title: The role of the anterolateral ligament in ACL insufficient and reconstructed knees on rotatory stability: A biomechanical study on human cadavers.
abstract: Studies suggest that the anterolateral ligament (ALL) is important for knee stability. The purpose was to clarify ALL's effect on rotatory and anterior-posterior stability in the anterior cruciate ligament (ACL)-insufficient and reconstructed knees and the effect of reconstruction of an insufficient ALL. Eighteen cadaveric knees were included. Stability was tested for intact (+ALL), detached (-ALL) and reconstructed (+ reALL) ALL, with ACL removed (-ACL) and reconstructed (+ACL) in six combinations. All were tested in 0, 30, 60, and 90 °C flexion. Anterior-posterior stability was measured with a rolimeter. Rotation with a torque of 8.85 Nm was measured photographically. The ALL was well defined in 78% of knees. ACL reconstruction had a significant effect on anterior-posterior stability. Detaching the ALL had a significant effect on internal rotatory stability and on anterior-posterior stability in ACL-insufficient knees. Reconstruction of ACL and ALL reestablished knee stability. The appearance of the ALL was not uniform. The ALL was an internal rotational stabilizer. Anatomical ALL reconstruction in combination with ACL reconstruction could reestablish stability. ALL reconstruction might be considered in patients with combined ACL and ALL tears, but the clinical effect should be established in a controlled clinical study.
authors.affiliation: Department of Cellular and Molecular Medicine (ICMM), University of Copenhagen, Copenhagen, Denmark.
authors.forename: M
authors.initials: M
authors.lastname: Tavlo
authors.affiliation: Section of Sports Traumatology M51, Bispebjerg-Frederiksberg Hospitals, Copenhagen, Denmark.
authors.forename: S
authors.initials: S
authors.lastname: Eljaja
authors.affiliation: Department of Cellular and Molecular Medicine (ICMM), University of Copenhagen, Copenhagen, Denmark.
authors.forename: J T
authors.initials: JT
authors.lastname: Jensen
authors.affiliation: The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
authors.forename: V D
authors.initials: VD
authors.lastname: Siersma
authors.affiliation: Section of Sports Traumatology M51, Bispebjerg-Frederiksberg Hospitals, Copenhagen, Denmark.
authors.forename: M R
authors.initials: MR
authors.lastname: Krogsgaard
mesh_terms: D000368:Aged; D016118:Anterior Cruciate Ligament / Q000503:physiopathology*; D059549:Anterior Cruciate Ligament Reconstruction; D001696:Biomechanical Phenomena; D002102:Cadaver; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000503:physiopathology*; D007719:Knee Joint / Q000503:physiopathology* / Q000601:surgery; D008023:Ligaments, Articular / Q000503:physiopathology* / Q000601:surgery; D008297:Male; D012399:Rotation
keywords: AP stability; Anterior cruciate ligament; anterolateral ligament; concomitant instability; knee instability; rotatory stability