LIVRE JDG 2016

ANTEROLATERAL LIGAMENT HISTORY AND SURGICAL TECHNIQUES

which is passed superficial to FCL. The graft is

fixed, with an interference screw, in a blind

tunnel on the LFE [13].

Losee technique: “sling and reef”

operation

[14]

A strip of ITB (16cm long) is harvested and left

attached to the Gerdy’s tubercle. A tunnel was

made through the lateral femoral condyle,

anterior and distal to the attachment of the

FCL. This femoral insertion site closely

approximates the anatomic attachment. The

graft is passed through this tunnel. Then it

passed back through the lateral gastrocnemius

tendon, exiting through the posterolateral

capsule posterior to the FCL and passed under

the FCL. The gastrocnemius tendon,

posterolateral capsule and the graft are all

sutured to the FCL at 45° of knee flexion. Then,

the graft is sutured back to Gerdy’s tubercle

(fig. 4).

Ellison technique

[15]

In 1979, Ellison described a bony transfer of

the ITB distal insertion (fig. 5). A bone block of

1,5cm wide is harvested from Gerdy’s tubercle.

A 1.5cm strip of ITB is released from the bone

block. A passage is made under the FCL. The

capsule beneath the FCL is incised vertically

and plicated. A small hole is then made anterior

to Gerdy’s tubercle, just under the lateral

border of the patella tendon. The bony block is

then passed underneath the FCL and into the

bone trough. It is fixed with a staple at 90° of

knee flexion.

James Andrews technique

[16]

This extra-articular tenodesis used a strip of

ITB of 10cm long, left attached on the tibial

distal insertion. Two small drill holes were

made in the distal femur, corresponding to the

Graft

Fig. 4:

Line drawing demonstrating the completed

graft position in Losee technique [14]

(from Lerat

and al. [26])

LFE, lateral femoral epicondyle; GT, Gerdy’s tubercle;

FCL, fibular collateral ligament; LGT, lateral gastrocnemius

tendon.

Fig. 5: