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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 ACL 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 reconstruction are reviewed. (Sou...
Source: Operative Techniques in Orthopaedics - February 22, 2017 Category: Orthopaedics Authors: Jorge Chahla, Gilbert Moatshe, Andrew Geeslin, Robert F. LaPrade Source Type: research

Secondary Stabilizers of the ACL 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. While the ACL is generally considered the primary soft tissue restraint to antero-posterior 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 22, 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

MRI Analysis of the Anterolateral Complex of the Knee
This article reviews the historical perspectives and the normal and pathological 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 22, 2017 Category: Orthopaedics Authors: Camilo Partezani Helito, Paulo Victor Partezani Helito Source Type: research

Ultrasonographic Visualization of Anterolateral Complex of the Knee
The anterolateral ligament (ALL) of the knee attracted much attention when a cadaveric dissection study using embalmed specimens described a discreet, constant ligamentous structure. Further multi-disciplinary studies of the anterolateral knee region revealed more intricate anatomy of this region, collectively best referred as the anterolateral complex (ALC) of the knee. An attempt has been made to further characterize and visualize this complex using different imaging modalities including magnetic resonance imaging (MRI) and musculoskeletal ultrasound. (Source: Operative Techniques in Orthopaedics)
Source: Operative Techniques in Orthopaedics - February 22, 2017 Category: Orthopaedics Authors: Macio Bottene Villa Albers, Masahito Yoshida, Freddie H. Fu, Kentaro Onishi Source Type: research

Historical Overview of Lateral Tenodeses Procedures and State of the Art in 2016
Since the original descriptions of the lateral capsuloligamentous complex of the knee, this structure (also known as the anterolateral ligament (ALL)) has been known to be commonly injured at the time of anterior cruciate ligament (ACL) injury. Surgeons have sought to reconstruct the ALL in ACL deficient knees with the goal of restoring normal kinematics. Numerous surgical procedures have been developed over the past 50 years to correct the pathologic anterior and rotatory laxity seen with ACL tears. (Source: Operative Techniques in Orthopaedics)
Source: Operative Techniques in Orthopaedics - February 22, 2017 Category: Orthopaedics Authors: C écile BATAILLER, Daniel WASCHER, Philippe LANDREAU, Philippe NEYRET Source Type: research

Repair of the Anterolateral Structures in the Acutely Injured ACL
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 ACL reconstruction, are simple procedures strictly related to type of injury. In type I and II tears, when a clear stretching is encountered (limited to the anterolateral capsule and ligament or extended towards...
Source: Operative Techniques in Orthopaedics - February 22, 2017 Category: Orthopaedics Authors: Andrea Ferretti Source Type: research

Individualizing the return to sports after ACL reconstruction
Because of the epidemiological incidence of anterior cruciate ligament (ACL) injuries, the high re-injury rates that occur when returning back to sports, the actual number of patients that 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 s hould be used to return an athlete back to spor...
Source: Operative Techniques in Orthopaedics - February 22, 2017 Category: Orthopaedics Authors: George J. Davies 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), utilizing 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 22, 2017 Category: Orthopaedics Authors: Alan Getgood, Elmar Herbst Source Type: research

Anterior Cruciate Ligament Augmentation for One-Bundle Tears
One-bundle anterior cruciate ligament (ACL) tears continue to pose a dilemma for orthopaedic surgeons. Though relatively rare, 1-bundle tears can be symptomatic and often evolve into complete tears. Early management of these injuries could prove invaluable to decreased injury-related morbidity. Diagnosis of these injuries relies on clinical history, examination, imaging studies, and arthroscopic evaluation. The key to success lies in the confirmation of the diagnosis on the basis of functional symptoms. (Source: Operative Techniques in Orthopaedics)
Source: Operative Techniques in Orthopaedics - February 21, 2017 Category: Orthopaedics Authors: Humza Shaikh, Ata A. Rahnemai-Azar, Freddie H. Fu Source Type: research

ACL Augmentation for One-Bundle Tears
One-bundle Anterior cruciate ligament (ACL) tears continue to pose a dilemma for orthopaedic surgeons. Though relatively rare, one-bundle tears can be symptomatic and often evolve into complete tears. Early management of these injuries could prove invaluable to decreased injury related morbidity. Diagnosis of these injuries relies on clinical history, examination, imaging studies, and arthroscopic evaluation. The key to success lies in the confirmation of the diagnosis on the basis of functional symptoms. (Source: Operative Techniques in Orthopaedics)
Source: Operative Techniques in Orthopaedics - February 20, 2017 Category: Orthopaedics Authors: Humza Shaikh, Ata A. Rahnemai-Azar, Freddie H. Fu Source Type: research

Anatomical Double-Bundle Anterior Cruciate Ligament Reconstruction: The Chinese Experience
The double-bundle (DB) anterior cruciate ligament (ACL) reconstruction has evolved gradually and got nationwide attentions in China for 13 years. This review summarizes the experiences we have achieved since the DB ACL reconstruction was started in our country in 1998, regarding choice of grafts, surgical approach, bone tunnel placement, and fixation methods. A growing number of articles reveal that DB ACL reconstruction brings better clinical outcomes regarding the results of KT-1000, pivot-shift, and Lachman tests, International Knee Documentation Committee (IKDC) outcomes, and complications. (Source: Operative Techniques in Orthopaedics)
Source: Operative Techniques in Orthopaedics - February 1, 2017 Category: Orthopaedics Authors: Wei Lu, Juan Wang, Rui Wang, Biao Chen, Weimin Zhu, Freddie H. Fu Source Type: research

Intraoperative Landmarks for Tunnel Placement in Anatomical Anterior Cruciate Ligament Reconstruction
Anatomical anterior cruciate ligament reconstruction, which stabilizes the knee without a loss of motion, requires graft placement within anterior cruciate ligament attachment-area tunnels. Intraoperatively identifiable arthroscopic landmarks for the femoral attachment area include the resident ’s ridge, proximal cartilage margin, and posterior cartilage margin. In turn, tibial landmarks include the anterior ridge or Parson’s knob, intercondylar eminence, medial intercondylar ridge, and anterior horn of the lateral meniscus. (Source: Operative Techniques in Orthopaedics)
Source: Operative Techniques in Orthopaedics - February 1, 2017 Category: Orthopaedics Authors: Konsei Shino, Ryo Iuchi, Yuta Tachibana, Tomohiko Matsuo, Tomoki Ohori, Tatsuo Mae Source Type: research

Bony Morphology: Comparative Anatomy and its Importance for the Anterior Cruciate Ligament
Bone morphology is related to static and dynamic parameters during anterior cruciate ligament (ACL) kinematics and can affect injury mechanism patterns, gait analysis, biomechanical properties, and surgical references for ligament reconstructions. It does not only depend on mechanical factors but also reflects a developmental program with many other factor involved, including nutrition and hormones, especially those involved in the calcium metabolism. Although Wolff ׳s law continues to be a dominant paradigm in Orthopaedics, in the past 15 years enormous advances have been made that have improved our understanding of how ...
Source: Operative Techniques in Orthopaedics - February 1, 2017 Category: Orthopaedics Authors: Sheila J. McNeill Ingham, Rogerio Teixeira de Carvalho, Rene J. Abdalla, Freddie H. Fu, C. Owen Lovejoy Source Type: research

Editorial: “Individualized Anatomical Anterior Cruciate Ligament Reconstruction”
Despite humans sharing 99.9% of DNA, differences in the remaining 0.1% provide us with the rich diversity we see between populations and between sexes.1 Biological variability is inherent to mankind, and this is manifested through multiple aspects, including human anatomy itself. (Source: Operative Techniques in Orthopaedics)
Source: Operative Techniques in Orthopaedics - January 31, 2017 Category: Orthopaedics Authors: Sebasti án Irarrázaval, Ryosuke Kuroda Source Type: research

Matching the Anterior Cruciate Ligament Graft to the Patient
The aim of anterior cruciate ligament (ACL) reconstruction is to restore normal knee functioning. Key to successful ACL reconstruction understands how to match the ACL graft to the bone tunnel while taking into account interpatient variances. Bone tunnel location and size should be determined according to the original ACL footprint anatomy of each patient. Therefore, appropriate assessments of individual anatomy should be obtained before surgery using imaging techniques. Additionally, graft type should be carefully selected after fully considering biomechanical properties, donor site morbidities, patient activities and lif...
Source: Operative Techniques in Orthopaedics - January 31, 2017 Category: Orthopaedics Authors: Yuichi Hoshino, Freddie H. Fu Source Type: research