University of Colorado School of Medicine, Department of Orthopedics, Aurora, Colorado, USA.
Steadman Philippon Research Institute, Vail, Colorado, USA.
Am J Sports Med. 2018 Apr;46(5):1235-1242. doi: 10.1177/0363546517701920. Epub 2017 Apr 20.
In 1879, Paul Segond described an avulsion fracture (now known as a Segond fracture) at the anterolateral proximal tibia with the presence of a fibrous band at the location of this fracture. Although references to this ligament were occasionally made in the anatomy literature after Segond's discovery, it was not until 2012 that Vincent et al named this ligament what we know it as today, the anterolateral ligament (ALL) of the knee. The ALL originates near the lateral epicondyle of the distal femur and inserts on the proximal tibia near Gerdy's tubercle. The ALL exists as a ligamentous structure that comes under tension during internal rotation at 30°. In the majority of specimens, the ALL can be visualized as a ligamentous structure, whereas in some cases it may only be palpated as bundles of more tense capsular tissue when internal rotation is applied. Biomechanical studies have shown that the ALL functions as a secondary stabilizer to the anterior cruciate ligament (ACL) in resisting anterior tibial translation and internal tibial rotation. These biomechanical studies indicate that concurrent reconstruction of the ACL and ALL results in significantly reduced internal rotation and axial plane tibial translation compared with isolated ACL reconstruction (ACLR) in the presence of ALL deficiency. Clinically, a variety of techniques are available for ALL reconstruction (ALLR). Current graft options include the iliotibial (IT) band, gracilis tendon autograft or allograft, and semitendinosus tendon autograft or allograft. Fixation angle also varies between studies from full knee extension to 60° to 90° of flexion. To date, only 1 modern study has described the clinical outcomes of concomitant ALLR and ACLR: a case series of 92 patients with a minimum 2-year follow-up. Further studies are necessary to define the ideal graft type, location of fixation, and fixation angle for ALLR. Future studies also must be designed in a prospective comparative manner to compare the clinical outcomes of patients undergoing ACLR with ALL reconstruction versus without ALL reconstruction. By discovering the true effect of the ALL, investigators can elucidate the importance of ALLR in the setting of an ACL tear.
1879 年,Paul Segond 描述了前外侧胫骨近端的撕脱骨折(现在称为 Segond 骨折),并在骨折处发现了一条纤维带。尽管在 Segond 发现之后,解剖学文献中偶尔会提到这条韧带,但直到 2012 年,Vincent 等人将这条韧带命名为我们今天所知的膝关节前外侧韧带 (ALL)。ALL 起于股骨远端外侧髁附近,止于胫骨近端 Gerdy 结节附近。ALL 作为一种韧带结构存在,在 30°内旋时会受到张力的作用。在大多数标本中,可以将 ALL 视为一种韧带结构,而在某些情况下,当施加内旋时,它可能仅被视为更紧张的囊组织束。生物力学研究表明,ALL 作为前交叉韧带 (ACL) 的次要稳定器,在抵抗胫骨前向平移和内旋方面发挥作用。这些生物力学研究表明,与 ACL 单独重建 (ACLR) 相比,ACL 和 ALL 同时重建可显著减少内旋和轴向平面胫骨平移,在 ALL 缺陷的情况下。临床上,有多种技术可用于 ALL 重建 (ALLR)。目前的移植物选择包括阔筋膜张肌 (IT) 带、股薄肌腱自体或同种异体移植物,以及半腱肌腱自体或同种异体移植物。固定角度也因研究而异,从膝关节完全伸展到 60°到 90°屈曲。迄今为止,只有 1 项现代研究描述了同时进行 ALLR 和 ACLR 的临床结果:一项 92 例患者的病例系列研究,随访时间至少 2 年。还需要进一步的研究来确定 ALLR 的理想移植物类型、固定位置和固定角度。未来的研究还必须以前瞻性比较的方式设计,以比较接受 ACLR 加 ALL 重建与不进行 ALL 重建的患者的临床结果。通过发现 ALL 的真正作用,研究人员可以阐明 ALLR 在 ACL 撕裂中的重要性。