Function and strain of the anterolateral ligament part I: biomechanical analysis.

Authors:
Oliver Kessler
Oliver Kessler
University of Zurich
Switzerland
Wolfgang Franz
Wolfgang Franz
Ludwig-Maximilians-University
Germany
Maren Freutel
Maren Freutel
University of Ulm
Germany

Knee Surg Sports Traumatol Arthrosc 2017 Apr 3;25(4):1132-1139. Epub 2017 Mar 3.

Institute of Orthopedic Research and Biomechanics, Trauma Research Center, University of Ulm-Medical Center, Helmholtzstraße 14, 89081, Ulm, Germany.

Purpose: Because reconstruction of the anterior cruciate ligament (ACL) in a double-bundle technique did not solve the problem of persistent rotatory laxity after surgery, new potential answers to this issue are of great interest. One of these is an extraarticular stabilization based on the rediscovery of the anterolateral ligament (ALL). Knowledge about its biomechanical function and benchmark data for an optimal reconstruction remain lacking. Therefore, the purpose of this study was to assess the function of the ALL under passive motion, anterior tibial translation and tibial rotational moments.

Methods: Continuous passive motion (0°-120° flexion), ap-translation and static pivot shift tests were performed on eight cadaveric knees. The knees were measured in intact, ACL-resected (ACL) and ACL + ALL-resected (ALL) conditions. Ap-translation and static pivot shift under 134 N anterior shear load were determined at 0°, 30°, 60° and 90° flexion. Strain of the ALL was recorded in intact and ACL conditions.

Results: During continuous passive motion under unloaded conditions, no significant difference in internal rotation between ACL and ALL was observed. With an additional internal tibial torque of 1-4 Nm, internal rotation increased significantly between 60° and 120° after resection of the ALL (p ≤ 0.05). Anterior tibial translation was significantly higher at 30° in ALL (p = 0.01) and for a simulated pivot shift at 60° and 90° in ACL (p ≤ 0.01). The ALL was not strained under unloaded passive motion. Adding different internal tibial torques led to strain starting at 60° flexion (1 N m internal torque) and 15° flexion (4 N m internal torque) in intact ligaments. In ACL, significantly greater ALL strains under lower flexion angles were seen for each condition (p ≤ 0.05).

Conclusions: This study demonstrated the ALL to be without function under passive motion and with no influence on tibial rotation. On application of extrinsic loads, the ALL had a low but significant stabilizing effect against anterior tibial shear load at low flexion angles. For this reason, it can be concluded that the ALL is supporting the ACL against internal tibial loads to a minor degree. A relationship between the ALL and the pivot shift cannot be concluded. With these results ALL-reconstruction cannot be recommended at the moment without further biomechanical investigations.

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00167-017-4472-3DOI Listing

Still can't find the full text of the article?

We can help you send a request to the authors directly.
April 2017
26 Reads

Article Mentions


Provided by Crossref Event Data
twitter
Twitter: VolkerMusahl
April 14, 2017, 9:03 pm EST
twitter
Twitter: DebbourSaid
April 14, 2017, 3:22 pm EST
twitter
Twitter: KSSTA
April 14, 2017, 6:26 am EST

Publication Analysis

Top Keywords

passive motion
20
pivot shift
16
anterior tibial
12
internal tibial
12
tibial translation
8
flexion angles
8
continuous passive
8
tibial
8
static pivot
8
internal rotation
8
shear load
8
function passive
8
internal torque
8
ap-translation static
8
60° 90°
8
anterolateral ligament
8
acl
7
internal
7
flexion
6
passive
5

References

(Supplied by CrossRef)
Article in Knee Surg Sports Traumatol Arthrosc
S Caterine et al.
Knee Surg Sports Traumatol Arthrosc 2014
Article in J Anat
S Claes et al.
J Anat 2013
Article in J Bone Joint Surg Am
WG Clancy et al.
J Bone Joint Surg Am 1982
Article in Arthroscopy
M Daggett et al.
Arthroscopy 2016
Article in Bone Joint J
AL Dodds et al.
Bone Joint J 2014
Article in Am J Sports Med
L Dürselen et al.
Am J Sports Med 2011
Article in J Bone Joint Surg Am
AE Ellison et al.
J Bone Joint Surg Am 1979
Article in Am J Sports Med
L Engebretsen et al.
Am J Sports Med 1990
Article in Arthroscopy
M Ferretti et al.
Arthroscopy 2007
Article in Am J Sports Med
RE Fleming et al.
Am J Sports Med 1983
Article in Knee Surg Sports Traumatol Arthrosc
FH Fu et al.
Knee Surg Sports Traumatol Arthrosc 2015

Similar Publications