Minimally invasive anatomic reconstruction of the anterolateral ligament with ipsilateral gracilis tendon: a kinematic in‐vitro study
Abstract Purpose The anterolateral ligament (ALL) has been defined as a key stabilizer of internal tibial rotation at 35° or more of knee flexion, with a minimal primary or secondary stabilizing role in the AP direction. This study aimed to demonstrate that anatomical reconstruction of the ALL confe...
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| Format: | Article |
| Language: | English |
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Wiley
2022-01-01
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| Series: | Journal of Experimental Orthopaedics |
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| Online Access: | https://doi.org/10.1186/s40634-022-00543-2 |
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| author | Giulio Maria Marcheggiani Muccioli Vito Gaetano Rinaldi Marcello Zappia Giada Lullini Simone Bignozzi Stefano Zaffagnini Giovanni Felice Trinchese |
| author_facet | Giulio Maria Marcheggiani Muccioli Vito Gaetano Rinaldi Marcello Zappia Giada Lullini Simone Bignozzi Stefano Zaffagnini Giovanni Felice Trinchese |
| author_sort | Giulio Maria Marcheggiani Muccioli |
| collection | DOAJ |
| description | Abstract Purpose The anterolateral ligament (ALL) has been defined as a key stabilizer of internal tibial rotation at 35° or more of knee flexion, with a minimal primary or secondary stabilizing role in the AP direction. This study aimed to demonstrate that anatomical reconstruction of the ALL confers rotational stability equal to that of the uninjured knee. Hypothesis: anteroposterior (AP) and rotatory laxity will significantly vary after ALL tenotomy and ALL reconstruction with the author’s previously described technique. Methods After ultrasound (US) ALL identification, different kinematic measurements were performed with an image‐less Computer‐Assisted Navigation System with dedicated software for Laxity Analysis in 5 knee specimens. Anteroposterior (AP) translations and varus/valgus (VV) and Internal‐External (IE) rotations were evaluated by two trained orthopedic surgeons before ALL section, after ALL section, and after ALL anatomical reconstruction with doubled ipsilateral autologous gracilis tendon. Results ALL resection significantly increased laxity in IE rotations with knee 90° flexed (IE90) and AP translation with tibia internally rotated and the knee 30° flexed (APlat) (p < 0.05). ALL reconstruction significantly reduced laxity in IE90 and APlat (p < 0.05) and reduced VV rotations at 30° of flexion (VV30) (p < 0.05). There were no statistically significant elongation differences between native ALL and reconstructed ALL (graft) during laxity tests. The inter‐operator repeatability of the tests was excellent for each measurement. Conclusions ALL acted as an important internal tibial rotation restrain at 90° and a significant (secondary) AP stabilizer at 30° of knee flexion. The presented ALL reconstruction technique significantly restored the increase of knee laxity produced by the ALL section. Scientific level Case‐Controlled Laboratory Study, Level III. |
| format | Article |
| id | doaj-art-9cc1efa3fdef461ebeeba2f1b609a2e9 |
| institution | OA Journals |
| issn | 2197-1153 |
| language | English |
| publishDate | 2022-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Experimental Orthopaedics |
| spelling | doaj-art-9cc1efa3fdef461ebeeba2f1b609a2e92025-08-20T02:24:25ZengWileyJournal of Experimental Orthopaedics2197-11532022-01-0191n/an/a10.1186/s40634-022-00543-2Minimally invasive anatomic reconstruction of the anterolateral ligament with ipsilateral gracilis tendon: a kinematic in‐vitro studyGiulio Maria Marcheggiani Muccioli0Vito Gaetano Rinaldi1Marcello Zappia2Giada Lullini3Simone Bignozzi4Stefano Zaffagnini5Giovanni Felice Trinchese6II Clinica Ortopedica e Traumatologica IRCCS Istituto Ortopedico Rizzoli Bologna ItalyII Clinica Ortopedica e Traumatologica IRCCS Istituto Ortopedico Rizzoli Bologna ItalyDepartment of Medicine and Health Science University of Molise Campobasso ItalyDIBINEM University of Bologna via di Barbiano, 1/10 – c/o Lab Biomeccanica ed Innovazione Tecnologica 40136 Bologna ItalyOrthokey Srl Florence ItalyII Clinica Ortopedica e Traumatologica IRCCS Istituto Ortopedico Rizzoli Bologna ItalyDepartment of Orthopaedics and Traumatology Villa Malta Hospital Sarno SA ItalyAbstract Purpose The anterolateral ligament (ALL) has been defined as a key stabilizer of internal tibial rotation at 35° or more of knee flexion, with a minimal primary or secondary stabilizing role in the AP direction. This study aimed to demonstrate that anatomical reconstruction of the ALL confers rotational stability equal to that of the uninjured knee. Hypothesis: anteroposterior (AP) and rotatory laxity will significantly vary after ALL tenotomy and ALL reconstruction with the author’s previously described technique. Methods After ultrasound (US) ALL identification, different kinematic measurements were performed with an image‐less Computer‐Assisted Navigation System with dedicated software for Laxity Analysis in 5 knee specimens. Anteroposterior (AP) translations and varus/valgus (VV) and Internal‐External (IE) rotations were evaluated by two trained orthopedic surgeons before ALL section, after ALL section, and after ALL anatomical reconstruction with doubled ipsilateral autologous gracilis tendon. Results ALL resection significantly increased laxity in IE rotations with knee 90° flexed (IE90) and AP translation with tibia internally rotated and the knee 30° flexed (APlat) (p < 0.05). ALL reconstruction significantly reduced laxity in IE90 and APlat (p < 0.05) and reduced VV rotations at 30° of flexion (VV30) (p < 0.05). There were no statistically significant elongation differences between native ALL and reconstructed ALL (graft) during laxity tests. The inter‐operator repeatability of the tests was excellent for each measurement. Conclusions ALL acted as an important internal tibial rotation restrain at 90° and a significant (secondary) AP stabilizer at 30° of knee flexion. The presented ALL reconstruction technique significantly restored the increase of knee laxity produced by the ALL section. Scientific level Case‐Controlled Laboratory Study, Level III.https://doi.org/10.1186/s40634-022-00543-2Anterolateral ligamentKnee jointAnatomical reconstructionIn‐vitro studyLaxityKinematics |
| spellingShingle | Giulio Maria Marcheggiani Muccioli Vito Gaetano Rinaldi Marcello Zappia Giada Lullini Simone Bignozzi Stefano Zaffagnini Giovanni Felice Trinchese Minimally invasive anatomic reconstruction of the anterolateral ligament with ipsilateral gracilis tendon: a kinematic in‐vitro study Journal of Experimental Orthopaedics Anterolateral ligament Knee joint Anatomical reconstruction In‐vitro study Laxity Kinematics |
| title | Minimally invasive anatomic reconstruction of the anterolateral ligament with ipsilateral gracilis tendon: a kinematic in‐vitro study |
| title_full | Minimally invasive anatomic reconstruction of the anterolateral ligament with ipsilateral gracilis tendon: a kinematic in‐vitro study |
| title_fullStr | Minimally invasive anatomic reconstruction of the anterolateral ligament with ipsilateral gracilis tendon: a kinematic in‐vitro study |
| title_full_unstemmed | Minimally invasive anatomic reconstruction of the anterolateral ligament with ipsilateral gracilis tendon: a kinematic in‐vitro study |
| title_short | Minimally invasive anatomic reconstruction of the anterolateral ligament with ipsilateral gracilis tendon: a kinematic in‐vitro study |
| title_sort | minimally invasive anatomic reconstruction of the anterolateral ligament with ipsilateral gracilis tendon a kinematic in vitro study |
| topic | Anterolateral ligament Knee joint Anatomical reconstruction In‐vitro study Laxity Kinematics |
| url | https://doi.org/10.1186/s40634-022-00543-2 |
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