Combined ACL and Anterolateral Ligament Reconstruction
Adnan Saithna1,2, Mathieu Thaunat3, Jean Romain Delaloye3
1Medical Technologies and Advanced Materials, Clifton Campus, Nottingham Trent University, Nottingham, United Kingdom.
JBJS Essential Surgical Techniques
|September 21, 2018
Summary
Combined anterior cruciate ligament (ACL) and anterolateral ligament (ALL) reconstruction significantly reduces ACL graft rupture and improves return-to-sport rates. This anatomic procedure restores knee kinematics and avoids complications seen with older, nonanatomic techniques.
Area of Science:
- Orthopedic Surgery
- Sports Medicine
- Knee Biomechanics
Background:
- Isolated anterior cruciate ligament (ACL) reconstruction has high graft rupture rates and suboptimal return-to-sport outcomes.
- Lateral extra-articular tenodesis procedures aim to protect the ACL graft and restore knee kinematics.
- Historically, nonanatomic lateral extra-articular tenodesis procedures were associated with poor outcomes and complications.
Purpose of the Study:
- To evaluate the clinical efficacy of combined ACL and anterolateral ligament (ALL) reconstruction.
- To compare the outcomes of combined ACL and ALL reconstruction with isolated ACL reconstruction.
- To assess the impact of anatomic ALL reconstruction on ACL graft integrity and patient return to sports.
Main Methods:
- ACL graft constructed from semitendinosus and gracilis tendons.
- Anatomic femoral tunnel placement for ACL reconstruction.
- Anatomic ALL reconstruction using gracilis tendon routed under the iliotibial band through a tibial tunnel.
Main Results:
- Combined ACL and ALL reconstruction significantly reduces ACL graft rupture rates compared to isolated ACL reconstruction.
- Patients undergoing combined ACL and ALL reconstruction demonstrate improved rates of return to sports.
- Anatomic ALL reconstruction restores normal knee kinematics and avoids overconstraint, unlike older nonanatomic techniques.
Conclusions:
- Combined anatomic ACL and ALL reconstruction is superior to isolated ACL reconstruction for reducing graft failure and improving functional outcomes.
- Anatomic ALL reconstruction offers a safe and effective adjunct to ACL reconstruction, with complication rates comparable to isolated ACL procedures.
- This combined approach represents the current standard of care for patients requiring ACL reconstruction with an associated need for lateral extra-articular stabilization.
Related Concept Videos
01:22Cardiopulmonary Resuscitation II: ACLS Airway Management
672
Airway management is a key skill in emergency and critical care settings, as maintaining a clear airway is essential for adequate oxygenation and ventilation.Head Tilt-Chin Lift TechniqueThe head tilt-chin lift maneuver is an essential technique primarily used in patients without suspected cervical spine injuries. To perform this maneuver, one hand is placed on the patient’s forehead, and gentle pressure is applied backward to tilt the head. The fingertips of the other hand are positioned...
672
01:10Reconstruction of Signal using Interpolation
734
Signal processing techniques are essential for accurately converting continuous signals to digital formats and vice versa. When a continuous signal is sampled with a period T, the resulting sampled signal exhibits replicas of the original spectrum in the frequency domain, spaced at intervals equal to the sampling frequency. To handle this sampled signal, a zero-order hold method can be applied, which creates a piecewise constant signal by retaining each sample's value until the next...
734
01:21Impedance Combination
754
Consider a string of christmas lights, each bulb symbolizing an impedance element. In this series configuration, the flow of electric current remains uniform across every component. This behavior aligns with Kirchhoff's Voltage Law (KVL), which asserts that the total impedance in such a setup equals the sum of individual impedances—akin to resistors in series. It follows that the voltage from the power source is distributed proportionally among these components, adhering to the voltage...
754
01:18Combination Of Resistors
3.9K
Electrical devices in any circuit can be connected either by series or parallel connections. Additionally, circuits can be connected involving both of these connections, known as combination or complex circuits. As these circuits have complex resistor connections, it is necessary to identify different parts as either series or parallel connections, then the whole combination of series and parallel resistors can be reduced to a single equivalent resistance. With the known equivalent resistance...
3.9K
01:16Combining Functions
243
Functions can be combined to form new mathematical models that describe interactions between variables. These combinations are fundamental in understanding relationships between changing quantities and are commonly encountered in scientific and engineering contexts. The combination methods—addition, subtraction, multiplication, division, and composition—each have unique implications for the resulting function’s domain and behavior.When combining functions through arithmetic...
243
01:07Electron Microscope Tomography and Single-particle Reconstruction
2.9K
Transmission electron microscopy (TEM) can be used to determine the 3D structure of biological samples with the help of techniques such as electron microscope tomography and single-particle reconstruction. While single-particle reconstruction can examine macromolecules and macromolecular complexes in vitro conditions only, tomography permits the study of cell components or small cells in vivo.
Electron Tomography
Electron tomography can be performed either in TEM or STEM (scanning transmission...
Electron Tomography
Electron tomography can be performed either in TEM or STEM (scanning transmission...
2.9K