scholarly journals Lemaire extraarticular plasty in anterolateral knee instability

2017 ◽  
Vol 5 (1_suppl) ◽  
pp. 2325967117S0000
Author(s):  
Vicente Paús ◽  
Ariel Graieb ◽  
Federico Torrengo
Keyword(s):  
Femoral Condyle ◽  
Cruciate Ligament ◽  
Rotational Instability ◽  
Lateral Side ◽  
Patient History ◽  
Surgical Decision ◽  
The Past ◽  
Isolated Injury ◽  
Anterior Cruciate ◽  
Anterolateral Instability

Anterolateral instability of the knee results from injury to the lateral capsular complex and the anterior cruciate ligament (ACL), and it should not be considered an isolated injury. Over the past years these structures have received renewed interest. The anterolateral ligament (ALL) recently described extends from the lateral side of the lateral femoral condyle to the antero-lateral edge of the tibia, and it is supposed to play a major role in anterolateral stability. ACL extra-articular tenodesis, initially developed as a single procedure, is now complementary to intra-articular plasty. Our indications are: pure rotational instability, symptomatic instability in non-athletes, and revision surgery. Lemaire-type plasty and post-opeartive care are described in detail. We suggest thorough patient history and clinical examination prior to surgical decision. Lemaire-type plasty effectively controls anterolateral instability.

scholarly journals Microvasculature of Anterior Cruciate Ligament by Immunohistochemistry using VE-Cadherin

2020 ◽  
Vol 6 (1) ◽  
pp. 58-61
Author(s):  
Jahira Banu T ◽  
Yogesh Ashok Sontakke
Keyword(s):  
Anterior Cruciate Ligament ◽  
Postoperative Complications ◽  
Knee Joint ◽  
Blood Vessels ◽  
Transmembrane Protein ◽  
Femoral Condyle ◽  
Cruciate Ligament ◽  
Middle Part ◽  
The Past ◽  
Anterior Cruciate

Introduction: The anterior cruciate ligament (ACL) is one of the knee stabilizer and acts to prevent excessive anterior mobility as well as rotational movement. The ACL is extending from the lateral femoral condyle to the anterior intercondylar area of tibia. During excessive movement or abnormal mobility affecting the knee joint, the ACL is under tension and prone for injury. The injured ACL was managed by surgery as it was an option for treatment owing to its poor vascularity. The distribution of the blood vessels within the ACL was not clear and only few studies reported in the past. The present study focused on distribution of blood vessels in the ACL. Subjects and Methods: The ACL microvasculature was assessed using 48 cadaveric ACL tissues using immunohistochemistry. The antibody against the transmembrane protein VE-Cadherin was targeted to study the blood vessels. Results: It was observed that the middle part of the ACL was less vascular compared with the peripheral parts of ACL. Conclusion: The knowledge of the ACL vasculature may help in planning surgeries of ACL to reduce postoperative complications.

Lateral Extra-articular Tenodesis with Iliotibial Band Strip – a Solution for Anterolateral Instability?

2019 ◽  
Vol 21 (6) ◽  
pp. 397-406
Author(s):  
Adam Kwapisz ◽  
Scott Mollison ◽  
Jerzy Cholewiński ◽  
Peter MacDonald ◽  
Marek Synder ◽  
...  
Keyword(s):  
Cruciate Ligament ◽  
Acl Injury ◽  
Iliotibial Band ◽  
Rotational Instability ◽  
Femoral Fixation ◽  
Graft Rupture ◽  
Lateral Tenodesis ◽  
Anterior Cruciate ◽  
Historical Methods ◽  
Anterolateral Instability

It is widely acknowledged that anterior cruciate ligament (ACL) injury is the cause of anterolateral insta­bility, but in some cases not only the ACL ruptures, but also anterolateral structures (ALS), including the antero­lateral ligament. Their insufficiency may be the cause of residual instability after ACL reconstruction, which significantly increases the risk of graft rupture. In the past, anterolateral instability caused by ACL injury was treat­ed with extra-articular reconstructions, including lateral extra-articular tenodesis. Nowadays those techni­ques are used simultaneously in cases of complex anterolateral and rotational instability. This article briefly describes historical methods of lateral tenodesis and presents step-by-step two techniques used in our depart­ments involving two alternative graft femoral fixation methods.

scholarly journals Evaluation of functional outcome of arthroscopic anterior cruciate ligament reconstruction by modified AMP technique

2019 ◽  
Vol 5 (5) ◽  
pp. 824
Author(s):  
Saurabh Gupta ◽  
Meenakshi Garg ◽  
Raj Singh
Keyword(s):  
Anterior Cruciate Ligament ◽  
Femoral Tunnel ◽  
Femoral Condyle ◽  
Cruciate Ligament ◽  
Rotational Instability ◽  
Tunnel Length ◽  
Acl Tear ◽  
Starting Point ◽  
Ikdc Score ◽  
Anterior Cruciate

<p class="abstract"><strong>Background:</strong> In anterior cruciate ligament (ACL) reconstruction, transtibial (TT) drilling of the femoral tunnel has been criticized for its vertical and less anatomical tunnel, which accompanied rotational instability of knee. Antero medial portal (AMP) drilling technique creates more oblique and anatomic femoral tunnel. However, recent researches show that oblique tunnel is related to risks of too short femoral tunnel, blowout of back wall, and posterolateral structures injury. Modified AMP technique creates vertical tunnel with anatomical FSP (femoral starting point).</p><p class="abstract"><strong>Methods:</strong> In our study we have functionally evaluated 30 patients of ACL tear who underwent reconstruction by modified AMP technique. Modified AMP technique creates vertical tunnel with anatomical FSP.<strong></strong></p><p class="abstract"><strong>Results:</strong> Mean postoperative Lysholm score is 94.4±1.22 and mean postoperative subjective IKDC score is 93.308. All the cases of ACL tear reported their knees as normal or near normal according to objective IKDC score after reconstruction. Mean coronal angle is 51.112±6.3 and mean femoral tunnel length is 41.8±3.55 mm while posterior wall blowout of lateral femoral condyle and postero lateral structure injury has not been observed.</p><p class="abstract"><strong>Conclusions:</strong> The modified AMP technique provides an anatomic and safe mode with vertical tunnel and oblique graft, by reduces the risks involved in the AMP technique.</p>

scholarly journals Anterolateral ligament of the knee: back to the future in anterior cruciate ligament reconstruction

2015 ◽  
Vol 7 (2) ◽  
Author(s):  
Davide Edoardo Bonasia ◽  
Andrea D'Amelio ◽  
Pietro Pellegrino ◽  
Federica Rosso ◽  
Roberto Rossi
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Double Bundle ◽  
Anterolateral Ligament ◽  
Rotational Instability ◽  
Small Subset ◽  
Acl Injuries ◽  
Anterior Cruciate ◽  
Double Bundle Acl Reconstruction

Although the importance of the anterolateral stabilizing structures of the knee in the setting of anterior cruciate ligament (ACL) injuries has been recognized since many years, most of orthopedic surgeons do not take into consideration the anterolateral structures when performing an ACL reconstruction. Anatomic single or double bundle ACL reconstruction will improve knee stability, but a small subset of patients may experience some residual anteroposterior and rotational instability. For this reason, some researchers have turned again towards the anterolateral aspect of the knee and specifically the anterolateral ligament. The goal of this review is to summarize the existing knowledge regarding the anterolateral ligament of the knee, including anatomy, histology, biomechanics and imaging. In addition, the most common anterolateral reconstruction/tenodesis techniques are described together with their respective clinical outcomes.

Lateral Augmentation Procedures in Anterior Cruciate Ligament Reconstruction: Anatomic, Biomechanical, Imaging, and Clinical Evidence

2018 ◽  
Vol 47 (3) ◽  
pp. 740-752 ◽  
Author(s):  
Alexander E. Weber ◽  
William Zuke ◽  
Erik N. Mayer ◽  
Brian Forsythe ◽  
Alan Getgood ◽  
...  
Keyword(s):  
Systematic Review ◽  
Anterior Cruciate Ligament ◽  
Clinical Outcomes ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Surgical Techniques ◽  
Rotational Instability ◽  
Imaging Diagnostics ◽  
Cruciate Ligament Reconstruction ◽  
Anterior Cruciate

Background: There has been an increasing interest in lateral-based soft tissue reconstructive techniques as augments to anterior cruciate ligament reconstruction (ACLR). The objective of these procedures is to minimize anterolateral rotational instability of the knee after surgery. Despite the relatively rapid increase in surgical application of these techniques, many clinical questions remain. Purpose: To provide a comprehensive update on the current state of these lateral-based augmentation procedures by reviewing the origins of the surgical techniques, the biomechanical data to support their use, and the clinical results to date. Study Design: Systematic review. Methods: A systematic search of the literature was conducted via the Medline, EMBASE, Scopus, SportDiscus, and CINAHL databases. The search was designed to encompass the literature on lateral extra-articular tenodesis (LET) procedures and the anterolateral ligament (ALL) reconstruction. Titles and abstracts were reviewed for relevance and sorted into the following categories: anatomy, biomechanics, imaging/diagnostics, surgical techniques, and clinical outcomes. Results: The search identified 4016 articles. After review for relevance, 31, 53, 27, 35, 45, and 78 articles described the anatomy, biomechanics, imaging/diagnostics, surgical techniques, and clinical outcomes of either LET procedures or the ALL reconstruction, respectively. A multitude of investigations were available, revealing controversy in addition to consensus in several categories. The level of evidence obtained from this search was not adequate for systematic review or meta-analysis; thus, a current concepts review of the anatomy, biomechanics, imaging, surgical techniques, and clinical outcomes was performed. Conclusion: Histologically, the ALL appears to be a distinct structure that can be identified with advanced imaging techniques. Biomechanical evidence suggests that the anterolateral structures of the knee, including the ALL, contribute to minimizing anterolateral rotational instability. Cadaveric studies of combined ACLR-LET procedures demonstrated overconstraint of the knee; however, these findings have yet to be reproduced in the clinical literature. The current indications for LET augmentation in the setting of ACLR and the effect on knee kinematic and joint preservation should be the subject of future research.

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