Objective To make further exploration of the structure characteristics of anterolateral ligament (ALL) and provide clinical reference for diagnosis and treatment of ALL injury, especially for ALL reconstruction through anatomical study of ALL in a Chinese population. Methods Sixteen cadaveric knees, including 8 left knees and 8 right knees with sex ratio of 1∶1 and a mean age of 73.5 years (range, 57-84 years), were dissected to reveal the ALL through a standard approach. A qualitative and a quantitative characterizations of the ALL were performed. Results ALL was seen in 75.0% of the specimens, originating on the lateral femoral epicondyle, proximal and posterior to the lateral collateral ligament (LCL). It coursed on LCL or was parallel to LCL, anterodistally to its anterolateral tibial attachment approximately midway between the center of the Gerdy’s tubercle and the lateral margin of the fibular head. A strong connection was observed between the middle part of the ALL and the periphery of the meniscal body of the lateral meniscus. The distance between the center of the insertion and Gerdy’s tubercle was (23.9±3.3) mm; and the distance between the center of the insertion and the lateral margin of the fibular head was (23.8±4.0) mm. The ALL length at 0° and 60° flexion and neutral knee rotation were (44.8±5.1) mm and (47.8±5.5) mm respectively (t=14.071, P=0.000), and the ligament had its great extend at 60° of knee flexion and internal rotation. Furthermore, the ALL length at 0° and 60° flexion of males were both significantly higher than those of females (t=2.920, P=0.015; t=2.806, P=0.019), while other measurements differences were significant between males and females (P>0.05). Conclusion ALL is an independent and a non-isometric ligament located in the anterolateral area to the knee, of which the length is different between males and females. ALL plays a role in rotational stability of the knee, and should be put much emphasis in clinical practice.
ObjectiveTo review research progress in the anterolateral ligament (ALL) of knee, and provide a clinical reference for diagnosis and treatment of ALL injury.MethodsThe literature on the diagnosis and treatment of ALL injury was widely reviewed. The incidence, anatomy, biomechanics, injury mechanism, and treatment status of ALL were summarized.ResultsThe ALL contributes to the effect of controlling the internal rotation and anterior translation of the tibia, which affects the axial migration of the knee. ALL injury can be diagnosed according to the signs and MRI examination. Currently, no consensus exists for the surgical indications of ALL injury, but most surgeons tend to perform ALL reconstruction in patients requiring anterior cruciate ligament (ACL) reconstruction or revision surgery with higher pivot-shift tests. At present, various techniques have been used for ALL reconstruction, and there is no optimal technique. In addition, the long-term effectiveness of ALL reconstruction is unclear due to the lack of high-quality studies and long-term postoperative follow-up.ConclusionThe ALL contributes to maintaining knee stability, and the ALL reconstruction technique and its effectiveness still need further research.
ObjectiveTo investigate the effectiveness of double-bundle anterior cruciate ligament (ACL) reconstruction combined with anterolateral ligament (ALL) reconstruction in the treatment of revision patients with ACL graft failure.MethodsBetween January 2018 and June 2019, 15 patients underwent ACL revision with double-bundle ACL reconstruction combined with ALL reconstruction. There were 12 males and 3 females with an average age of 30.1 years (range, 17-49 years). The technique of primary ACL reconstruction included single-bundle reconstruction in 13 cases and double-bundle reconstruction in 2 cases. These reconstructions applied autografts in 14 cases and allograft in 1 case. The causes of ACL reconstruction failure were identified as traumatic rupture in 9 cases and non-traumatic failure in 6 cases, including 2 cases of graft absorption and 3 cases of graft laxity. The average time from the primary ACL reconstruction to revision was 28.5 months (range, 8-60 months). The subjective and objective indicators of knee joint function were compared before operation and at last follow-up to evaluate the effectiveness. The subjective indicators included International Knee Documentation Committee (IKDC) score, Lysholm score, and Tegner score. The objective indicators included anterior tibial translation (dynamic and static) and side-to-side difference (SSD), pivot-shift test, Lachman test, the difference of single-legged hop test, and the loss ratio of extensor muscle strength on the affected side.ResultsAll incisions healed by first intetion, and no complications such as infection, venous thrombosis of lower extremity, or neurovascular injury occurred. All patients were followed up for an average of 19.1 months (range, 12-30 months). At last follow-up, all patients had returned to pre-injury sports level. The IKDC score, Lysholm score, and Tegner score were significantly improved (P<0.05); anterior tibial translations (dynamic and static) significantly decreased when compared with preoperative one (P<0.05) and returned to the physiological range. The SSD, Lachman test, pivot-shift test, the difference of single-legged hop test, and the loss ratio of extensor muscle strength on the affected side were significantly better than those before operation (P<0.05).During the follow-up, there was no re-rupture of the graft, no stiffness of the knee joint and limitation of mobility; 1 case had a protruding femoral end compression screw, which was removed through the original incision under local anesthesia. ConclusionDouble-bundle ACL reconstruction combined with ALL reconstruction can significantly improve the knee function in revision patients with ACL graft failure. It can reduce the anterior translation of tibia, and effectively prevent postoperative rotational instability of the knee.