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ACL Reconstruction in Combination with an Extra-articular Tenodesis
Rotatory instability of the knee is very often associated with the antero-posterior laxity in the ACL deficient knee and it is most probably caused by lesions of the anterolateral structures such the capsule and the anterolateral ligament. If underdiagnosed or undertreated with isolated ACL reconstruction this residual instability may lead to re-injury of premature arthritis.This manuscript focuses on the role of lateral extra-articular tenodesis (LET) in re-establishing dynamic stability when performed together with ACL reconstruction; then it describes our preferred surgical technique, which always associates ACL and LET...
Source: Operative Techniques in Orthopaedics - March 6, 2017 Category: Orthopaedics Authors: Stefano Zaffagnini, Tommaso Roberti Di Sarsina, Luca Macchiarola, Alberto Grassi, Federico Raggi, Cecilia Signorelli, Maurilio Marcacci Source Type: research

Editorial Board
(Source: Operative Techniques in Orthopaedics)
Source: Operative Techniques in Orthopaedics - March 1, 2017 Category: Orthopaedics Source Type: research

Table of Contents
(Source: Operative Techniques in Orthopaedics)
Source: Operative Techniques in Orthopaedics - March 1, 2017 Category: Orthopaedics Source Type: research

Contributors
(Source: Operative Techniques in Orthopaedics)
Source: Operative Techniques in Orthopaedics - March 1, 2017 Category: Orthopaedics Source Type: research

Anterolateral Complex Reconstruction: Who, When, and How?
Anterior translation and rotatory laxity of the knee joint is the result of an anterior cruciate ligament (ACL) rupture. The goal of ACL reconstruction is to restore normal knee biomechanics. Abnormal knee kinematics have been thought to be one of the primary factors in the progression toward osteoarthritis after ACL reconstruction. It has been demonstrated that even with a well-performed single or double bundle ACL reconstruction rotatory laxity can persist. This persistent rotatory laxity is one of the reasons to the recent international focus on the stabilizing role of the anterolateral complex in the knee. (Source: Ope...
Source: Operative Techniques in Orthopaedics - February 24, 2017 Category: Orthopaedics Authors: Aad Dhollander, Alan Getgood Source Type: research

Anterolateral Complex Reconstruction – Who, When and How?
Anterior translation and rotatory laxity of the knee joint is the result of an anterior cruciate ligament (ACL) rupture. The goal of ACL reconstruction is to restore normal knee biomechanics. Abnormal knee kinematics have been thought to be one of the primary factors in the progression towards osteoarthritis after ACL reconstruction. It has been demonstrated that even with a well-performed single or double bundle ACL reconstruction rotatory laxity can persist. This persistent rotatory laxity is one of the reasons to the recent international focus on the stabilizing role of the anterolateral complex in the knee. (Source: Op...
Source: Operative Techniques in Orthopaedics - February 23, 2017 Category: Orthopaedics Authors: Aad Dhollander, Alan Getgood Source Type: research

Biomechanical Role of Lateral Structures in Controlling Anterolateral Rotatory Laxity: The Iliotibial Tract
Recent research, focusing on rotatory knee laxity, has intrigued the whole orthopaedic knee community. First popularized by Hughston et al, peripheral knee injuries at the time of cruciate ligament rupture have regained more and more recognition, which has led to a better understanding of these injuries. Recent research has been focused on anterolateral rotatory instability, especially regarding those structures that are responsible for the high-grade anterior subluxation of the lateral tibial plateau when damaged. (Source: Operative Techniques in Orthopaedics)
Source: Operative Techniques in Orthopaedics - February 23, 2017 Category: Orthopaedics Authors: Christoph Kittl, Andy Williams, Andrew A. Amis Source Type: research

Individualizing the Return to Sports After Anterior Cruciate Ligament Reconstruction
Because of the epidemiological incidence of anterior cruciate ligament (ACL) injuries, the high reinjury rates that occur when returning back to sports, the actual number of patients who return to the same premorbid level of competition, the high incidence of osteoarthritis at 5-10 year follow-ups and the effects on the long-term health of the knee and the quality of life for the patient, individualizing the return to sports after ACL reconstruction (ACL-R) is critical. However, one of the challenging but unsolved dilemmas, is what criteria and clinical decision making should be used to return an athlete back to sports fol...
Source: Operative Techniques in Orthopaedics - February 23, 2017 Category: Orthopaedics Authors: George J. Davies Source Type: research

Biomechanical Role of Lateral Structures in Controlling Anterolateral Rotatory Laxity: The Anterolateral Ligament
Recent renewed interest in the anatomy of the anterolateral complex of the knee, combined with concern regarding persistent instability after anterior cruciate ligament reconstruction, has led to an expansion of the literature on the biomechanics of many structures of the anterolateral complex of the knee. A review of the clinical significance and the key biomechanical principles concerning this region is performed. The primary and secondary roles of key anatomical structures, with a specific emphasis on the anterolateral ligament, along with length change patterns and implications on anterolateral complex-based reconstruc...
Source: Operative Techniques in Orthopaedics - February 23, 2017 Category: Orthopaedics Authors: Jorge Chahla, Gilbert Moatshe, Andrew G. Geeslin, Robert F. LaPrade Source Type: research

Secondary Stabilizers of the Anterior Cruciate Ligament —Deficient Knee
Eliminating rotatory knee instability during anterior cruciate ligament (ACL) reconstruction surgery is crucial to ensure patients return to normal function after ACL injury. Although the ACL is generally considered the primary soft tissue restraint to anteroposterior laxity of the knee, several additional structures, such as the anterolateral complex of the knee, lateral and medial menisci and their capsular attachments, posterolateral corner structures, and collateral ligaments, also play important roles in knee stability. (Source: Operative Techniques in Orthopaedics)
Source: Operative Techniques in Orthopaedics - February 23, 2017 Category: Orthopaedics Authors: Ata A. Rahnemai-Azar, Jason Zlotnicki, Jeremy M. Burnham, Daniel Guenther, Ashish Soni, Richard E. Debski, Volker Musahl Source Type: research

The Anterolateral Complex —Why all the Fuss?
The world of anterior cruciate ligament (ACL) surgery continues to evolve at a steady pace. In 1916, Hey Groves of Bristol performed the first ACL reconstruction with an intra-articular fascia lata graft to address anterior tibial translation.1 The concept of anterolateral tibial subluxation was first addressed by Strickler in 1937, and later by Lemaire (1960) and MacIntosh (1970s), using the lateral extra-articular tenodesis, a method of controlling internal rotation without addressing the intra-articular ACL pathology. (Source: Operative Techniques in Orthopaedics)
Source: Operative Techniques in Orthopaedics - February 23, 2017 Category: Orthopaedics Authors: Alan Getgood, Elmar Herbst Source Type: research

Magnetic Resonance Imaging Analysis of the Anterolateral Complex of the Knee
This article reviews the historical perspectives and the normal and pathologic aspects of the anterolateral complex of the knee, consisting of the iliotibial tract, the lateral collateral ligament, the biceps tendon, and the anterolateral ligament, including the causative structures of the Segond fracture. (Source: Operative Techniques in Orthopaedics)
Source: Operative Techniques in Orthopaedics - February 23, 2017 Category: Orthopaedics Authors: Camilo Partezani Helito, Paulo Victor Partezani Helito Source Type: research

Repair of the Anterolateral Structures in the Acutely Injured Anterior Cruciate Ligament
Repair of the acutely injured anterolateral complex is a surgical procedure justified by biomechanical studies, surgical findings, and clinical results. In a lack of specific radiological protocols able to reliably detect such injuries, indications are still related to the degree of pivot test, as evaluated preoperatively under anesthesia (explosive pivot shift). Repair techniques, to be always performed along with an anterior cruciate ligament reconstruction, are simple procedures strictly related to the type of injury. (Source: Operative Techniques in Orthopaedics)
Source: Operative Techniques in Orthopaedics - February 23, 2017 Category: Orthopaedics Authors: Andrea Ferretti Source Type: research

Layer-by-Layer Anatomy of the Anterolateral Complex of the Knee
Injuries to the anterior cruciate ligament (ACL) can be associated with anterolateral capsular injuries. Recently, these capsular tears have been suggested to play an important role in rotatory knee instability. A critical review of the anterolateral complex of the knee is necessary to clarify nomenclatures of same structures and the complex anatomy of anterolateral side of the knee. In addition to the lateral collateral ligament and the arcuate complex, the iliotibial band (ITB) is an important lateral structure. (Source: Operative Techniques in Orthopaedics)
Source: Operative Techniques in Orthopaedics - February 22, 2017 Category: Orthopaedics Authors: Elmar Herbst, Jeremy M. Burnham, Marcio Albers, Volker Musahl, Freddie H. Fu Source Type: research

Biomechanical Role of Lateral Structures in Controlling Anterolateral Rotatory Laxity - The ITB
Recent research, focusing on rotatory knee laxity, has intrigued the whole orthopaedic knee community. First popularized by Hughston et al. peripheral knee injuries at the time of cruciate ligament rupture have regained more and more recognition, which has led to a better understanding of these injuries. Recent research has been focused on anterolateral rotatory instability, especially regarding which structures are responsible for the high-grade anterior subluxation of the lateral tibial plateau when damaged. (Source: Operative Techniques in Orthopaedics)
Source: Operative Techniques in Orthopaedics - February 22, 2017 Category: Orthopaedics Authors: Christoph Kittl, Andy Williams, Andrew A. Amis Source Type: research