Department of Orthopaedic Surgery, Dongguk University Ilsan Hospital, 814 Siksadong, Ilsandonggu, Goyangsi, Gyeonggido, 411-773, South Korea.
Department of Orthopaedic Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
Orthop Traumatol Surg Res. 2022 May;108(3):103224. doi: 10.1016/j.otsr.2022.103224. Epub 2022 Jan 31.
There is much controversy about the practical role of the anterolateral ligament (ALL) and its relation to other anterolateral knee structures including the anterolateral capsule (ALC) and iliotibial band (ITB). The purpose of this cadaveric study was to investigate the effect of the ALL and ALC injuries on knee laxity with the iliotibial band (ITB) preserved in the anterior cruciate ligament (ACL)-injured knee.
The ALL and ALC would contribute to knee joint stability during anterior translation and internal rotation of the tibia in an ACL-injured knee.
For 10 fresh-frozen cadaveric knees, we measured knee laxity with the following state of knee injuries with ITB preserved: (1) intact knee, (2) ACL-sectioned knee (ACL-), (3) additional sectioning of the ALL (ACL-/ALL-), and (4) additional sectioning of the ALC (ACL-/ALL-/ALC-). We did biomechanical measurements in internal-external rotation, anterior-posterior translation, and varus-valgus angulation for each condition at knee flexion angles of 0°, 30°, 60°, and 90°.
After we sectioned the ALL (ACL-/ALL-), the mean IR at 0°, 30°, 60°, and 90° of knee flexion were significantly increased, compared to the intact knee (p=<0.001, <0.001, <0.001, and 0.002) and ACL- (p=<0.001, <0.001, <0.001, and 0.002). The additional transection of the ALC (ACL-/ALL-/ALC-) significantly increased IR laxity from the ACL-/ALL- at 30°, 60°, and 90° (p=0.005, 0.003, and 0.047). For anterior laxity, ACL-/ALL- resulted in significantly increased anterior laxity from the ACL- at 30° and 60° (p=0.003 and 0.019), and ACL-/ALL-/ALC- significantly increased anterior laxity even from the ACL-/ALL- at 30° and 60° (p=0.007 and 0.011). For varus laxity, ACL-/ALL- resulted in significantly increased varus laxity from both the intact knee and ACL- at 60° (p=0.004 and 0.007) and 90° (p=<0.001 and<0.001). ACL-/ALL-/ALC- resulted in significantly increased varus from ACL-/ALL- at 60° and 90° (p=<0.001 and 0.003).
The anterolateral ligament and anterolateral capsule injuries in ACL-injured knees even with ITB preserved had a synergistic effect on knee laxity in the aspects of internal rotation, anterior translation, and varus angulation.
II, Controlled laboratory study.
关于前外侧韧带（ALL）的实际作用及其与前外侧膝关节结构（包括前外侧囊[ALC]和阔筋膜张肌[ITB]）的关系存在很多争议。本尸体研究的目的是探讨在保留前交叉韧带（ACL）损伤患者的 ITB 的情况下，ALL 和 ALC 损伤对膝关节松弛度的影响。
在 ACL 损伤的膝关节中，ALL 和 ALC 会在前胫骨平移和内旋过程中对膝关节稳定性产生影响。
对于 10 个新鲜冷冻的尸体膝关节，我们在保留 ITB 的情况下测量了以下膝关节损伤状态下的膝关节松弛度：（1）完整膝关节，（2）ACL 切断膝关节（ACL-），（3）ACL 切断后进一步切断 ALL（ACL-/ALL-），以及（4）ACL-/ALL-后进一步切断 ALC（ACL-/ALL-/ALC-）。我们在膝关节屈曲 0°、30°、60°和 90°时，在内外旋转、前后平移和内外翻角度进行了生物力学测量。
与完整膝关节（p=<0.001，<0.001，<0.001 和 0.002）和 ACL-（p=<0.001，<0.001，<0.001 和 0.002）相比，在切断 ALL 后（ACL-/ALL-），膝关节在 0°、30°、60°和 90°的平均 IR 显著增加（p=<0.001，<0.001，<0.001 和 0.002）。进一步切断 ALC（ACL-/ALL-/ALC-）会使 ACL-/ALL-在 30°、60°和 90°时的 IR 松弛度进一步增加（p=0.005、0.003 和 0.047）。对于前向松弛度，ACL-/ALL-导致 ACL-在 30°和 60°时前向松弛度显著增加（p=0.003 和 0.019），而 ACL-/ALL-/ALC-甚至在 ACL-/ALL-时在 30°和 60°时也会导致前向松弛度显著增加（p=0.007 和 0.011）。对于外翻松弛度，ACL-/ALL-会导致 60°和 90°时从完整膝关节和 ACL-（p=0.004 和 0.007）以及 90°（p=<0.001 和<0.001）时外翻松弛度显著增加。ACL-/ALL-/ALC-会导致 60°和 90°时外翻松弛度从 ACL-/ALL-时显著增加（p=<0.001 和 0.003）。
ACL 损伤患者即使保留 ITB，ALL 和 ALC 损伤也会对膝关节内旋转、前平移和外翻角度的松弛度产生协同作用。
II，对照实验室研究。
