LIVRE JDG 2016

ANTEROLATERAL LIGAMENT HISTORY AND SURGICAL TECHNIQUES

A variation of this procedure has been

developed. A band of fascia lata (10cm by

10mm) is harvested and left attached on Gerdy’s

tubercle. This graft is passed underneath the

FCL, then in femoral tunnel with the bone

block of patellar tendon of intra-articular

reconstruction. The fascia lata graft is tensioned

at 30° of flexion in neutral external rotation of

the knee while the wedge shaped patellar bone

block is impacted into the femoral tunnel.

Marcacci technique

[24]

In this procedure, the gracilis and the semi

tendinosus tendons are harvested and sutured to

one another. They are left attached on the tibia,

and are passed through the tibial tunnel of ACL

reconstruction, then through the “over the top”

of the lateral femoral condyle. At the exit of the

femoral tunnel, they passed under the ITB but

superficial to the FCL, and then are fixed on

Gerdy’s tubercle by two staples at 90° of flexion.

“Anatomic” anterolateral ligament

reconstructions

Currently other surgical techniques called

“anatomic” have been described. Their aim is

to reproduce the insertion sites of the more

superficial ALL, described by Kennedy [8].

They are recent and few results are reported.

The Smith technique [25] consists of an “all

inside” ACL reconstruction with the

semitendinosus tendon, associated with an

independent extra-articular reconstruction with

the gracilis tendon. Two bone tunnels are

drilled: the first just anterior and superior to the

FCL femoral insertion and the second halfway

between Gerdy’s tubercle and the fibular head.

The gracilis tendon is fixed into the femoral

tunnel with threaded knotless anchor, and then

it is passed under the ITB and is fixed into tibial

tunnel with anchor.

CONCLUSION

Various techniques are performed to control

rotational stability with ACL deficient. They

are based on different principles: anterolateral

extra-articular augmentation or anatomic ALL

reconstruction. The different studies reported

satisfying results for the combined extra and

intra-articular reconstructions. However few

studies compared the various extra-articular

procedures. The “anatomic” reconstructions

are recent and should be evaluated at long term.

The mechanical properties and the function of

this superficial ALL are still poorly understood

and need more investigations.

Fig. 6:

Per operative view (a) and line drawing (b) of

a right knee showing the KJT procedure, described

by Neyret.

From Magnussen and al. [23]

LCL, lateral

collateral ligament; ITB, iliotibial band; GT, Gerdy’s tubercle;

white arrow: tibial bone block; black arrows, two limbs of

gracilis tendon.