Moreno Mateo Fernando, Perea Sofia Hidalgo, Green Daniel W
Division of Pediatric Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA.
Curr Opin Pediatr. 2022 Feb 1;34(1):71-75. doi: 10.1097/MOP.0000000000001084.
The aim of this study was to review the most recent available evidence about lateral-extra articular tenodesis (LET) and anterolateral ligament (ALL) reconstruction in young patients treated for anterior cruciate ligament (ACL) injury.
The ALL of the knee acts as a secondary stabilizer of the knee preventing anterior translation and internal rotation. In vitro and in vivo biomechanical studies as well as prospective clinical trials have shown the importance of the ALL in knee biomechanics. The ALL injury has a synergetic impact on the knee stability in patients with acute ACL injury. ALL augmentation of ACL provides reduction of knee instability and graft failure and higher return to sport rates in high-risk patients. It has not been demonstrated that extra-articular procedures increase the risk of knee osteoarthritis secondary to knee over-constriction. Both Iliotibial band (ITB) ALL reconstruction and modified Lemaire LET have been shown safe and effective. Minimal biomechanical or clinical differences have been found between the two reconstruction methods.
Young patients with ACL tears and risk factors such as laxity or pivot shift willing to return to sports may benefit from ALL augmentation. Therefore, it is essential to identify these high-risk patients to individualize treatment.
本研究旨在回顾有关年轻患者前交叉韧带（ACL）损伤治疗中，外侧关节外肌腱固定术（LET）和前外侧韧带（ALL）重建的最新可用证据。
膝关节的ALL作为膝关节的二级稳定器，可防止前向平移和内旋。体外和体内生物力学研究以及前瞻性临床试验均表明ALL在膝关节生物力学中的重要性。ALL损伤对急性ACL损伤患者的膝关节稳定性具有协同影响。ACL的ALL增强可降低膝关节不稳定性和移植物失败率，并提高高危患者的运动恢复率。尚未证明关节外手术会增加因膝关节过度紧缩继发的膝关节骨关节炎风险。髂胫束（ITB）ALL重建和改良Lemaire LET均已证明安全有效。两种重建方法之间在生物力学或临床方面的差异极小。
患有ACL撕裂且有诸如松弛或轴移等危险因素、愿意恢复运动的年轻患者可能会从ALL增强中受益。因此，识别这些高危患者以实现个体化治疗至关重要。
