Anterolateral Knee Extra-articular Stabilizers: A Robotic Study Comparing Anterolateral Ligament Reconstruction and Modified Lemaire Lateral Extra-articular Tenodesis
Anterior cruciate ligament (ACL) injuries are commonplace in the world of sports medicine and are often treated with ACL reconstruction. Following reconstruction, however, patients may continue to experience knee instability. This study aimed to determine the impact of the anterolateral structures on knee stability in the setting of ACL reconstruction using cadaveric knees. The stability of each knee was tested in various states: completely intact, injured ACL and anterolateral structures (anterolateral ligament (ALL) and Kaplan fibers), post-ACL reconstruction, and post-lateral extra-articular tenodesis (LET) or ALL reconstruction.
In knees with anterolateral structure injury and ACL reconstruction, laxity was observed with internal rotation of the tibia and forward movement of the tibia in relation to the femur. Following ACL reconstruction and either ALL reconstruction or LET, the tibia exhibited less internal rotation, sometimes showing less internal rotation than the intact state, suggesting possible over-correction. LET was more effective than ALL in preventing internal rotation of the tibia, but both procedures were successful in preventing the tibia from sliding forward. This study demonstrates the importance of examining the anterolateral structures for injury at the time of ACL injury and performing either ALL reconstruction or LET with ACL reconstruction.
Figure 3. Lateral aspect of a right knee demonstrating a modified Lemaire lateral extra-articular tenodesis procedure, with the iliotibial band autograft passed deep to the fibular collateral ligament (FCL) and secured at the center of the distal Kaplan fibers. ALL, anterolateral ligament; PFL, popliteofibular ligament.