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Review
. 2017 Apr;25(4):1015-1023.
doi: 10.1007/s00167-017-4494-x. Epub 2017 Mar 15.

Anterolateral knee biomechanics

Andrew A Amis  1   2
Affiliations
Review

Anterolateral knee biomechanics

Andrew A Amis. Knee Surg Sports Traumatol Arthrosc. 2017 Apr.

Abstract

This article reviews the evidence for the roles of the anterolateral soft-tissue structures in rotatory stability of the knee, including their structural properties, isometry, and contributions to resisting tibial internal rotation. These data then lead to a biomechanical demonstration that the ilio-tibial band is the most important structure for the restraint of anterolateral rotatory instability. Level of evidence V.

Keywords: ACL; Anterolateral rotatory instability; Biomechanics; Ilio-tibial band; Tibial internal rotation.

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Conflict of interest statement

Conflict of interest

Prof Amis has received funds into a research account of Imperial College London from Smith & Nephew Co to undertake research related to the subject field of this article, and has also been paid for presenting research papers at educational events run by the Smith & Nephew Co.

Funding

No funding was received for the writing of this article.

Ethical approval

This article does not contain any studies with human participants performed by any of the authors.

Informed consent

For this type of study formal consent is not required.

Figures

Fig. 1
Fig. 1
Mean contribution (%) of tested structures in restraining a 5 N m internal rotation torque at 0°, 30°, 60°, and 90°. sITB superficial layer of the iliotibial band, dITB deep and capsulo-osseous layer of the iliotibial band, ALL anterolateral ligament, ALCap anterolateral capsule, ACL anterior cruciate ligament. (Based on data from Kittl et al. [26])
Fig. 2
Fig. 2
Dissection to show the anterolateral ligament (ALL) as described by Dodds et al. [12]. View of the anterolateral aspect of a left knee at 90° flexion. The red pin is at the lateral femoral epicondyle; the blue pin is at the distal attachment of the lateral (fibular) collateral ligament (LCL); the green pin is at Gerde’s tubercle. The ALL passes superficially over the proximal part of the LCL and attaches mid-way between Gerde’s tubercle and the head of the fibula
Fig. 3
Fig. 3
Left A graft placed at the attachments of the anterolateral ligament (ALL) has a relatively steep orientation as it crosses the tibio-femoral joint line, thus a graft tension produces a small posterior component of force to resist tibial internal rotation. Right The more-anterior attachment of a tenodesis based on Gerdy’s tubercle creates a more efficient orientation to restrain tibial internal rotation than a procedure based at the tibial attachment of the ALL, particularly if the graft is passed deep to the LCL, which then acts like a pulley. In this diagram, the posterior force vector is four times larger in the right diagram than in the left, yet the graft tensions are the same
Fig. 4
Fig. 4
This picture of the anterolateral aspect of a left knee held with an internal rotation torque applied to the tibia shows clearly that the more-anterior graft attached at Gerde’s tubercle is better-oriented to resist tibial internal rotation than is the more-posterior arm of the graft, which simulates the line of action of the anterolateral ligament
See this image and copyright information in PMC

References

    1. Amis AA, Dawkins GPC. Functional anatomy of the anterior cruciate ligament: fibre bundle actions related to ligament replacements and injuries. J Bone Joint Surg Br. 1991;73-B:260–267. - PubMed
    1. Amis AA, Scammell BE. Biomechanics of intraarticular and extraarticular reconstructions of the anterior cruciate ligament. J Bone Joint Surg Br. 1993;75-B:812–817. - PubMed
    1. Amis AA, Zavras TD. Isometricity and graft placement during anterior cruciate ligament reconstruction. Knee. 1995;2:5–17. doi: 10.1016/0968-0160(95)00003-8. - DOI
    1. Ardern CL, Webster KE, Taylor NF, Feller JA. Return to sport following anterior cruciate ligament reconstruction surgery: a systematic review and meta-analysis of the state of play. Br J Sports Med. 2011;45:596–606. doi: 10.1136/bjsm.2010.076364. - DOI - PubMed
    1. Bedi A, Musahl V, Lane C, Citak M, Warren RF, Pearle AD. Lateral compartment translation predicts the grade of pivot shift: a cadaveric and clinical analysis. Knee Surg Sports Traumatol Arthrosc. 2010;18:1269–1276. doi: 10.1007/s00167-010-1160-y. - DOI - PubMed

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