Tollefson Luke V, Kennedy Nicholas I, LaPrade Robert F
Twin Cities Orthopedics, Edina, Minnesota, USA.
Orthopedics Northwest, Yakima, Washington, USA.
Video J Sports Med. 2024 May 23;4(3):26350254231225476. doi: 10.1177/26350254231225476. eCollection 2024 May-Jun.
Anterior cruciate ligament reconstructions (ACLRs) are performed to restore knee biomechanics, increase knee stability, and slow the progression of osteoarthritis. After ACLRs, many patients still have residual anterolateral instability which is a risk factor for ACL graft failure. An anterolateral ligament reconstruction (ALLR) attempts to restore the native function of the anterolateral complex to augment the ACL. Performing an ALLR with an ACLR has been reported to reduce symptoms of instability and improve clinical outcomes.
While no definitive indication for an ALLR has been set, current considerations include high posterior tibial slope >12°, revision ACLR, high-grade pivot shift, skeletally immature patients, hyperlaxity, and patients in high-level sports.
The preoperative assessment includes a thorough physical examination with special attention paid to rotational laxity assessed via the pivot-shift examination. Imaging should include standard radiographic series (anteroposterior, posteroanterior flexion, lateral, and sunrise views), long-leg mechanical axis views to assess coronal plane alignment and standing lateral ACL stress radiographs to assess sagittal alignment and objective instability. The iliotibial band ALLR graft is harvested first. An 8-cm long by 1-cm wide strip of the inferior iliotibial band is harvested in a standard fashion, leaving the distal aspect attached to Gerdy's tubercle. An anchor is placed centered upon the native ALL distal tibial insertion. The native ALL femoral origin is identified at 4.7 mm posterior and proximal to the fibular collateral ligament, and a second suture anchor is placed at this point. Final fixation is performed after the final fixation of the ACLR graft.
A study by Pioger et al reported that patients with ACLR and ALLR had significantly less reoperation rate than patients with isolated ACLR, 8.9% versus 20.5% respectively. Lee et al found that a revision ACLR in combination with an ALLR was effective in reducing rotational laxity, which was assessed by the pivot-shift test.
We describe a technique for a new anatomic ALLR using the iliotibial band that attempts to restore the native ALL anatomy. This surgical technique effectively restores rotational laxity and improves knee stability.
The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
前交叉韧带重建术（ACLR）旨在恢复膝关节生物力学，增强膝关节稳定性，并减缓骨关节炎的进展。ACLR术后，许多患者仍存在残余的前外侧不稳定，这是前交叉韧带移植物失败的一个危险因素。前外侧韧带重建术（ALLR）试图恢复前外侧复合体的天然功能以增强前交叉韧带。据报道，在ACLR的同时进行ALLR可减轻不稳定症状并改善临床结果。
虽然尚未确定ALLR的明确适应证，但目前的考虑因素包括胫骨后倾角度>12°、ACLR翻修术、高级别轴移、骨骼未成熟患者、关节过度松弛以及从事高水平运动的患者。
术前评估包括全面的体格检查，尤其要通过轴移试验特别关注旋转松弛情况。影像学检查应包括标准的放射学系列（前后位、后前位屈曲、侧位和日出位）、长腿机械轴位片以评估冠状面排列以及站立位侧位前交叉韧带应力位片以评估矢状面排列和客观不稳定情况。首先获取髂胫束ALLR移植物。以标准方式获取一条长8cm、宽1cm的髂胫束下带条，使远端附着于Gerdy结节。在天然ALL的胫骨远端插入点中心放置一个锚钉。在距腓侧副韧带后方和近端4.7mm处确定天然ALL的股骨起点，并在此处放置第二个缝合锚钉。在ACLR移植物最终固定后进行最终固定。
Pioger等人的一项研究报告称，接受ACLR和ALLR的患者的再次手术率明显低于单纯接受ACLR的患者，分别为8.9%和20.5%。Lee等人发现，ACLR翻修术联合ALLR在减轻旋转松弛方面是有效的，这通过轴移试验进行评估。
我们描述了一种使用髂胫束进行新型解剖学ALLR的技术，该技术试图恢复天然ALL的解剖结构。这种手术技术有效地恢复了旋转松弛并改善了膝关节稳定性。
作者证明已获得本出版物中出现的任何患者的同意。如果个体可能被识别，作者已随本投稿附上患者的豁免声明或其他书面形式的批准，以供发表。
