title: Biomechanical analysis of simulated clinical testing and reconstruction of the anterolateral ligament of the knee.
abstract: BACKGROUND
  Anatomic anterolateral ligament (ALL) reconstruction has been proposed to assist anterior cruciate ligament (ACL) reconstruction in controlling anterolateral rotational laxity of the knee. However, the biomechanical effects have not been reported.
  
  
  OBJECTIVE
  (1) To investigate the effect of ALL transection on rotational knee kinematics and (2) to determine the effect on knee biomechanics of ALL reconstruction procedures compared with lateral extra-articular tenodesis (LET).
  
  
  METHODS
  Controlled laboratory study.
  
  
  METHODS
  A total of 12 cadaveric knee specimens were tested in the following sequence: (1) ACLintact, (2) anteromedial bundle of ACL sectioned (ACLamb), (3) complete ACL sectioned (ACLfull), (4) ALL sectioned (ALLsec), (5) anatomic ALL reconstruction (ALLanat), and (6) LET. Biomechanical anterior drawer and Lachman tests were performed in which a 90-N load was applied to the posterior tibia, and anterior translation was measured. A combined load to simulate the early phase of the pivot-shift test was executed in which a 5-N·m internal rotation moment was applied to a fully extended knee; anterior translation and internal rotation were measured.
  
  
  RESULTS
  Anterior translation increased across conditions for the biomechanical tests. Internal rotation during the simulated early-phase pivot-shift test was significantly different between ACLfull and ALLsec. Anatomic ALL reconstruction did not significantly reduce internal rotation or anterior translation during the simulated early-phase pivot-shift test. After LET, a significant decrease in anterior translation was found. There was no evidence of overconstraint of the knee with either anatomic ALL reconstruction or LET.
  
  
  CONCLUSIONS
  The ALL demonstrated a role in controlling anterolateral laxity. LET had a composite effect in governing both anterior and rotational laxity. Anatomic ALL reconstruction did not reduce anterolateral rotational laxity.
  
  
  CONCLUSIONS
  Profiling the biomechanical characteristics of anterolateral reconstruction is integral to understanding the implications and potential benefit of such an additional procedure to ACL reconstruction.
authors.affiliation: Fowler Kennedy Sport Medicine Clinic, London, Ontario, Canada.
authors.forename: Luke
authors.initials: L
authors.lastname: Spencer
authors.affiliation: Department of Mechanical and Materials Engineering, Western University, London, Ontario, Canada.
authors.forename: Timothy A
authors.initials: TA
authors.lastname: Burkhart
authors.affiliation: Fowler Kennedy Sport Medicine Clinic, London, Ontario, Canada.
authors.forename: Michael N
authors.initials: MN
authors.lastname: Tran
authors.affiliation: Fowler Kennedy Sport Medicine Clinic, London, Ontario, Canada.
authors.forename: Alex James
authors.initials: AJ
authors.lastname: Rezansoff
authors.affiliation: Fowler Kennedy Sport Medicine Clinic, London, Ontario, Canada.
authors.forename: Shaneel
authors.initials: S
authors.lastname: Deo
authors.affiliation: Fowler Kennedy Sport Medicine Clinic, London, Ontario, Canada. Department of Anatomy and Cell Biology, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
authors.forename: Scott
authors.initials: S
authors.lastname: Caterine
authors.affiliation: Fowler Kennedy Sport Medicine Clinic, London, Ontario, Canada. alan.getgood@uwo.ca.
authors.forename: Alan M
authors.initials: AM
authors.lastname: Getgood
mesh_terms: D000368:Aged; D016118:Anterior Cruciate Ligament / Q000502:physiology / Q000601:surgery; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods*; D001696:Biomechanical Phenomena / Q000502:physiology; D002102:Cadaver; D016022:Case-Control Studies; D000071938:Fasciotomy; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000503:physiopathology / Q000601:surgery; D007719:Knee Joint / Q000502:physiology / Q000601:surgery; D008023:Ligaments, Articular / Q000502:physiology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012399:Rotation; D013710:Tendons / Q000502:physiology / Q000601:surgery; D053656:Tenodesis / Q000379:methods; D013977:Tibia / Q000601:surgery
keywords: anterior cruciate ligament; anterolateral ligament; biomechanical analysis; lateral extra-articular tenodesis