Purpose
To compare the elongation patterns of the anterior and posterior borders of the anterolateral
ligament (ALL) at varying knee flexion angles with the knee in a neutral position
without any external forces and with external forces applied, including anterior-posterior
translation, internal-external rotation, and varus-valgus angulation.
Methods
Eight cadaveric knees were tested in a custom knee testing system. Elongation of the
anterior and posterior borders of the ALL was measured using a MicroScribe 3DLX system
at knee flexion angles of 0°, 30°, 60°, and 90° and after the application of internal-external
rotation, anterior-posterior translation, and varus-valgus angulation.
Results
The anterior border showed a slight noncontinuous increase in percentage elongation
(0.8% ± 2.2%) whereas the posterior border showed a continuous decrease in percentage
elongation (–12.0% ± 2.8%) as knee flexion increased (P < .001). Apart from the elongation of the posterior border at 90° of knee flexion,
internal rotation, varus angulation, and anterior translation resulted in a significant
increase in the percentage elongation of the anterior and posterior borders at each
flexion angle compared with external rotation, valgus angulation, and posterior translation,
respectively.
Conclusions
The ALL shows different elongation patterns between the anterior and posterior borders,
with a continuous decrease in the percentage elongation of the posterior border as
knee flexion increases.
Clinical Relevance
This study presents useful evidence to resolve the uncertainty regarding the change
in length of the ALL at various degrees of knee flexion. This information may be helpful
for deciding the optimal knee flexion angle during ALL graft fixation. The findings
from this study suggest that graft fixation during ALL reconstructions should be performed
at close to full extension of the knee.
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References
- Current concepts of the anterolateral ligament of the knee: Anatomy, biomechanics, and reconstruction.Am J Sports Med. 2018; 46: 1235-1242
- Variables associated with return to sport following anterior cruciate ligament reconstruction: A systematic review.Br J Sports Med. 2014; 48: 356-364
- Return to sport after ACL reconstruction: A survey between the Italian Society of Knee, Arthroscopy, Sport, Cartilage and Orthopaedic Technologies (SIGASCOT) members.Eur J Orthop Surg Traumatol. 2016; 26: 509-516
- Return to play following ACL reconstruction: Survey among experienced arthroscopic surgeons (AGA instructors).Arch Orthop Trauma Surg. 2013; 133: 969-977
- Function and strain of the anterolateral ligament part I: Biomechanical analysis.Knee Surg Sports Traumatol Arthrosc. 2017; 25: 1132-1139
- The involvement of the anterolateral ligament in rotational control of the knee.Am J Sports Med. 2016; 44: 1209-1214
- Anterolateral ligament reconstruction is associated with significantly reduced ACL graft rupture rates at a minimum follow-up of 2 years.Am J Sports Med. 2017; 45: 1547-1557
- Anterolateral ligament of the knee: Anatomy, function, imaging, and treatment.Am J Sports Med. 2018; 46: 217-223
- Effects of different femoral tunnel positions on tension changes in anterolateral ligament reconstruction.Knee Surg Sports Traumatol Arthrosc. 2017; 25: 1272-1278
- Length changes of the anterolateral ligament during passive knee motion: A human cadaveric study.Am J Sports Med. 2015; 43: 2545-2552
- Evaluation of the length and isometric pattern of the anterolateral ligament with serial computer tomography.Orthop J Sports Med. 2014; 2 (2325967114562205)
- The anterolateral ligament: Anatomy, length changes and association with the Segond fracture.J Bone Joint Br. 2014; 96: 325-331
- High interspecimen variability in engagement of the anterolateral ligament: An in vitro cadaveric study.Clin Orthop Relat Res. 2017; 475: 2438-2444
- In vivo length changes of the anterolateral ligament and related extra-articular reconstructions.Am J Sports Med. 2016; 44: 2557-2562
- Why do authors differ with regard to the femoral and meniscal anatomic parameters of the knee anterolateral ligament?: Dissection by layers and a description of its superficial and deep layers.Orthop J Sports Med. 2016; 4 (2325967116675604)
- Femoral origin of the anterolateral ligament: An anatomic analysis.Arthroscopy. 2016; 32: 835-841
- Anatomy and histology of the knee anterolateral ligament.Orthop J Sports Med. 2013; 1 (2325967113513546)
- Anatomy of the anterolateral ligament of the knee.J Anat. 2013; 223: 321-328
- Effects of kneeling on tibiofemoral contact pressure and area in posterior cruciate-retaining and posterior cruciate-sacrificing total knee arthroplasty.J Arthroplasty. 2012; 27: 620-624
- Biomechanical effects of joint line elevation in total knee arthroplasty.Clin Biomech. 2012; 27: 824-829
- Biomechanical and anatomical assessment after knee hyperextension injury.Am J Sports Med. 2008; 36: 80-84
- Biomechanical and anatomical effects of an external rotational torque applied to the knee: A cadaveric study.Am J Sports Med. 2006; 34: 1623-1629
- The effects of tibial rotation on the patellofemoral joint: Assessment of the changes in in situ strain in the peripatellar retinaculum and the patellofemoral contact pressures and areas.J Rehabil Res Dev. 2001; 38: 463-469
- Muscle architecture of the human lower limb.Clin Orthop Relat Res. 1983; : 275-283
- In vivo anterolateral ligament length change in the healthy knee during functional activities-a combined magnetic resonance and dual fluoroscopic imaging analysis.Arthroscopy. 2017; 33: 133-139
- The anterolateral ligament of the knee: A dissection study.Knee. 2016; 23: 8-12
Article info
Publication history
Accepted:
February 7,
2019
Received:
August 4,
2018
Footnotes
See commentary on page 2160
The authors report the following potential conflicts of interest or sources of funding: This study was supported by the research fund from Smith & Nephew. The funding sources had no role in the design or conduct of the study; collection, management, analysis, or interpretation of the data; or preparation, review, or approval of the manuscript. J.H.A. receives support from Orthopaedic Biomechanics Laboratory, Tibor Rubin VA Medical Center. T.Q.L. receives support from Orthopaedic Biomechanics Laboratory, Tibor Rubin VA Medical Center. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
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© 2019 by the Arthroscopy Association of North America
ScienceDirect
Access this article on ScienceDirectLinked Article
- Editorial Commentary: Extension of Knowledge—and the Knee! New Biomechanical Study Suggests the Clinical Practice of Anterolateral Ligament Fixation Near ExtensionArthroscopyVol. 35Issue 7
- PreviewThe knee anterolateral ligament (ALL) is one of the most hotly debated topics in sports medicine in the last decade. Once one aspect of discussion regarding the ALL reaches a consensus, attention immediately turns to the next one. This has already happened with the existence of the ALL itself, its anatomic features, the ability to visualize the ALL with magnetic resonance imaging, and many other topics. In the end, the most important aspect must be clinical outcomes, and existing studies are trying to find the optimum surgical technique to best restore knee stability and reduce failure rates.
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