated to be less common. But even in these injuries, the involvement of the other structures, such as the COL of the IT band and anterior arm of the short head of the biceps cannot be excluded. Is the injury more proximal, involving both the ALL and the COL at its retrograde fiber insertion on the femur? Past clinical studies would show that this may be the case.
      • Ferretti A.
      • Monaco E.
      • Fabbri M.
      • Maestri B.
      • De Carli A.
      Prevalence and classification of injuries of anterolateral complex in acute anterior cruciate ligament tears.
      Arthroscopy. 2017; 33: 147-154
      And of course, depending upon the timing of the MRI, we may not see an injury at all. Similar to the fibular collateral ligament, a chronic injury may show normal signal from the tissue in question, yet a level of strain having occurred within the tissue that leads to pathological laxity may be determined on stress radiographs. And hence we may see variability in the ACL-deficient knee clinical examination, such as a higher-grade pivot shift, even when the MRI may be of relatively normal looking appearance anterolaterally.
      So where do we go from here? In my opinion, it is important to take a step back and examine what we know and what we don't.
      • 1.
        Based on anatomic and biomechanical studies, we know that different grades of laxity may be observed when structures of the ALC are sectioned in combination with the ACL.
        • Sonnery-Cottet B.
        • Lutz C.
        • Daggett M.
        • et al.
        The involvement of the anterolateral ligament in rotational control of the knee.
        Am J Sports Med. 2016; 44: 1209-1214
        , 
        • Geeslin A.G.
        • Chahla J.
        • Moatshe G.
        • et al.
        Anterolateral knee extra-articular stabilizers: A robotic sectioning study of the anterolateral ligament and distal iliotibial band Kaplan fibers.
        Am J Sports Med. 2018; 46: 1352-1361
        , 
        • Kittl C.
        • El-Daou H.
        • Athwal K.K.
        • et al.
        The role of the anterolateral structures and the ACL in controlling laxity of the intact and ACL-deficient knee.
        Am J Sports Med. 2016; 44: 345-354
        , 
        • Spencer L.
        • Burkhart T.A.
        • Tran M.N.
        • et al.
        Biomechanical analysis of simulated clinical testing and reconstruction of the anterolateral ligament of the knee.
        Am J Sports Med. 2015; 43: 2189-2197
        , 
        • Rasmussen M.T.
        • Nitri M.
        • Williams B.T.
        • 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: 585-592
      • 2.
        We know that there is variability in the laxity pattern of ACL-deficient knees,
        • Musahl V.
        • Rahnemai-Azar A.A.
        • Costello J.
        • 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: 3126-3131
        and this may be attributable to a number of pathological deficiencies including but not limited to
        • a.
          Meniscal deficiency
          • Musahl V.
          • Citak M.
          • O'Loughlin P.F.
          • Choi D.
          • Bedi A.
          • Pearle A.D.
          The effect of medial versus lateral meniscectomy on the stability of the anterior cruciate ligament-deficient knee.
          Am J Sports Med. 2010; 38: 1591-1597
        • b.
          Medial meniscus posteromedial meniscotibial ligament injury (ramp lesion)
          • Stephen J.M.
          • Halewood C.
          • Kittl C.
          • Bollen S.R.
          • Williams A.
          • Amis A.A.
          Posteromedial meniscocapsular lesions increase tibiofemoral joint laxity with anterior cruciate ligament deficiency, and their repair reduces laxity.
          Am J Sports Med. 2015; 44: 400-408
        • c.
          Lateral meniscus root tears
          • Lording T.
          • Corbo G.
          • Bryant D.
          • Burkhart T.A.
          • Getgood A.
          Rotational laxity control by the anterolateral ligament and the lateral meniscus is dependent on knee flexion angle: A cadaveric biomechanical study.
          Clin Orthop Relat Res. 2017; 475: 2401-2408
          , 
          • Shybut T.B.
          • Vega C.E.
          • Haddad J.
          • et al.
          Effect of lateral meniscal root tear on the stability of the anterior cruciate ligament-deficient knee.
          Am J Sports Med. 2015; 43: 905-911
        • d.
          Posterior tibial slope
          • Salmon L.J.
          • Heath E.
          • Akrawi H.
          • Roe J.P.
          • Linklater J.
          • Pinczewski L.A.
          20-year outcomes of anterior cruciate ligament reconstruction with hamstring tendon autograft: The catastrophic effect of age and posterior tibial slope.
          Am J Sports Med. 2018; 46: 531-543
        • e.
          Generalized ligamentous laxity
          • Larson C.M.
          • Bedi A.
          • Dietrich M.E.
          • et al.
          Generalized hypermobility, knee hyperextension, and outcomes after anterior cruciate ligament reconstruction: Prospective, case-control study with mean 6 years follow-up.
          Arthroscopy. 2017; 33: 1852-1858
        • f.
          ALC deficiency
          • Geeslin A.G.
          • Chahla J.
          • Moatshe G.
          • et al.
          Anterolateral knee extra-articular stabilizers: A robotic sectioning study of the anterolateral ligament and distal iliotibial band Kaplan fibers.
          Am J Sports Med. 2018; 46: 1352-1361
      • 3.
        It is clear from the literature that all ACL reconstructions do not perform optimally, with many patents still exhibiting rotatory laxity,
        • Mohtadi N.G.
        • Chan D.S.
        • Dainty K.N.
        • Whelan D.B.
        Patellar tendon versus hamstring tendon autograft for anterior cruciate ligament rupture in adults.
        Cochrane Database Syst Rev. 2011; : CD005960
        reduced rates of return to sport,
        • Ardern C.L.
        • Webster K.E.
        • Taylor N.F.
        • Feller J.A.
        Return to sport following anterior cruciate ligament reconstruction surgery: A systematic review and meta-analysis of the state of play.
        Br J Sports Med. 2011; 45: 596-606
        and high graft failure rates,
        • Webster K.E.
        • Feller J.A.
        Exploring the high reinjury rate in younger patients undergoing anterior cruciate ligament reconstruction.
        Am J Sports Med. 2016; 44: 2827-2832
        particularly in the younger age, high activity level population.
      • 4.
        We know that meta-analyses of past studies have shown that rotatory laxity may be improved by the addition of an anterolateral procedure, such as a lateral extra-articular tenodesis (LET).
        • Hewison C.E.
        • Tran M.N.
        • Kaniki N.
        • Remtulla A.
        • Bryant D.
        • Getgood A.M.
        Lateral extra-articular tenodesis reduces rotational laxity when combined with anterior cruciate ligament reconstruction: A systematic review of the iterature.
        Arthroscopy. 2015; 31: 2022-2034
        , 
        • Devitt B.M.
        • Bell S.W.
        • Ardern C.L.
        • 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 (2325967117731767)
      • 5.
        More recent studies have shown a reduction in graft failure
        • Sonnery-Cottet B.
        • Saithna A.
        • Cavalier 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: 1547-1557
        and improved meniscal repair rates
        • Sonnery-Cottet B.
        • Praz C.
        • Rosenstiel N.
        • et al.
        Epidemiological evaluation of meniscal ramp lesions in 3214 anterior cruciate ligament-injured knees from the SANTI Study Group database: A risk factor analysis and study of secondary meniscectomy rates following 769 ramp repairs.
        Am J Sports Med. 2018; 46: 3189-3197
        with the addition of an ALL reconstruction, another method of addressing ALC deficiency.
      • 6.
        It still remains to be shown in what population an anterolateral procedure is required, with imaging having not been shown to offer any significant benefit to diagnosis or prognosis of the ACL plus ALC-injured knee.
      It is therefore clear that we need much improved clinical data to inform best practices as to the decision of when to add an anterolateral procedure to ACL reconstruction. Many indications have been postulated, such as age, activity level, high-grade pivot shift, generalized ligamentous laxity, high tibial slope, and revision. However, no study has been able to determine which of these criteria hold the most prognostic value.
      Until this information is available, the diagnostic criteria likely should be refined, with attempts made to standardize the MRI sequences to best visualize the complex anatomy of the lateral side of the knee. However, one still must ask the question—does it really matter? Will MRI identification of ALL or ALC injury change clinical management? It is possible that the acute ACL injury, with associated ALC signal on MRI, still only requires a well-performed ACL reconstruction, as the extra-articular structures may have an opportunity to heal following knee stabilization. Equally, a chronic ACL injury with high-grade anterolateral laxity may by definition have ALC laxity and therefore should be addressed surgically to achieve optimal stability and patient outcomes. Only when appropriate clinical trials with adequate power are performed will we really get close to understanding this question. We hope that the results of our randomized trial of hamstring tendon autograft single-bundle ACL reconstruction with or without LET (stability study) will help guide future treatment. Stay tuned for spring 2019….

      Supplementary Data

      References

        • Claes S.
        • Vereecke E.
        • Maes M.
        • Victor J.
        • Verdonk P.
        • Bellemans J.
        Anatomy of the anterolateral ligament of the knee.
        J Anatomy. 2013; 223: 321-328
        View in Article
        • Caterine S.
        • Litchfield R.
        • Johnson M.
        • Chronik B.
        • Getgood A.
        A cadaveric study of the anterolateral ligament: Re-introducing the lateral capsular ligament.
        Knee Surg Sports Traumatol Arthrosc. 2015; 23: 3186-3195
        View in Article
        • Daggett M.
        • Busch K.
        • Sonnery-Cottet B.
        Surgical dissection of the anterolateral ligament.
        Arthrosc Tech. 2016; 5: e185-e188
        View in Article
        • Dodds A.L.
        • Halewood C.
        • Gupte C.M.
        • Williams A.
        • Amis A.A.
        The anterolateral ligament: Anatomy, length changes and association with the Segond fracture.
        Bone Joint J. 2014; 96-B: 325-331
        View in Article
        • Helito C.P.
        • do Prado Torres J.A.
        • Bonadio M.B.
        • et al.
        Anterolateral ligament of the fetal knee: An anatomic and histological study.
        Am J Sports Med. 2017; 45: 91-96
        View in Article
        • Kennedy M.I.
        • Claes S.
        • Fuso F.A.
        • et al.
        The anterolateral ligament: An anatomic, radiographic, and biomechanical analysis.
        Am J Sports Med. 2015; 43: 1606-1615
        View in Article
        • Herbst E.
        • Albers M.
        • Burnham J.M.
        • et al.
        The anterolateral complex of the knee: A pictorial essay.
        Knee Surg Sports Traumatol Arthrosc. 2017; 25: 1009-1014
        View in Article
        • Musahl V.
        • Rahnemai-Azar A.A.
        • van Eck C.F.
        • Guenther D.
        • Fu F.H.
        Anterolateral ligament of the knee, fact or fiction?.
        Knee Surg Sports Traumatol Arthrosc. 2016; 24: 2-3
        View in Article
        • Monaco E.
        • Fabbri M.
        • Mazza D.
        • et al.
        The effect of sequential tearing of the anterior cruciate and anterolateral ligament on anterior translation and the pivot-shift phenomenon: A cadaveric study using navigation.
        Arthroscopy. 2018; 34: 1009-1014
        View in Article
        • Monaco E.
        • Ferretti A.
        • Labianca L.
        • et al.
        Navigated knee kinematics after cutting of the ACL and its secondary restraint.
        Knee Surg Sports Traumatol Arthrosc. 2012; 20: 870-877
        View in Article
        • Imbert P.
        • Lutz C.
        • Daggett M.
        • et al.
        Isometric characteristics of the anterolateral ligament of the knee: A cadaveric navigation study.
        Arthroscopy. 2016; 32: 2017-2024
        View in Article
        • Sonnery-Cottet B.
        • Lutz C.
        • Daggett M.
        • et al.
        The involvement of the anterolateral ligament in rotational control of the knee.
        Am J Sports Med. 2016; 44: 1209-1214
        View in Article
        • Geeslin A.G.
        • Chahla J.
        • Moatshe G.
        • et al.
        Anterolateral knee extra-articular stabilizers: A robotic sectioning study of the anterolateral ligament and distal iliotibial band Kaplan fibers.
        Am J Sports Med. 2018; 46: 1352-1361
        View in Article
        • Guenther D.
        • Rahnemai-Azar A.A.
        • Bell K.M.
        • et al.
        The anterolateral capsule of the knee behaves like a sheet of fibrous tissue.
        Am J Sports Med. 2017; 45: 849-855
        View in Article
        • Kittl C.
        • El-Daou H.
        • Athwal K.K.
        • et al.
        The role of the anterolateral structures and the ACL in controlling laxity of the intact and ACL-deficient knee.
        Am J Sports Med. 2016; 44: 345-354
        View in Article
        • Spencer L.
        • Burkhart T.A.
        • Tran M.N.
        • et al.
        Biomechanical analysis of simulated clinical testing and reconstruction of the anterolateral ligament of the knee.
        Am J Sports Med. 2015; 43: 2189-2197
        View in Article
        • Getgood A.
        • Brown C.
        • Lording T.
        • et al.
        • for the ALC Consensus Group
        The anterolateral complex of the knee: Results from the International ALC Consensus Group Meeting.
        Knee Surg Sports Traumatol Arthrosc. 2018; https://doi.org/10.1007/s00167-018-5072-6
        View in Article
        • Andrade R.
        • Marques A.
        • Bastos R.
        • et al.
        Identification of normal and injured anterolateral ligaments of the knee: A systematic review of magnetic resonance imaging studies.
        Arthroscopy. 2019; 35: 1594-1613
        View in Article
        • Ferretti A.
        • Monaco E.
        • Fabbri M.
        • Maestri B.
        • De Carli A.
        Prevalence and classification of injuries of anterolateral complex in acute anterior cruciate ligament tears.
        Arthroscopy. 2017; 33: 147-154
        View in Article
        • Rasmussen M.T.
        • Nitri M.
        • Williams B.T.
        • 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: 585-592
        View in Article
        • Musahl V.
        • Rahnemai-Azar A.A.
        • Costello J.
        • 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: 3126-3131
        View in Article
        • Musahl V.
        • Citak M.
        • O'Loughlin P.F.
        • Choi D.
        • Bedi A.
        • Pearle A.D.
        The effect of medial versus lateral meniscectomy on the stability of the anterior cruciate ligament-deficient knee.
        Am J Sports Med. 2010; 38: 1591-1597
        View in Article
        • Stephen J.M.
        • Halewood C.
        • Kittl C.
        • Bollen S.R.
        • Williams A.
        • Amis A.A.
        Posteromedial meniscocapsular lesions increase tibiofemoral joint laxity with anterior cruciate ligament deficiency, and their repair reduces laxity.
        Am J Sports Med. 2015; 44: 400-408
        View in Article
        • Lording T.
        • Corbo G.
        • Bryant D.
        • Burkhart T.A.
        • Getgood A.
        Rotational laxity control by the anterolateral ligament and the lateral meniscus is dependent on knee flexion angle: A cadaveric biomechanical study.
        Clin Orthop Relat Res. 2017; 475: 2401-2408
        View in Article
        • Shybut T.B.
        • Vega C.E.
        • Haddad J.
        • et al.
        Effect of lateral meniscal root tear on the stability of the anterior cruciate ligament-deficient knee.
        Am J Sports Med. 2015; 43: 905-911
        View in Article
        • Salmon L.J.
        • Heath E.
        • Akrawi H.
        • Roe J.P.
        • Linklater J.
        • Pinczewski L.A.
        20-year outcomes of anterior cruciate ligament reconstruction with hamstring tendon autograft: The catastrophic effect of age and posterior tibial slope.
        Am J Sports Med. 2018; 46: 531-543
        View in Article
        • Larson C.M.
        • Bedi A.
        • Dietrich M.E.
        • et al.
        Generalized hypermobility, knee hyperextension, and outcomes after anterior cruciate ligament reconstruction: Prospective, case-control study with mean 6 years follow-up.
        Arthroscopy. 2017; 33: 1852-1858
        View in Article
        • Mohtadi N.G.
        • Chan D.S.
        • Dainty K.N.
        • Whelan D.B.
        Patellar tendon versus hamstring tendon autograft for anterior cruciate ligament rupture in adults.
        Cochrane Database Syst Rev. 2011; : CD005960
        View in Article
        • Ardern C.L.
        • Webster K.E.
        • Taylor N.F.
        • Feller J.A.
        Return to sport following anterior cruciate ligament reconstruction surgery: A systematic review and meta-analysis of the state of play.
        Br J Sports Med. 2011; 45: 596-606
        View in Article
        • Webster K.E.
        • Feller J.A.
        Exploring the high reinjury rate in younger patients undergoing anterior cruciate ligament reconstruction.
        Am J Sports Med. 2016; 44: 2827-2832
        View in Article
        • Hewison C.E.
        • Tran M.N.
        • Kaniki N.
        • Remtulla A.
        • Bryant D.
        • Getgood A.M.
        Lateral extra-articular tenodesis reduces rotational laxity when combined with anterior cruciate ligament reconstruction: A systematic review of the iterature.
        Arthroscopy. 2015; 31: 2022-2034
        View in Article
        • Devitt B.M.
        • Bell S.W.
        • Ardern C.L.
        • 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 (2325967117731767)
        View in Article
        • Sonnery-Cottet B.
        • Saithna A.
        • Cavalier 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: 1547-1557
        View in Article
        • Sonnery-Cottet B.
        • Praz C.
        • Rosenstiel N.
        • et al.
        Epidemiological evaluation of meniscal ramp lesions in 3214 anterior cruciate ligament-injured knees from the SANTI Study Group database: A risk factor analysis and study of secondary meniscectomy rates following 769 ramp repairs.
        Am J Sports Med. 2018; 46: 3189-3197
        View in Article

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      Footnotes

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      The author reports the following potential conflicts of interest or sources of funding: A.G. Receives support from Smith & Nephew, the Canadian Institute of Health Research, and ISAKOS. Full ICMJE author disclosure forms are available for this article online, as supplementary material.

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      DOI: https://doi.org/10.1016/j.arthro.2019.02.015

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      © 2019 by the Arthroscopy Association of North America

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