ACL Reconstruction Combined with Lateral Monoloop Tenodesis Can Restore Intact Knee Laxity

Overview

Journal Knee Surg Sports Traumatol Arthrosc

Publisher Wiley

Specialties Emergency Medicine
General Surgery
Orthopedics

Date 2020 Jan 26

PMID 31980844

Citations 12

Authors

Koen C Lagae

Joris Robberecht

Kiron K Athwal

Peter C M Verdonk

Andrew A Amis

Affiliations

Soon will be listed here.

Abstract

Purpose: An anterior cruciate ligament (ACL) injury is often combined with injury to the lateral extra-articular structures, which may cause a combined anterior and rotational laxity. It was hypothesised that addition of a 'monoloop' lateral extra-articular tenodesis (mLET) to an ACL reconstruction would restore anteroposterior, internal rotation and pivot-shift laxities better than isolated ACL reconstruction in combined injuries.

Method: Twelve cadaveric knees were tested, using an optical tracking system to record the kinematics through 0°-100° of knee flexion with no load, anterior and posterior translational forces (90 N), internal and external rotational torques (5 Nm), and a combination of an anterior translational (90 N) plus internal rotational load (5 Nm). They were tested intact, after sectioning the ACL, sectioning anterolateral ligament (ALL), iliotibial band (ITB) graft harvest, releasing deep ITB fibres, hamstrings tendon ACL reconstruction, mLET combined with ACL reconstruction, and isolated mLET. Two-way repeated-measures ANOVA compared laxity data across knee states and flexion angles. When differences were found, paired t tests with Bonferroni correction were performed.

Results: In the ACL-deficient knee, cutting the ALL significantly increased anterior laxity only at 20°-30°, and only significantly increased internal rotation at 50°. Additional deep ITB release significantly increased anterior laxity at 40°-90° and caused a large increase of internal rotation at 20°-100°. Isolated ACL reconstruction restored anterior drawer, but significant differences remained in internal rotation at 30°-100°. After adding an mLET there were no remaining differences with anterior translation or internal rotation compared to the intact knee. With the combined injury, isolated mLET allowed abnormal anterior translation and rotation to persist.

Conclusions: Cutting the deep fibres of the ITB caused large increases in tibial internal rotation laxity across the range of knee flexion, while cutting the ALL alone did not. With ACL deficiency combined with anterolateral deficiency, ACL reconstruction alone was insufficient to restore native knee rotational laxity. However, combining a 'monoloop' lateral extra-articular tenodesis with ACL reconstruction did restore native knee laxity.

Citing Articles

No difference in stability among various knee flexion angles during fixation of anterolateral ligament reconstruction or lateral extra-articular tenodesis: A systematic review and meta-analysis of biomechanical studies.

Kolin D, Jones R, Heyworth B, Jivanelli B, Fabricant P J Exp Orthop. 2024; 11(3):e12079.

PMID: 39015341 PMC: 11250156. DOI: 10.1002/jeo2.12079.

A Comparative Biomechanical Study of Alternative Medial Collateral Ligament Reconstruction Techniques.

Shatrov J, Bonacic Bartolin P, Holthof S, Ball S, Williams A, Amis A Am J Sports Med. 2024; 52(6):1505-1513.

PMID: 38551132 PMC: 11064462. DOI: 10.1177/03635465241235858.

Must a Knee with Anterior Cruciate Ligament Deficiency and High-grade Pivot Shift Test Present an Increase in Internal Rotation?.

Lima L, Gomes J Rev Bras Ortop (Sao Paulo). 2024; 59(1):e82-e87.

PMID: 38524720 PMC: 10957268. DOI: 10.1055/s-0044-1779316.

Lateral Extra-Articular Tenodesis with Indirect Femoral Fixation Using an Anterior Cruciate Ligament Reconstruction Suspensory Device.

Bechis M, Rosso F, Blonna D, Rossi R, Bonasia D J Clin Med. 2024; 13(2).

PMID: 38256513 PMC: 10816928. DOI: 10.3390/jcm13020377.

Modified Lemaire Tenodesis Forces in Cadaveric Specimens Are Not Affected by Random Small-Scale Variations in the Femoral Insertion Point During Active Knee Joint Flexion-Extension.

Sigloch M, Mayr R, Glodny B, Coppola C, Hoermann R, Schmoelz W Arthrosc Sports Med Rehabil. 2023; 5(3):e799-e807.

PMID: 37388897 PMC: 10300583. DOI: 10.1016/j.asmr.2023.04.007.

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