LIVRE JDG 2016

WHAT ARE THE INTRINSIC FACTORS IN ACL FAILURE?

175

Song

& al.

[15] conclude that the combination

of anterolateral plasty and ACL reconstruction

is effective in eliminating the PS phenomenon.

We propose that the association of SSD >9 mm

(Telos

) with PS test 2+ or 3+ may require an

additional anterolateral plasty (modified

Lemaire). In a biomechanical study, Kittl

& al.

[16] demonstrate the surgical rationale of this

technique showing that a graft fixed proximally

to the lateral femoral epicondyle and running

under the lateral collateral ligament provides

the desirable graft behavior, without excessive

slackening or tightening of the plasty during

knee motion.

Deflexion osteotomy has to be considered

especially after the failure of two or more

consecutive ACL procedures, when PTS is

higher than 12° and in case of meniscal lesions

or previous meniscectomy, which could

exacerbate the effects of a high PTS [8] (fig. 5).

Dejour

& al.

[8] report a mean PTS reduction

from 13,2°±2,6° pre-operatively to 4,4°±2,4°

post-operatively and a mean SSD decrease

from

11,7±5,2mm

pre-operatively

4,3±2,5mm post-operatively. However, the

authors conclude that the correction of

excessive PTS should be considered also in the

first revision ACL reconstruction as this can

reduce the risks of failure.

Fig. 4:

In case of pivot shift 2+/3+ and SSD > 9 mm (Telos

), an anterolateral plasty (modified Lemaire) can

be associated to the ACL reconstruction. (a) A strip of Ileotibial band (ITB) is harvested keeping intact its

distal insertion. (b) The lateral collateral ligament (LCL) is identified and two mini-arthrotomies (posterior

and anterior to LCL) are performed. (c) The strip of ITB is pulled under the LCL. (d) An half tunnel is drilled

proximally to the lateral femoral epicondyle and the fixation is achieved with an interference bioabsorbable

screw.