Thomas Neri1, Fabien Palpacuer2, Rodolphe Testa2, Florian Bergandi3, Bertrand Boyer4, Frederic Farizon5, Remi Philippot5. 1. Department of Orthopaedic Surgery, University Hospital of Saint Etienne, Saint-Etienne, France; Univ Lyon - UJM-Saint-Etienne, Inter-university Laboratory of Human Movement Science, EA 7424, F-42023, Saint-Etienne, France. Electronic address: thomas.neri@chu-st-etienne.fr. 2. Univ Lyon - UJM-Saint-Etienne, Inter-university Laboratory of Human Movement Science, EA 7424, F-42023, Saint-Etienne, France. 3. Laboratory of Human Anatomy, Faculty of Medicine, University Hospital of Saint-Etienne, University of Saint-Etienne, Saint-Etienne, France. 4. Department of Orthopaedic Surgery, University Hospital of Saint Etienne, Saint-Etienne, France. 5. Department of Orthopaedic Surgery, University Hospital of Saint Etienne, Saint-Etienne, France; Univ Lyon - UJM-Saint-Etienne, Inter-university Laboratory of Human Movement Science, EA 7424, F-42023, Saint-Etienne, France.
Abstract
BACKGROUND: The purpose of this study was to define the best anatomic parameters with which to perform an accurate anterolateral ligament (ALL) reconstruction. These parameters were anatomical insertions, allowing favorable isometry, length variation during flexion, and anthropometric predictors of ALL lengths. METHODS: A total of 84 fresh-frozen cadaver knees were dissected to analyze the ALL, focusing on its femoral insertion. The ALL length was measured in different degrees of flexion (extension, 30°, 60°, and 90° of flexion) and rotation (neutral, internal or external rotation). The ALL width and thickness were measured. A correlation between ALL length, the general knee size and individual characteristics was investigated. RESULTS: The ALL was present in 80 specimens (95%). The femoral footprint was always posterior (5.52±0.93 mm, range 3.83-6.94) and slightly proximal (1.51±0.75mm, range 0.63-2.37) to the lateral femoral epicondyle. The mean ALL length increased with internal rotation and decreased with external rotation (P<0.05). The maximum ALL length was found at 30° of flexion, and the minimum at 90°. There was a significant correlation between the ALL length and height, sex, and proximal femur dimensions. CONCLUSION: In order to get an anatomical reconstruction with favorable isometry, it is recommended that the ALL femoral graft is implanted posterior and slightly proximal to the epicondyle. It is also suggested that the tension be adjusted by fixing the graft between 0 and 30° of flexion, being tighter near extension. This will allow good rotational stability without implying any stiffness.
BACKGROUND: The purpose of this study was to define the best anatomic parameters with which to perform an accurate anterolateral ligament (ALL) reconstruction. These parameters were anatomical insertions, allowing favorable isometry, length variation during flexion, and anthropometric predictors of ALL lengths. METHODS: A total of 84 fresh-frozen cadaver knees were dissected to analyze the ALL, focusing on its femoral insertion. The ALL length was measured in different degrees of flexion (extension, 30°, 60°, and 90° of flexion) and rotation (neutral, internal or external rotation). The ALL width and thickness were measured. A correlation between ALL length, the general knee size and individual characteristics was investigated. RESULTS: The ALL was present in 80 specimens (95%). The femoral footprint was always posterior (5.52±0.93 mm, range 3.83-6.94) and slightly proximal (1.51±0.75mm, range 0.63-2.37) to the lateral femoral epicondyle. The mean ALL length increased with internal rotation and decreased with external rotation (P<0.05). The maximum ALL length was found at 30° of flexion, and the minimum at 90°. There was a significant correlation between the ALL length and height, sex, and proximal femur dimensions. CONCLUSION: In order to get an anatomical reconstruction with favorable isometry, it is recommended that the ALL femoral graft is implanted posterior and slightly proximal to the epicondyle. It is also suggested that the tension be adjusted by fixing the graft between 0 and 30° of flexion, being tighter near extension. This will allow good rotational stability without implying any stiffness.
Authors: Emil Toft Nielsen; Kasper Stentz-Olesen; Sepp de Raedt; Peter Bo Jørgensen; Ole Gade Sørensen; Bart Kaptein; Michael Skipper Andersen; Maiken Stilling Journal: Orthop J Sports Med Date: 2018-08-10
Authors: Gloria M Hohenberger; Marco Maier; Angelika M Schwarz; Peter Grechenig; Andreas H Weiglein; Georg Hauer; Andreas Leithner; Patrick Sadoghi Journal: Sci Rep Date: 2019-07-05 Impact factor: 4.379