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. 2020 Mar;27(2):397-405.
doi: 10.1016/j.knee.2020.02.015. Epub 2020 Mar 13.

Anterolateral ligament reconstruction as an augmented procedure for double-bundle anterior cruciate ligament reconstruction restores rotational stability: Quantitative evaluation of the pivot shift test using an inertial sensor

Sanshiro Yasuma  1 , Masahiro Nozaki  2 , Atsunori Murase  1 , Makoto Kobayashi  1 , Yusuke Kawanishi  1 , Hiroaki Fukushima  1 , Tetsuya Takenaga  1 , Masahito Yoshida  1 , Gen Kuroyanagi  1 , Yohei Kawaguchi  1 , Yuko Nagaya  1 , Hideki Murakami  1
Affiliations

Anterolateral ligament reconstruction as an augmented procedure for double-bundle anterior cruciate ligament reconstruction restores rotational stability: Quantitative evaluation of the pivot shift test using an inertial sensor

Sanshiro Yasuma et al. Knee. 2020 Mar.

Abstract

Purpose: The purpose of this study was to investigate the biomechanical function of the anterolateral structures (ALS) of the knee regarding rotational stability, and to attempt to verify the effectiveness of anterolateral ligament (ALL) reconstruction concomitant with double-bundle anterior cruciate ligament (ACL) reconstruction by quantifying the pivot shift test (PST) using an inertial sensor.

Methods: Six knees of the fresh-frozen cadavers were evaluated during the following phases: (1) [Intact]; (2) ACL-deficient [ACL-D]; (3) ACL-reconstructed [ACL-R]; (4) ACL-reconstructed + ALS-deficient [ACL-R + ALS-D]; and (5) combined ACL and ALL reconstructed [ACL-R + ALL-R]. We evaluated knee rotational instability during each phase using the PST. We used an inertial sensor to calculate tibial external rotational angular velocity (ERAV) and tibial acceleration. Data were analyzed using repeated-measures analysis of variance; statistical significance was accepted as P < 0.05.

Results: Relative to [Intact], [ACL-D] caused a significant increase in ERAV and acceleration. However, there was no difference in these parameters between [ACL-R] and [Intact]. [ACL-R + ALS-D] increased ERAV significantly compared with [ACL-R], and there was a significant difference between ERAV during [ACL-R + ALS-D] and [Intact]. However, ERAV was significantly reduced during [ACL-R + ALL-R] compared with [ACL-R + ALS-D], and there was no significant difference in ERAV or acceleration between [ACL-R + ALL-R] and [Intact].

Conclusions: ALS controlled rotational instability in cooperation with the ACL in a cadaveric model. In cases of combined injury of ACL and ALS, concomitant ACL and ALL reconstruction may restore knee stability comparable with the intact state.

Keywords: Anterior cruciate ligament; Anterolateral ligament; Inertial sensor; Pivot shift test.

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Conflict of interest statement

Declaration of competing interest The authors have no conflicts of interest to declare.

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