title: Anterolateral Ligament Expert Group consensus paper on the management of internal rotation and instability of the anterior cruciate ligament - deficient knee.
abstract: Purpose of this paper is to provide an overview of the latest research on the anterolateral ligament (ALL) and present the consensus of the ALL Expert Group on the anatomy, radiographic landmarks, biomechanics, clinical and radiographic diagnosis, lesion classification, surgical technique and clinical outcomes. A consensus on controversial subjects surrounding the ALL and anterolateral knee instability has been established based on the opinion of experts, the latest publications on the subject and an exchange of experiences during the ALL Experts Meeting (November 2015, Lyon, France). The ALL is found deep to the iliotibial band. The femoral origin is just posterior and proximal to the lateral epicondyle; the tibial attachment is 21.6 mm posterior to Gerdy's tubercle and 4-10 mm below the tibial joint line. On a lateral radiographic view the femoral origin is located in the postero-inferior quadrant and the tibial attachment is close to the centre of the proximal tibial plateau. Favourable isometry of an ALL reconstruction is seen when the femoral position is proximal and posterior to the lateral epicondyle, with the ALL being tight upon extension and lax upon flexion. The ALL can be visualised on ultrasound, or on T2-weighted coronal MRI scans with proton density fat-suppressed evaluation. The ALL injury is associated with a Segond fracture, and often occurs in conjunction with acute anterior cruciate ligament (ACL) injury. Recognition and repair of the ALL lesions should be considered to improve the control of rotational stability provided by ACL reconstruction. For high-risk patients, a combined ACL and ALL reconstruction improves rotational control and reduces the rate of re-rupture, without increased postoperative complication rates compared to ACL-only reconstruction. In conclusion this paper provides a contemporary consensus on all studied features of the ALL. The findings warrant future research in order to further test these early observations, with the ultimate goal of improving the long-term outcomes of ACL-injured patients. Level of evidence Level V-Expert opinion.
authors.affiliation: Centre Orthopédique Paul Santy, FIFA Medical Center of Excellence, Groupe Ramsay-Generale de Santé, 24 avenue Paul Santy, 69008, Lyon, France. sonnerycottet@aol.com.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Sonnery-Cottet
authors.affiliation: Kansas City University, Kansas City, MO, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Daggett
authors.affiliation: Centre Orthopédique Paul Santy, FIFA Medical Center of Excellence, Groupe Ramsay-Generale de Santé, 24 avenue Paul Santy, 69008, Lyon, France.
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Fayard
authors.affiliation: Orthopaedic Unit and Kirk Kilgour Sports Injury Center, Sant'Andrea University Hospital, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Ferretti
authors.affiliation: Knee Surgery Division, University of São Paulo, São Paulo, Brazil.
authors.forename: Camilo Partezani
authors.initials: CP
authors.lastname: Helito
authors.affiliation: Division of Sportstraumatology, Department of Orthopedics, Aarhus University Hospital, Tage Hansens Gade 2, 8000, Aarhus C, Denmark.
authors.forename: Martin
authors.initials: M
authors.lastname: Lind
authors.affiliation: Orthopaedic Unit and Kirk Kilgour Sports Injury Center, Sant'Andrea University Hospital, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Edoardo
authors.initials: E
authors.lastname: Monaco
authors.affiliation: Associação Beneficente Hospital Universitário de Marilia-SP Brazil, Cidade Universitária, Rua Dr Prospero Cecilio Coimbra 80, Marilia, SP, 17525-160, Brazil.
authors.forename: Vitor Barion Castro
authors.initials: VBC
authors.lastname: de Pádua
authors.affiliation: Centre Orthopédique Paul Santy, FIFA Medical Center of Excellence, Groupe Ramsay-Generale de Santé, 24 avenue Paul Santy, 69008, Lyon, France.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Thaunat
authors.affiliation: Department of Sport and Exercise, Sport and Exercise Research Centre, University of Winchester, Winchester, SO22 4NR, UK.
authors.forename: Adrian
authors.initials: A
authors.lastname: Wilson
authors.affiliation: Dipartimento Rizzoli Sicilia, Ortopedia e Traumatologia, Università di Bologna, SS 113 al km 246, 90011, Bagheria, PA, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Zaffagnini
authors.affiliation: St. Antonius Hospital, Soestwetering 1, 3543 AZ, Utrecht, The Netherlands.
authors.forename: Jacco
authors.initials: J
authors.lastname: Zijl
authors.affiliation: Department of Orthopaedic Surgery and Traumatology, AZ Herentals, Herentals, Belgium.
authors.forename: Steven
authors.initials: S
authors.lastname: Claes
mesh_terms: D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries / Q000150:complications / Q000601:surgery*; D059549:Anterior Cruciate Ligament Reconstruction / Q000379:methods*; D001696:Biomechanical Phenomena; D006801:Humans; D007593:Joint Instability / Q000209:etiology / Q000601:surgery*; D007719:Knee Joint / Q000503:physiopathology / Q000601:surgery*; D016059:Range of Motion, Articular
keywords: Anterior cruciate ligament; Anterolateral ligament; Anterolateral ligament reconstruction; Pivot-shift; Segond fracture