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Different anterolateral procedures have variable impact on knee kinematics and stability when performed in combination with anterior cruciate ligament reconstruction
  1. Thomas Neri1,2,
  2. Danè Dabirrahmani3,
  3. Aaron Beach1,
  4. Samuel Grasso1,
  5. Sven Putnis1,
  6. Takeshi Oshima1,
  7. Joseph Cadman3,
  8. Brian Devitt4,
  9. Myles Coolican1,
  10. Brett Fritsch1,
  11. Richard Appleyard3,
  12. David Parker1
  1. 1 Sydney Orthopaedic Research Institute Ltd, Chatswood, New South Wales, Australia
  2. 2 Laboratory of Human Movement Biology (LIBM EA 7424), University of Lyon–Jean Monnet, Saint Etienne, France
  3. 3 Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
  4. 4 OrthoSport Victoria, Richmond, Victoria, Australia
  1. Correspondence to Dr Thomas Neri, Sydney Orthopaedic Research Institute Ltd, Chatswood, NSW 2067, Australia; thomas.neri{at}outlook.com

Abstract

Objective The optimal anterolateral procedure to control anterolateral rotational laxity of the knee is still unknown. The objective was to compare the ability of five anterolateral procedures performed in combination with anterior cruciate ligament reconstruction (ACLR) to restore native knee kinematics in the setting of a deficient anterior cruciate ligament (ACL) and anterolateral structures.

Methods A controlled laboratory study was performed using 10 fresh-frozen cadaveric whole lower limbs with intact iliotibial band. Kinematics from 0° to 90° of flexion were recorded using a motion analysis three-dimensional (3D) optoelectronic system, allowing assessment of internal rotation (IR) and anteroposterior (AP) tibial translation at 30° and 90° of flexion. Joint centres and bony landmarks were calculated from 3D bone models obtained from CT scans. Intact knee kinematics were assessed initially, followed by sequential section of the ACL and anterolateral structures (anterolateral ligament, anterolateral capsule and Kaplan fibres). After ACLR, five anterolateral procedures were performed consecutively on the same knee: ALLR, modified Ellison, deep Lemaire, superficial Lemaire and modified MacIntosh. The last three procedures were randomised. For each procedure, the graft was fixed in neutral rotation at 30° of flexion and with a tension of 20 N.

Results Isolated ACLR did not restore normal overall knee kinematics in a combined ACL plus anterolateral-deficient knee, leaving a residual tibial rotational laxity (p=0.034). Only the ALLR (p=0.661) and modified Ellison procedure (p=0.641) restored overall IR kinematics to the normal intact state. Superficial and deep Lemaire and modified MacIntosh tenodeses overconstrained IR, leading to shifted and different kinematics compared with the intact condition (p=0.004, p=0.001 and p=0.045, respectively). Compared with ACLR state, addition of an anterolateral procedure did not induce any additional control on AP translation at 30° and 90° of flexion (all p>0.05), except for the superficial Lemaire procedure at 90° (p=0.032).

Conclusion In biomechanical in vitro setting, a comparison of five anterolateral procedures revealed that addition of either ALLR or modified Ellison procedure restored overall native knee kinematics in a combined ACL plus anterolateral-deficient knee. Superficial and deep Lemaire and modified MacIntosh tenodeses achieved excellent rotational control but overconstrained IR, leading to a change from intact knee kinematics.

Level of evidence The level-of-evidence statement does not apply for this laboratory experiments study.

  • knee
  • ACL / PCL
  • repair / reconstruction
  • biomechanics

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Footnotes

  • Presented at Finalist of the ISAKOS Albert Trillat Young Investigator Award 2019

  • Contributors All authors were fully involved in the study. They have read and approved the manuscript. TN: conception, acquisition, analysis, data interpretation, work drafting, final approval, final agreement. DD: analysis, work drafting, final approval, final agreement. AB: conception, acquisition, analysis, work drafting, final approval, final agreement. SG: conception, analysis, data interpretation, work drafting, final approval, final agreement. SP: acquisition, data interpretation, work drafting, final approval, final agreement. TO: acquisition, work drafting, final approval, final agreement. JC: analysis, work drafting, final approval, final agreement. BD: conception, work drafting, final approval, final agreement. MC: conception, work drafting, final approval, final agreement. BF: conception, work drafting, final approval, final agreement. RA: conception, analysis, work drafting, final approval, final agreement. DP: conception, analysis, data interpretation, work drafting, final approval, final agreement.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This study obtained ethics approval from Surgical Skills and Anatomy Centre, Faculty of Medicine and Science, Macquarie University (application for approval to undertake research involving cadavers).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

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