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DOS Kongressen 2016 ·
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The influence of the anterolateral ligament on
knee stability during flexion-internal rotation.
A biomechanical cadaver study using dynamic
radiostereometric analysis
Emil T. Nielsen, Kasper Stentz-Olesen, Sepp de Raedt, Peter Bo Jørgensen, Ole G.
Sørensen, Bart Kaptein, Michael S. Andersen, Maiken Stilling
Orthopedic Research Department, Aarhus University Hospital; Orthopedic
Research Department, Aarhus University Hospital; , Nordisk Røntgen Teknik;
Orthopedic Research Department, Aarhus University Hospital; Department of
Sportstraumatology, Aarhus University Hospital; Biomechanics and Imaging
Group at Department of Orthopedic Surgery, Leiden University Medical Center;
Department of Mechanical Engineering and Manufacturing, Aalborg University;
Department of Clinical Medicine, University of Aarhus
Background:
Anterior cruciate ligament (ACL) rupture often occurs during in-
ternal rotation knee trauma and may be associated with damage to extracapsu-
lar knee rotation-stabilizing structures, such as the anterolateral ligament (ALL).
Purpose / Aim of Study:
To investigate knee rotation stability with and with-
out ALL reconstruction as a supplement to ACL reconstruction surgery.
Materials and Methods:
Eight cadaver knees were recorded with dynamic
radiostereometry during a pivot-like dynamic movement simulated by a con-
stant internal tibial rotation during knee flexion (0° to 50°). The cadavers were
tested in five successive ligament situations: intact, ACL lesion, ACL+ALL le-
sions, ACL reconstruction, and ACL+ALL reconstruction. The knee stability was
determined by three-dimensional kinematics and articular surface interactions.
Findings / Results:
For the entire motion, resecting the ALL caused increased
instability (p<0.014) for all degrees of freedom. The largest effects of ALL re-
section were found for external-internal rotation (EI), anterior- posterior trans-
lation (AP), and proximal-distal (PD) translation. Reconstruction of the ALL
caused increased stability (p<0.001) for all degrees of freedom, except varus/
valgus. Evaluating knee laxity in 10° ranges of knee flexion for ACL and ALL
lesions against ligament intact knees, knee instability was largest for knee flex-
ion below 30° (p<0.035). Combined ACL and ALL reconstructions were unable
to completely restore native kinematics/stability at flexion angles below 10°
(EI,PD) and 20° (AP) (p<0.02).
Conclusions:
Adjuvant reconstruction of the ALL with ACL reconstruction in a
cadaver setting provides internal rotation knee stability similar to knee kinemat-
ics with intact ligaments, except in knee flexion between 0° to 20°.
No conflicts of interest reported
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