Purpose
To compare the biomechanical effects of anterolateral structure reconstructions (ALSRs)
with different tibial attachments on tibiofemoral kinematics and anterolateral structure
(ALS) graft forces.
Methods
Eight cadaveric knees were tested in a customized knee testing system, using a novel
pulley system to simulate more muscle tensions by loading the iliotibial band at 30
N and quadriceps at 10 N in all testing states. Anterior stability during anterior
load and anterolateral rotatory stability during 2 simulated pivot-shift tests (PST1
and PST2) were evaluated in 5 states: intact, ALS-deficient (Def), ALSR-Ta (anterior
tibial site), ALSR-Tm (middle tibial site), and ALSR-Tp (posterior tibial site). Tibiofemoral
kinematics and resulting ALS graft forces against the applied loads were measured
and compared in the corresponding states.
Results
In anterior load, 3 ALSRs mitigated the anterior laxities of the ALS Def state at
all degrees, which were close to intact state at 0° and 30° but showed significantly
overconstraints at 60° and 90°. In both PSTs, all ALSRs significantly reduced the
anterolateral rotatory instability of ALS Def, whereas the significant overconstraints
were detected in ALSR-Ta and ALSR-Tm at greater knee flexion angles. All ALS grafts
carried forces in resisting anterior and pivot-shift loads. Only ALS graft force in
ALSR-Ta increased continuously with knee flexion angles. The ALS graft forces carried
by ALSR-Ta were significantly larger than those by ALSR-Tp and ALSR-Tm when resisting
anterior load and PSTs at greater knee flexion angles.
Conclusions
ALSRs with different tibial attachment sites similarly restored knee laxities close
to the native tibiofemoral kinematics in an ALS-deficient knee, whereas the ALSR-Tp
showed less propensity for overconstraining the knee at greater flexion angles. The
ALS graft in ALSR-Ta carried more forces than those in ALSR-Tp and ALSR-Tm against
simulated loads.
Clinical Relevance
Altering the tibial attachment sites of ALSRs may not significantly affect tibiofemoral
kinematics at most degrees whereas the posterior may have less overconstraints at
greater flexion angles. However, ALS graft positioning at a more anterior tibial attachment
site may carry more forces in resisting anterior and pivot–shift loads.
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References
- Biomechanical effects of additional anterolateral structure reconstruction with different femoral attachment sites on anterior cruciate ligament reconstruction.Am J Sports Med. 2019; 47: 3373-3380
- The anterolateral complex of the knee: A pictorial essay.Knee Surg Sports Traumatol Arthrosc. 2017; 25: 1009-1014
- The anterolateral complex of the knee: Results from the International ALC Consensus Group Meeting.Knee Surg Sports Traumatol Arthrosc. 2019; 27: 166-176
- Combined anterolateral and anterior cruciate ligament reconstruction improves pivot shift compared with isolated anterior cruciate ligament reconstruction: A systematic review and meta-analysis of randomized controlled trials.Arthroscopy. 2021; 37: 2677-2703
- There are differences in knee stability based on lateral extra-articular augmentation technique alongside anterior cruciate ligament reconstruction.Knee Surg Sports Traumatol Arthrosc. 2021; 29: 3854-3863
- Supplementary lateral extra-articular tenodesis for residual anterolateral rotatory instability in patients undergoing single-bundle anterior cruciate ligament reconstruction: A meta-analysis of randomized controlled trials.Orthop J Sports Med. 2021; 9 (232596712110022)
- Reconstruction for chronic acl tears with or without anterolateral structure augmentation in patients at high risk for clinical failure: A randomized clinical trial.J Bone Joint Surg Am. 2021; 103: 1482-1490
- Effects of anterolateral structure augmentation on the in vivo kinematics of anterior cruciate ligament-reconstructed knees.Am J Sports Med. 2021; 49: 656-666
- Double-bundle anterior cruciate ligament reconstruction with lateral extra-articular tenodesis is effective in restoring knee stability in a chronic, complex anterior cruciate ligament-injured knee model: A cadaveric biomechanical study.Arthroscopy. 2021; 37: 2220-2234
- Anterolateral tenodesis or anterolateral ligament complex reconstruction: Effect of flexion angle at graft fixation when combined with ACL reconstruction.Am J Sports Med. 2017; 45: 3089-3097
- Biomechanical comparison of anterolateral procedures combined with anterior cruciate ligament reconstruction.Am J Sports Med. 2017; 45: 347-354
- Anterolateral knee extra-articular stabilizers: A robotic study comparing anterolateral ligament reconstruction and modified Lemaire lateral extra-articular tenodesis.Am J Sports Med. 2018; 46: 607-616
- Effects of different femoral tunnel positions on tension changes in anterolateral ligament reconstruction.Knee Surg Sports Traumatol Arthrosc. 2017; 25: 1272-1278
- Anterolateral structure reconstruction similarly improves the stability and causes less over-constraint in ACL-reconstructed knees compared with modified lemaire lateral extra-articular tenodesis: A biomechanical study.Arthroscopy. 2022; 38: 911-924
- Anterolateral ligament reconstruction and modified lemaire lateral extra-articular tenodesis similarly improve knee stability after anterior cruciate ligament reconstruction: A biomechanical study.Arthroscopy. 2020; 36: 1942-1950
- A biomechanical study of the role of the anterolateral ligament and the deep iliotibial band for control of a simulated pivot shift with comparison of minimally invasive extra-articular anterolateral tendon graft reconstruction versus modified Lemaire reconstruction after anterior cruciate ligament reconstruction.Arthroscopy. 2019; 35: 1473-1483
- Length change patterns in the lateral extra-articular structures of the knee and related reconstructions.Am J Sports Med. 2015; 43: 354-362
- Biomechanical effects of combined anterior cruciate ligament reconstruction and anterolateral ligament reconstruction: A systematic review and meta-analysis.Orthop J Sports Med. 2021; 9 (23259671211009879)
- The effect of combined anterolateral and anterior cruciate ligament reconstruction on reducing pivot shift rate and clinical outcomes: A meta-analysis.Arthroscopy. 2021; 37: 694-705
- 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
- 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: 1598-1605
- Combined double-bundle anterior cruciate ligament reconstruction and anterior cruciate ligament-mimicking anterolateral structure reconstruction.Arthrosc Tech. 2020; 9: e1141-e1146
- Condyle-pinching double-bundle anterior cruciate ligament reconstruction.Arthrosc Tech. 2020; 9: e1109-e1114
- An in vitro robotic assessment of the anterolateral ligament, part 2: Anterolateral ligament reconstruction combined with anterior cruciate ligament reconstruction.Am J Sports Med. 2016; 44: 593-601
- A secondary injury of the anterolateral structure plays a minor role in anterior and anterolateral instability of anterior cruciate ligament-deficient knees in the case of functional iliotibial band.Arthroscopy. 2021; 37: 1182-1191
Xu J, Ye Z, Qiao Y, et al. Medial patellofemoral ligament reconstruction using adductor-transfer and adductor-sling at nonanatomic femoral attachment sites leads to unfavorable graft-length change patterns: A descriptive biomechanical study [published online November 9, 2021]. Arthroscopy. https://doi.org/10.1016/j.arthro.2021.10.030
- Elongation patterns of the anterior and posterior borders of the anterolateral ligament of the knee.Arthroscopy. 2019; 35: 2152-2159
- Lateral extra-articular tenodesis reduces anterior cruciate ligament graft force and anterior tibial translation in response to applied pivoting and anterior drawer loads.Am J Sports Med. 2020; 48: 3183-3193
- Posterior tibial loading results in significant increase of peak contact pressure in the patellofemoral joint during anterior cruciate ligament reconstruction: A cadaveric study.Am J Sports Med. 2021; 49: 1286-1295
- The anterolateral structure of the knee does not affect anterior and dynamic rotatory stability in anterior cruciate ligament injury: Quantitative evaluation with the electromagnetic measurement system.Am J Sports Med. 2019; 47: 3381-3388
- Does lateral extra-articular tenodesis of the knee affect anterior cruciate ligament graft in situ forces and tibiofemoral contact pressures?.Arthroscopy. 2020; 36: 1365-1373
- Biomechanical assessment of a distally fixed lateral extra-articular augmentation procedure in the treatment of anterolateral rotational laxity of the knee.Am J Sports Med. 2019; 47: 2102-2109
- Effect of anterolateral complex sectioning and tenodesis on patellar kinematics and patellofemoral joint contact pressures.Am J Sports Med. 2018; 46: 2922-2928
- High rate of initially overlooked Kaplan fiber complex injuries in patients with isolated anterior cruciate ligament injury.Am J Sports Med. 2021; 49: 2117-2124
- Biomechanical analysis of simulated clinical testing and reconstruction of the ALL: Response.Am J Sports Med. 2015; 43: NP41-NP42
- Biomechanical analysis of simulated clinical testing and reconstruction of the anterolateral ligament of the knee.Am J Sports Med. 2015; 43: 2189-2197
- Anterolateral ligament repair with suture tape augmentation.Arthrosc Tech. 2018; 7: e1311-e1314
- Anterolateral ligament repair augmented with suture tape in acute anterior cruciate ligament reconstruction.Arthrosc Tech. 2019; 8: e369-e373
- Percutaneous reconstruction of the anterolateral ligament of the knee with a polyester tape.Arthrosc Tech. 2016; 5: e691-e697
- Combined anterior cruciate ligament and anterolateral ligament reconstruction.Arthrosc Tech. 2016; 5: e1253-e1259
- Tibial slope and its effect on force in anterior cruciate ligament grafts: anterior cruciate ligament force increases linearly as posterior tibial slope increases.Am J Sports Med. 2019; 47: 296-302
- Effect of slope and varus correction high tibial osteotomy in the ACL-deficient and ACL-reconstructed knee on kinematics and ACL graft force: A biomechanical analysis.Am J Sports Med. 2021; 49: 410-416
- Posterior medial meniscus root tears potentiate the effect of increased tibial slope on anterior cruciate ligament graft forces.Am J Sports Med. 2020; 48: 334-340
- Editorial Commentary: Knee anterolateral ligament cadaveric, biomechanical analysis should include tensioning of all knee dynamic structures.Arthroscopy. 2021; 37: 1192-1193
- Anterolateral knee biomechanics.Knee Surg Sports Traumatol Arthrosc. 2017; 25: 1015-1023
- Rotational knee instability in acl-deficient knees: role of the anterolateral ligament and iliotibial band as defined by tibiofemoral compartment translations and rotations.J Bone Joint Surg Am. 2017; 99: 305-314
- Is an anterolateral ligament reconstruction required in ACL-reconstructed knees with associated injury to the anterolateral structures? A robotic analysis of rotational knee stability.Am J Sports Med. 2017; 45: 1018-1027
- The effect of an ACL reconstruction in controlling rotational knee stability in knees with intact and physiologic laxity of secondary restraints as defined by tibiofemoral compartment translations and graft forces.J Bone Joint Surg Am. 2018; 100: 586-597
- Anterior cruciate ligament function in providing rotational stability assessed by medial and lateral tibiofemoral compartment translations and subluxations.Am J Sports Med. 2015; 43: 683-692
- Evaluation of a simulated pivot shift test: a biomechanical study.Knee Surg Sports Traumatol Arthrosc. 2012; 20: 698-702
- Automatic construction of an anatomical coordinate system for three-dimensional bone models of the lower extremities—pelvis, femur, and tibia.J Biomech. 2014; 47: 1229-1233
- Misinterpretation of P values and statistical power creates a false sense of certainty: Statistical significance, lack of significance, and the uncertainty challenge.Arthroscopy. 2021; 37: 1057-1063
- Osteochondritis dissecans of the knee: an interrater reliability study of magnetic resonance imaging characteristics.Am J Sports Med. 2020; 48: 2221-2229
- Anterolateral structure reconstruction unnecessary with anatomic ACL reconstruction for knee stability: Commentary on an article by Frank R. Noyes, MD, et al.: "The effect of an ACL reconstruction in controlling rotational knee stability in knees with intact and physiologic laxity of secondary restraints as defined by tibiofemoral compartment translations and graft forces.".J Bone Joint Surg Am. 2018; 100: e47
- Anterolateral ligament reconstruction as an augmented procedure for double-bundle anterior cruciate ligament reconstruction restores rotational stability: Quantitative evaluation of the pivot shift test using an inertial sensor.Knee. 2020; 27: 397-405
- Lateral extra-articular tenodesis contributes little to change in vivo kinematics after anterior cruciate ligament reconstruction: A randomized controlled trial.Am J Sports Med. 2021; 49: 1803-1812
- Biomechanical results of lateral extra-articular tenodesis procedures of the knee: A systematic review.Arthroscopy. 2016; 32: 2592-2611
- Combined anterior cruciate ligament reconstruction and lateral extra-articular tenodesis does not result in an increased rate of osteoarthritis: A systematic review and best evidence synthesis.Knee Surg Sports Traumatol Arthrosc. 2017; 25: 1149-1160
- Combined reconstruction of the anterolateral ligament in patients with anterior cruciate ligament injury and ligamentous hyperlaxity leads to better clinical stability and a lower failure rate than isolated anterior cruciate ligament reconstruction.Arthroscopy. 2019; 35: 2648-2654
- Good mid-term outcomes and low rates of residual rotatory laxity, complications and failures after revision anterior cruciate ligament reconstruction (ACL) and lateral extra-articular tenodesis (LET).Knee Surg Sports Traumatol Arthrosc. 2020; 28: 418-431
- Combined anterior cruciate and anterolateral ligament reconstruction in the professional athlete: Clinical outcomes from the scientific anterior cruciate ligament network international study group in a series of 70 patients with a minimum follow-up of 2 years.Arthroscopy. 2019; 35: 885-892
- Contribution of additional anterolateral structure augmentation to controlling pivot shift in anterior cruciate ligament reconstruction.Am J Sports Med. 2019; 47: 2093-2101
- Two different knee rotational instabilities occur with anterior cruciate ligament and anterolateral ligament injuries: A robotic study on anterior cruciate ligament and extra-articular reconstructions in restoring rotational stability.Arthroscopy. 2018; 34: 2683-2695
- The scientific rationale for lateral tenodesis augmentation of intra-articular ACL reconstruction using a modified 'Lemaire' procedure.Knee Surg Sports Traumatol Arthrosc. 2017; 25: 1339-1344
- The biomechanical function of the anterolateral ligament of the knee: Letter to the Editor.Am J Sports Med. 2015; 43: NP21-NP22
- Methods to improve arthroscopic and orthopaedic biomechanical investigations: A few of our favorite things.Arthroscopy. 2019; 35: 2967-2969
Article info
Publication history
Published online: March 22, 2022
Accepted:
March 3,
2022
Received:
November 18,
2021
Footnotes
See commentary on page 2697
The authors report the following potential conflicts of interest or sources of funding: funded by the National Key Research and Development Program of China, 2018YFC1106200 and 2018YFC1106202; National Natural Science Foundation of China, Grant No. 81902186, 81671920, 31972923, and 81871753; and Natural Science Foundation of Shanghai, Grant No.19ZR1438500.
Junjie Xu, M.D., Zipeng Ye, M.D., Kang Han, M.D., contributed equally to the work.
Full ICMJE author disclosure forms are available for this article online, as supplementary material.
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