Abstract
Purpose
To investigate whether anterolateral ligament (ALL) sectioning (sALL) in the anterior
cruciate ligament (ACL)-sectioned (sACL) knee increases the anterior tibial translation
(ATT) or internal rotation (IR) of the knee from previous cadaveric biomechanical
studies.
Methods
Multiple comprehensive literature databases, including PubMed (MEDLINE), EMBASE, and
Cochrane Library, were searched for studies evaluating the in vitro biomechanical
function of ALL. This meta-analysis compared the increased ATT and IR between the
sACL and sACL + sALL knees at 30°, 60°, and 90° of knee flexion. Thresholds of 2 mm
for the difference in ATT and 2° for the difference in IR were considered to be clinically
significant.
Results
Thirteen cadaveric biomechanical studies were included. All 13 studies satisfied the
threshold for a satisfactory methodological quality (Quality Appraisal for Cadaveric
Studies score >75%). At 30° of knee flexion, the meta-analysis showed a greater increase
in ATT in the sACL + sALL knees than in the sACL knees by 1.23 mm (95% confidence
interval [CI], 0.62–1.84; P<0.0001). However, the mean difference was less than the
minimal clinically significant difference (< 2 mm). The meta-analysis also showed
a greater increase in IR in the sACL + sALL knees than in the sACL knees at 30° (mean
difference [MD], 2.24°; 95% CI, 1.39–3.09; P<0.00001), 60° (MD, 2.77°; 95% CI, 1.88–3.67;
P<0.00001), and 90° (MD, 2.29°; 95% CI, 1.42–3.15; P<0.00001) of knee flexion. The
differences in IR at 30°, 60°, and 90° of knee flexion were clinically relevant (>
2°).
Conclusion
Despite the different experimental setups and protocols between studies, the meta-analysis
of biomechanical cadaveric studies showed that sectioning of the ALL in sACL knees
increased IR at 30°, 60°, and 90° of knee flexion.
Clinical relevance
The results of this systematic review and meta-analysis suggest that ALL contributes
to IR in ACL-deficient knees at 30°, 60°, and 90° of flexion.
Key Terms
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Article info
Publication history
Accepted:
December 30,
2022
Received in revised form:
December 25,
2022
Received:
March 17,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Ethical approval: Ethical approval was not applicable in this study.
Acknowledgments: None
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Identification
Copyright
© 2023 Published by Elsevier on behalf of the Arthroscopy Association of North America
