LIVRE JDG 2016

BIOMECHANICS OF THE ANTEROLATERAL LIGAMENT

Ideally an ALL reconstruction should follow

this behavior to control internal tibial rotation

around 20 of exion without limitation of

ROM during exion and internal tibial rotation

at 90. Our results show that this can be achieved

only with the proximal-posterior femoral

location. A graft positioned at the epicondyle

femoral position will slightly tighten in exion

and can potentially overconstrain the knee in

internal rotation at 90 of exion. The anterior-

distal femoral location should be avoid ed

because of the risk of exion limitation and

overconstraint of the knee with internal rotation

at 90 of exion. To avoid these limitations, the

ALL could be xed at 90 of exion, but this

would subsequently ind uce a slack graft in

extension and be inef cient in restraining

internal tibial rotation.

The study of Imbert showed that the ALL did

not show an isometric behavior at any of the

femoral insertion locations but had different

length change patterns during knee flexion and

internal tibial rotation. The proximal and

posterior to epicondyle femoral position is the

only position with a favorable isometry, as

Fig. 1:

Cadaveric view of the lateral aspect of the right knee guring metallic pins on the femoral

and tibial benchmarks, (b) schematic of the 3 couples paired points in red, corresponding to the

different ALL anatomic descriptions, and (c) screen view of the sample from the navigation system

during isometry measurements.

Distal anterior

epicondyle

Proximal

posterior

epicondyle

Epicondyle

Gerdy

Fibular

head

LCL