ACL reconstruction combined with lateral monoloop tenodesis can restore intact knee laxity
File(s)
Published version
Author(s)
Lagae, Koen C
Robberecht, Joris
Athwal, Kiron K
Verdonk, Peter CM
Amis, Andrew A
Type
Journal Article
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.
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.
Date Issued
2020-04
Date Acceptance
2019-12-16
Citation
Knee Surgery Sports Traumatology Arthroscopy, 2020, 28, pp.1159-1168
ISSN
0942-2056
Publisher
Springer Verlag
Start Page
1159
End Page
1168
Journal / Book Title
Knee Surgery Sports Traumatology Arthroscopy
Volume
28
Copyright Statement
© The Author(s) 2020. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long
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as you give appropriate credit to the original author(s) and the source,
provide a link to the Creative Commons licence, and indicate if changes
were made. The images or other third party material in this article are
included in the article’s Creative Commons licence, unless indicated
otherwise in a credit line to the material. If material is not included in
the article’s Creative Commons licence and your intended use is not
permitted by statutory regulation or exceeds the permitted use, you will
need to obtain permission directly from the copyright holder. To view a
copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
Identifier
http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcApp=PARTNER_APP&SrcAuth=LinksAMR&KeyUT=WOS:000509136700001&DestLinkType=FullRecord&DestApp=ALL_WOS&UsrCustomerID=1ba7043ffcc86c417c072aa74d649202
Subjects
Science & Technology
Life Sciences & Biomedicine
Orthopedics
Sport Sciences
Surgery
ACL reconstruction
Monoloop
Knee laxity
Biomechanics
Lateral extra-articular tenodesis
Anterolateral rotational instability
ANTERIOR CRUCIATE LIGAMENT
VITRO ROBOTIC ASSESSMENT
ILIOTIBIAL-BAND TRANSFER
ANTEROLATERAL LIGAMENT
EXTRAARTICULAR TENODESIS
ROTATORY INSTABILITY
BIOMECHANICS
STABILITY
PATTERNS
ANATOMY
Publication Status
Published
Date Publish Online
2020-01-25