Editorial Commentary: Do We Need to Look for Isometry in Anterolateral Ligament Reconstruction?

In a recent computer simulation study, authors attempted to calculate the optimal femoral and tibial insertion points for an almost isometric anterolateral ligament (ALL) reconstruction. However, it is important to note that the tibial insertion of the ALL is broad and cannot be defined by a single point. Furthermore, previous studies have demonstrated that the ALL shows a nonisometric behavior during flexion-extension, tight close to extension to control the rotation (and the pivot shift), and slack in flexion to allow physiological internal rotation. Although the ALL remains a controversial topic, particularly in laboratory studies, respecting and restoring the anatomy in with anatomic reconstruction leads to excellent clinical results with a 3-fold reduction in graft rupture rates.