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. 2017 May 25:19:7-18.
doi: 10.1016/j.amsu.2017.05.009. eCollection 2017 Jul.

Does additional reconstruction of the anterolateral ligament during a primary anterior cruciate ligament reconstruction affect tibial rotational laxity - A case series

Rohi Shah  1 , Runveer Singh  1 , Clodagh Dugdale  2 , Guido Geutjens  1
Affiliations

Does additional reconstruction of the anterolateral ligament during a primary anterior cruciate ligament reconstruction affect tibial rotational laxity - A case series

Rohi Shah et al. Ann Med Surg (Lond). .

Abstract

Background: The current evidence suggests that rotational stability in not restored in patients with anterior cruciate ligament (ACL) ruptures, despite reconstructive surgery. The graded pivot-shift is a useful clinical test to delineate extent of ligamentous laxity within the knee. Given its lateralised position, we hypothesized that reconstruction of the anterolateral ligament (ALL) would provide restraint to excessive internal rotation, restoring rotational stability.

Methods: 10 patients with MRI confirmed diagnosis of an isolated ACL rupture were included. Patients assigned a grade-3 pivot-shift underwent dual-ligament reconstruction for the ACL and ALL (Group 2), whilst patients with an absent pivot-shift, grade-1 or grade-2 underwent single ligament reconstruction for just the ACL (Group 1). Total range of rotation (TRR) was measured using a 3D-kinematic system at 30°,60°and 90° of knee flexion. Data was collected on the pathology-free contralateral normal knee (CNK), ACL-deficient knee (ADK) and the ACL-reconstructed knee (ARK).

Results: A statistically significant pre-operative difference in TRR between the CNK and ADK was noted between Group 1 and 2 (4.04° vs. 1.53°; p < 0.05). Postoperatively, both groups achieved a TRR that was either equivalent, or surpassed values that were observed on the CNKs. The absolute and percentage reduction in TRR at 30° of knee flexion was significantly higher in Group-2 compared to Group-1 (-8.15° vs. -2.96°; p < 0.001) and (28.04% vs. 13.31%; p < 0.001) respectively.

Conclusion: Our findings are based primarily in anaesthetized patients, with kinematic values at time-zero postoperatively. Patients presenting with significant rotational instability following a primary ACL injury and assessed to have a grade-3 pivot-shift may benefit from dual-ligament reconstruction. Further research is required to assess long-term patient-centered clinical outcomes.

Keywords: Anterior cruciate ligament; Anterolateral ligament; Rotational stability.

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Figures

Fig. 1
Fig. 1
The MotionMonitor and Polhemus Fastrak system.
Fig. 2
Fig. 2
a: Anatomical landmarks. b: Preparation of femoral socket. c: Preparation of tibial socket. d: Fixation of the tibia end of the ALL graft, using the SwivelLock™. e: Tunnelling of the ALL graft under the ITB. f: Fixation of the femoral end of the ALL graft using the SwivelLock™. g: ALL graft in situ. h: skin closure with staples depicting origin and insertion landmarks.
Fig. 3
Fig. 3
Variation in TRR in Group 1 pre-operatively.
Fig. 4
Fig. 4
Variation in TRR in Group 2 pre-operatively.
Fig. 5
Fig. 5
Variation in TRR in Group 1 post-operatively.
Fig. 6
Fig. 6
Variation in TRR in Group 2 post-operatively.
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