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      Anterior Cruciate Ligament and Anterolateral Ligament Reconstruction With Pedicular Hamstrings Tendon Graft, Single-Strand Gracilis for ALL and Single Blind Femoral Tunnel

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      Author(s): , M.D. a , ∗ , , M.D. b , , M.D. f , , M.D. c , , M.D. d
      Publication date (Electronic):
      Journal: Arthroscopy Techniques
      Publisher: Elsevier

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          Abstract

          Combined anterior cruciate ligament and anterolateral ligament reconstruction (ACL+ALL r) is a common procedure to treat rotational instability and to prevent ACL graft failure. Recent studies have described numerous combined reconstruction techniques to obtain the most anatomical procedure with the least graft donor site morbidity and the best clinical results.

          Hamstring (HG) grafts are the most popular graft in literature. Leaving pedicle HG can preserve enough blood supply to improve tendon-bone healing with additional mechanical fixation of the graft on the tibial side. A single femoral tunnel reduces bone loss and prevents convergence of 2 femoral tunnels. We describe an original ACL and ALL reconstruction technique that preserves hamstring tibial insertion with a single blind femoral tunnel.

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          Anatomy of the anterolateral ligament of the knee.

          Steven Claes, Evie Vereecke, Michael Maes … (2013)
          In 1879, the French surgeon Segond described the existence of a 'pearly, resistant, fibrous band' at the anterolateral aspect of the human knee, attached to the eponymous Segond fracture. To date, the enigma surrounding this anatomical structure is reflected in confusing names such as '(mid-third) lateral capsular ligament', 'capsulo-osseous layer of the iliotibial band' or 'anterolateral ligament', and no clear anatomical description has yet been provided. In this study, the presence and characteristics of Segond's 'pearly band', hereafter termed anterolateral ligament (ALL), was investigated in 41 unpaired, human cadaveric knees. The femoral and tibial attachment of the ALL, its course and its relationship with nearby anatomical structures were studied both qualitatively and quantitatively. In all but one of 41 cadaveric knees (97%), the ALL was found as a well-defined ligamentous structure, clearly distinguishable from the anterolateral joint capsule. The origin of the ALL was situated at the prominence of the lateral femoral epicondyle, slightly anterior to the origin of the lateral collateral ligament, although connecting fibers between the two structures were observed. The ALL showed an oblique course to the anterolateral aspect of the proximal tibia, with firm attachments to the lateral meniscus, thus enveloping the inferior lateral geniculate artery and vein. Its insertion on the anterolateral tibia was grossly located midway between Gerdy's tubercle and the tip of the fibular head, definitely separate from the iliotibial band (ITB). The ALL was found to be a distinct ligamentous structure at the anterolateral aspect of the human knee with consistent origin and insertion site features. By providing a detailed anatomical characterization of the ALL, this study clarifies the long-standing enigma surrounding the existence of a ligamentous structure connecting the femur with the anterolateral tibia. Given its structure and anatomic location, the ALL is hypothesized to control internal tibial rotation and thus to affect the pivot shift phenomenon, although further studies are needed to investigate its biomechanical function.
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            Long-term failure of anterior cruciate ligament reconstruction.

            S Nicholas Crawford, Brian R Waterman, James Lubowitz (2013)
            The aim of this study was to review and describe the cumulative incidence of anterior cruciate ligament (ACL) graft rupture and/or clinical objective failures at greater than 10 years after ACL reconstruction.
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              Anterolateral Ligament Expert Group consensus paper on the management of internal rotation and instability of the anterior cruciate ligament - deficient knee

              Bertrand Sonnery-Cottet, Matthew Daggett, Jean-Marie Fayard … (2017)
              Purpose of this paper is to provide an overview of the latest research on the anterolateral ligament (ALL) and present the consensus of the ALL Expert Group on the anatomy, radiographic landmarks, biomechanics, clinical and radiographic diagnosis, lesion classification, surgical technique and clinical outcomes. A consensus on controversial subjects surrounding the ALL and anterolateral knee instability has been established based on the opinion of experts, the latest publications on the subject and an exchange of experiences during the ALL Experts Meeting (November 2015, Lyon, France). The ALL is found deep to the iliotibial band. The femoral origin is just posterior and proximal to the lateral epicondyle; the tibial attachment is 21.6 mm posterior to Gerdy’s tubercle and 4–10 mm below the tibial joint line. On a lateral radiographic view the femoral origin is located in the postero-inferior quadrant and the tibial attachment is close to the centre of the proximal tibial plateau. Favourable isometry of an ALL reconstruction is seen when the femoral position is proximal and posterior to the lateral epicondyle, with the ALL being tight upon extension and lax upon flexion. The ALL can be visualised on ultrasound, or on T2-weighted coronal MRI scans with proton density fat-suppressed evaluation. The ALL injury is associated with a Segond fracture, and often occurs in conjunction with acute anterior cruciate ligament (ACL) injury. Recognition and repair of the ALL lesions should be considered to improve the control of rotational stability provided by ACL reconstruction. For high-risk patients, a combined ACL and ALL reconstruction improves rotational control and reduces the rate of re-rupture, without increased postoperative complication rates compared to ACL-only reconstruction. In conclusion this paper provides a contemporary consensus on all studied features of the ALL. The findings warrant future research in order to further test these early observations, with the ultimate goal of improving the long-term outcomes of ACL-injured patients. Level of evidence Level V—Expert opinion.
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                Author and article information

                Contributors
                Thibaut Noailles
                Journal
                Journal ID (nlm-ta): Arthrosc Tech
                Journal ID (iso-abbrev): Arthrosc Tech
                Title: Arthroscopy Techniques
                Publisher: Elsevier
                ISSN (Electronic): 2212-6287
                Publication date PMC-release: 19 June 2023
                Publication date Collection: July 2023
                Publication date (Electronic): 19 June 2023
                Volume: 12
                Issue: 7
                Pages: e1145-e1154
                Affiliations
                [a ]Département de Chirurgie Orthopédique, Polyclinique de Bordeaux Nord, Bordeaux, France
                [b ]Service de Chirurgie Orthopédique, Centre Hospitalier Départemental Vendée, La Roche-sur-Yon, France
                [c ]Département de Chirurgie Orthopédique, Polyclinique de l’Atlantique, Saint Herblain Cedex, France
                [d ]Clinique du Sport Paris V, Paris, France
                [f ]Santé Atlantique, Saint-Herblain, France
                Author notes
                [∗ ]Address correspondence to Thibaut Noailles, M.D., Département de Chirurgie Orthopédique, Polyclinique de Bordeaux Nord, 15 rue Claude-Boucher, 33000 Bordeaux, France. noaillesthibaut@ 123456yahoo.fr
                Article
                Publisher Item ID: S2212-6287(23)00079-8
                DOI: 10.1016/j.eats.2023.03.003
                PMC ID: 10390882
                PubMed ID: 37533915
                SO-VID: 1ffad983-7af0-4a53-a458-e3ae6c7d7769
                Copyright © © 2023 The Authors
                License:

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Date received : 30 December 2022
                Date revision received : 26 February 2023
                Date accepted : 2 March 2023
                Categories
                Subject: Technical Note

                Data availability:

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