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 Extra-Articular Lateral Tenodesis for Anterior Cruciate Ligament Deficient Knee: A Case Report

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Diego García-Germán ◽  
Pablo Menéndez ◽  
Samuel González ◽  
Pablo de la Cuadra ◽  
Ricardo Rodríguez-Arozena
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Rotational Stability ◽  
Rotational Instability ◽  
Acl Graft ◽  
Graft Rupture ◽  
Lateral Tenodesis ◽  
Sporting Activities ◽  
Anterior Cruciate ◽  
Deficient Knee

We present the case of an extra-articular lateral tenodesis for an anterior cruciate ligament (ACL) deficient knee. A 46-year-old male patient sustained an ACL graft rupture after a motorcycle accident. He complained of rotational instability and giving-way episodes. His previous graft was fixed by an intra-articular femoral staple that was not possible to remove at the time of the ACL revision. A modified Lemaire procedure was then performed. He gained rotational stability and was able to resume his sporting activities. We believe that isolated extra-articular reconstructions may still have a role in selected indications including moderate-demand patients complaining of rotational instability after ACL graft failure.

Radiological Identification of Injury to the Kaplan Fibers of the Iliotibial Band in Association With Anterior Cruciate Ligament Injury

2020 ◽  
Vol 48 (9) ◽  
pp. 2213-2220
Author(s):  
Lachlan M. Batty ◽  
Jerome Murgier ◽  
Julian A. Feller ◽  
Richard O’Sullivan ◽  
Kate E. Webster ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Lateral Collateral Ligament ◽  
Acl Injury ◽  
Iliotibial Band ◽  
Time Interval ◽  
Collateral Ligament ◽  
Tibial Bone ◽  
Mri Scans ◽  
Anterior Cruciate

Background: Recent biomechanical studies have demonstrated that the Kaplan fibers (KFs) of the iliotibial band play a role in the control of anterolateral rotation of the knee. However, controversy exists regarding whether the KFs are injured in conjunction with anterior cruciate ligament (ACL) injury. Purpose: To establish the prevalence of radiological injury to the KFs in the ACL-injured knee; to evaluate the effect of the time interval between injury and magnetic resonance imaging (MRI) on diagnosis of KF injury; and to assess for any association between KF injury and other qualitative radiological findings. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Preoperative MRI scans were reviewed for 161 patients with ACL injury. Specific diagnostic criteria were developed and applied to identify KF injury. Chi-square testing was performed to look for associations among KF injury, the time from injury to MRI, and associated radiological knee injuries. Results: Radiological evidence of KF injury was identified in 30 (18.6%) patients. The diagnosis of KF injury was higher in patients who had MRI scans performed within 90 days of injury as compared with ≥90 days after injury (23.7 vs 6.4%; P = .010). Patients with an MRI diagnosis of KF injury had significantly higher rates of lateral meniscal injury (40% vs 18%; P = .007), posteromedial tibial bone marrow edema (73% vs 44%; P = .003), and injury to the lateral collateral ligament (13% vs 3%; P = .019) or medial collateral ligament (23% vs 8%; P = .019). Conclusion: The prevalence of injury to the KF in patients with ACL injury as diagnosed by MRI was relatively low (18.6% of patients). However, the time interval from injury to MRI was relevant to diagnosis, with significantly higher rates of injury identification in patients with early (within 90 days) versus delayed (≥90 days) MRI. KF injury was associated with higher rates of injury to the lateral meniscal and collateral ligaments, as well as posteromedial tibial bone bruising.

scholarly journals Lateral Tenodesis Associated With an Intra-articular Anterior Cruciate Ligament Reconstruction Without Proximal Disinsertion of Iliotibial Band

2019 ◽  
Vol 8 (10) ◽  
pp. e1217-e1221
Author(s):  
Helder Rocha da Silva Araújo ◽  
José Leonardo Rocha de Faria ◽  
Renan Simões Heyn ◽  
Ulbiramar Correia da Silva Filho ◽  
Eduardo Branco de Sousa ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Anterior Cruciate Ligament Reconstruction ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Iliotibial Band ◽  
Cruciate Ligament Reconstruction ◽  
Lateral Tenodesis ◽  
Anterior Cruciate

scholarly journals Rotational knee instability, Extra articular technique

2018 ◽  
Vol 6 (12_suppl5) ◽  
pp. 2325967118S0020
Author(s):  
Miguel Lapera ◽  
Facundo Gigante ◽  
Manuel Perez Zabala ◽  
Esteban Adjigogovic ◽  
Francisco Sylvester ◽  
...  
Keyword(s):  
Cruciate Ligament ◽  
Double Bundle ◽  
Rotational Instability ◽  
Inclusion Criteria ◽  
Lateral Tenodesis ◽  
The Mean ◽  
Anterior Cruciate ◽  
Grade 3 ◽  
Mean Time

Objectives: The Associated Extra-Articular Technique (AET) with Lateral Tenodesis (LT) to the current techniques of intra-articular reconstruction of the Anterior Cruciate Ligament (ACL) could potentially improve the laxity of the knee and act synergically in controlling the phenomenon of the pivot displacement in cases of severe rotational instability. Methods: Twenty-two consecutive patients were selected who met all the inclusion criteria and underwent reconstruction of the ACL with double bundle and AET between February 2012 and May 2013. The inclusion criteria in this study was the presence of moderate to severe rotational instability as revealed by a score of pivot test of 2 to 3 (on a scale ranging from 0 = negative, to 3 = subluxation). The least time between trauma and surgery was 3 months, and average age under 40 years old. Results: The mean time of follow-up was 32.4 ± 3.9 months. In all cases, the Lysholm and IKDC test scores improved significantly (p <0.0001). The differential laxity above the average was 8 ± 1.9 mm before surgery and significantly reduced to 0.7 ± 0.8 mm at the last follow-up (p <0.0001). Prior to surgery, patients had a Grade 3 Pivot Shift according to the IKDC criteria. After surgery, 15 patients had turned to a negative Pivot (Grade 0), and 7 patients were Grade 1. Conclusion: The lateral extra-articular reconstruction is generally used to control the internal rotation laxity of the tibia, and we are convinced that the combination of the LT with the reconstruction of the double bundle LCA would reduce the rotational translation during the pivot test.

Association Between Radiological Evidence of Kaplan Fiber Injury, Intraoperative Findings, and Pivot-Shift Grade in the Setting of Acute Anterior Cruciate Ligament Injury

2021 ◽  
Vol 49 (5) ◽  
pp. 1262-1269
Author(s):  
Brian M. Devitt ◽  
Ian Al’khafaji ◽  
Nicola Blucher ◽  
Lachlan M. Batty ◽  
Jerome Murgier ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Pivot Shift ◽  
Cruciate Ligament ◽  
Group Versus ◽  
Acl Injury ◽  
Iliotibial Band ◽  
Rotatory Laxity ◽  
Radiological Evidence ◽  
Anterior Cruciate ◽  
Grade 3

Background: Biomechanical studies have suggested that the Kaplan fibers (KFs) of the iliotibial band play a role in controlling anterolateral rotation of the knee. There is a paucity of clinical information on whether injury to the KF in the setting of anterior cruciate ligament (ACL) rupture contributes to increased rotatory laxity of the knee. Purpose/Hypothesis: The purpose was to evaluate the association among radiological evidence of KF injury, intraoperative arthroscopic findings, and grade of pivot shift at the time of ACL reconstruction (ACLR). It was hypothesized that KF injury would be associated with increased injury to the lateral compartment of the knee and a higher grade of pivot shift. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective magnetic resonance imaging (MRI) analysis was conducted on 267 patients with ACL-injured knees who underwent primary ACLR. Patients who had MRI and surgery within 60 days of injury were included (mean age, 23.6 years); there were 158 (59.2%) male patients. MRI was performed using standard knee protocols, and diagnostic criteria were applied to identify KF injury. Associations were made among MRI findings, intraoperative findings, and grade of pivot shift with the patient examined under anesthesia at the time of ACLR. A comparison was made between patients with and without radiological evidence of KF injury. Results: The prevalence of KF injury was 17.6% (47/267 patients). Arthroscopic evidence of lateral meniscal injury was associated with KF injury (KF intact, 31%; KF injured, 55%; P = .010). The majority of patients in the intact and injured KF groups had a grade 2 pivot shift (75% and 70%, respectively). A minority had grade 3 pivot shift: 5% in the intact group versus 6.4% in the injured group. There was no association between radiological evidence of KF injury and pivot-shift grade ( P = .600). Conclusion: In acute ACL injury, KF injuries were not very common (17.6%), and the rate of grade 3 pivot shift was low (5.2%). When present, KF injuries were not associated with a higher-grade pivot shift. However, there was an association between KF injury and lateral meniscal tears identified at the time of ACLR. The role of KFS in controlling anterolateral rotatory laxity in the acute ACL injury in the clinical setting may be less evident when compared with the biomechanical setting.

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 Complications Using Bioabsorbable Cross-Pin Femoral Fixation: A Case Report and Review of the Literature

2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
Saqib Hasan ◽  
Samir Nayyar ◽  
Ikemefuna Onyekwelu ◽  
Kunal Kalra ◽  
Soterios Gyftopoulos ◽  
...  
Keyword(s):  
Case Report ◽  
Cruciate Ligament ◽  
Fixation Strength ◽  
Iliotibial Band ◽  
Viable Option ◽  
Femoral Fixation ◽  
Clinical Complications ◽  
Patient Status ◽  
Anterior Cruciate ◽  
Iliotibial Band Friction Syndrome

The use of bioabsorbable cross-pin transcondylar fixation has remained a viable option for femoral fixation in anterior cruciate ligament reconstruction. Although numerous biomechanical studies have demonstrated high fixation strength and minimal slippage with use of this method of fixation, there have been increasing reports of a variety of clinical complications associated with these implants. We reviewed the literature for all complications associated with the Bio-TransFix implant and present a case report of a patient status after ACL reconstruction using Bio-TransFix cross-pin femoral fixation with iliotibial band friction syndrome from a broken cross-pin four month post-operatively.

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