DOS Kongressen 2014 ·
71
Significant role on rotatory stability of the
anterolateral ligament in ACL insufficient knees
Mette Tavlo, Salameh Eljaja, Jørgen Tranum-Jensen, Volkert Siersma,
Michael Rindom Krogsgaard
Institut for Cellulær og Molekylær Medicin, Københavns Universitet; Afdeling
for Idrætskirurgi, Bispebjerg Hospital; Forskningsenheden for Almen Praksis,
Center for Sundhed og Samfund
Background:
Recent studies have described the anatomy of an anterolateral
ligament (ALL) of the knee. This ligament has been linked to the Segond fracture
that is patognomonic for tear of the anterior cruciate ligament (ACL). ALL is
hypothesised to be important for the internal rotatory stability of the knee, but
its mechanical effect has yet to be clarified.
Purpose / Aim of Study:
Our aim was to test the function of the ALL for rota-
tory and anterior-posterior (AP) stability in ACL insufficient and reconstructed
knees and the effect of anatomical ALL reconstruction with a tendon.
Materials and Methods:
In 18 cadaver legs ALL was dissected. Function of
ALL (+/- ALL) and of ALL reconstruction (reALL) was tested with the ACL re-
moved (-ACL) and reconstructed (+ACL) with following combinations: +ACL-
ALL, +ACL+ALL, - ACL+ALL, -ACL-ALL, -ACL+reALL and +ACL+re-ALL. All
combinations were tested with the knees in 0, 30, 60 and 90 degrees of flexion.
AP stability was tested with a Rolimeter. Rotation of tibia was applied with 50
N internal and external and measured photographically from K-wires inserted in
tibia and femur.
Findings / Results:
The ALL did not appear uniform, but was well defined in 78
%. ACL (+/-) had a significant effect on the AP stability but not on rotation. ALL
(+/-) had significant effect on the rotatory stability (p = 0.0006), regardless
of the condition of ACL, and on the AP stability in ACL insufficient knees (p =
0.023). The lost stability of ALL was regained when ALL was reconstructed.
Conclusions:
ALL is a major rotational stabilizer. If ALL is torn in connection
with ACL rupture, reconstruction of ACL is not re-establishing rotatory stability.
When ALL is reconstructed anatomically, rotatory instability is re- established.
ALL reconstruction as supplement to ACL reconstruction might be considered in
patients with a Segond fracture.
18.
