28 / 244
27
INTRODUCTION
With the advent of recent reports, there has
been a renewed interest in extra-articular
reconstruction combined with reconstruction
of the anterior cruciate ligament (ACL) in
order to obtain better rotational control. The
quest for improved rotational control after ACL
reconstruction has continued to evolve.
Evidence of residual rotational instability after
a single-bundle ACL reconstruction, confirmed
by a positive pivot-shift led to the development
of a more anatomic graft placement in addition
to other surgical techniques. Double-bundle
ACL reconstruction emerged as an attempt to
further improve rotational control after ACL
reconstruction, however current data has failed
to prove its superiority to date.
Historically, extra-articular lateral tenodesis in
concurrence with ACL reconstruction has been
attempted to improve rotational control of the
tibia with disappointing results. However,
recent insights into the anatomical and
isometric characteristics of the ALL have
provided a more complete understanding of
this important structure.
The ALL has been placed under the scientific
microscope to closely examine its associated
biomechanics which range from native
structural properties to native and reconstructed
kinematics. These studies focus in on the ALL,
while not losing sight of surrounding lateral
structures and the ACL. The reason for this
close examination stems from the common
goal of utilizing an ALL reconstruction in the
setting of an ACL deficiency which thereby
may eliminate residual rotational knee laxity
and reduce the risk of ACL graft rupture in
select patients. These patients may include
ACL revision cases, the clinical presentation of
joint hyperlaxity, and those with either high-
demand for pivoting sports and/or presenting
with a high grade pivot-shift diagnosis. Due to
all of these recent studies, a consensus is now
defined on what the ALL is and what role it
plays in overall lateral knee stability.
Furthermore, this information has provided the
foundation to build effective and reproducible
ALL reconstructions in combination with the
treatment of a torn ACL.
STRUCTURAL PROPERTIES
AND INVOLVEMENT IN
ROTATIONAL CONTROL
OF THE KNEE
Structural property tensile testing of the
isolated ALL utilizing similar specimen setup
and crosshead speed (20mm/min) has produces
mean ultimate load values of 189 Newtons (N)
BIOMECHANICS OF THE
ANTEROLATERAL LIGAMENT
M. THAUNAT, C.A. WIJDICKS, P. IMBERT,
C. LUTZ, J.M. FAYARD, B. SONNERY-COTTET