Technique for Surgical Dissection and Histological Investigation of the Anterolateral Ligament in the Fetal Knee.

There is growing evidence into the structure and function of the anterolateral ligament (ALL) of the knee. However, debate still exists about the anatomical characteristics, biomechanical role, and even the existence of the ALL, despite numerous cadaveric, biomechanical, and clinical studies. This article describes, with video illustration, the surgical dissection of the ALL in human fetal lower limbs, including determination of detailed anatomical and histological features of the ALL during fetal development. The ALL was clearly identified in dissected fetal knees, and histologic analysis shows well-organized, dense collagenous tissue fibers with elongated fibroblasts, consistent with the properties of a ligament.

Postural control during single leg stance in individuals with clinical indication for combined reconstruction of the anterior cruciate and the anterolateral ligaments of the knee: a cross-sectional study.

BACKGROUND: Several studies have shown persistent postural control deficits and rotatory instability in patients after isolated Anterior Cruciate Ligament (ACL) reconstruction. There is evidence to support that the Anterolateral Ligament (ALL) plays an important role in the remaining anterolateral rotatory laxity of the knee. There are no further evidences in order to understand how patients with a combined ACL + ALL reconstruction surgery indication behave regarding postural control. The aim of this cross-sectional study was to assess if patients with a clinical indication for the combined ACL + ALL surgery showed a deficient postural control in single leg stance compared to subjects with a regular ACL reconstruction indication and to a control group. METHODS: An assessment of static postural control on single leg stance was performed on a force plate, with eyes open and closed, and the center of pressure (COP) displacement variables were analyzed: maximum and mean amplitude in anteroposterior (AP) and in mediolateral (ML) direction; mean velocity of displacement and area of displacement. Eighty-nine male individuals participated and were divided into 3 groups: ACL Group, ACL + ALL Group and Control Group. RESULTS: The ACL+ ALL Group showed significantly greater COP displacement in most variables in the injured leg for the eyes closed test, compared to the ACL Group, as detailed: Total ML displacement (9.8 ± 6.77 vs. 13.98 ± 6.64, p < 0.001); Mean ML displacement (2.58 ± 2.02 vs. 3.72 ± 1.99, p < 0.001); Total AP displacement (9.5 ± 3.97 vs. 11.7 ± 3.66, p = 0.001); Mean AP displacement (1.77 ± 0.87 vs. 2.27 ± 0.86, p = 0.001); Area of displacement (111.44 ± 127.3 vs. 183.69 ± 131.48, p < 0.001). CONCLUSION: Subjects with a clinical indication for ACL + ALL combined reconstruction surgery showed increased COP displacement compared to patients with indication for an ACL isolated reconstruction surgery.

Rate of Tibial Tunnel Malposition Is Not Changed by Drilling Entirely Within the Stump of Preserved Remnants During ACL Reconstruction: A Prospective Comparative 3D-CT Study.

BACKGROUND: Remnant preservation during anterior cruciate ligament (ACL) reconstruction (ACLR) is controversial, and it is unclear whether the stump aids or obscures tibial tunnel positioning. PURPOSE/HYPOTHESIS: The aim of this study was to determine whether the rate of tibial tunnel malposition is influenced by remnant preservation. The hypothesis was that using a remnant-preserving technique to drill entirely within the tibial stump would result in a significant reduction in tibial tunnel malposition as determined by postoperative 3-dimensional computed tomography (3D-CT). STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: Patients undergoing ACLR between October 2018 and December 2019 underwent surgery with a remnant-preserving technique (RP group) if they had a large stump present (>50% of the native ACL length) or if there was no remnant or if it was <50% of the native length of the ACL, they underwent remnant ablation (RA group) and use of standard landmarks for tunnel positioning. The postoperative tunnel location was reported as a percentage of the overall anteroposterior (AP) and mediolateral (ML) dimensions of the tibia on axial 3D-CT. The tunnel was classified as anatomically placed if the center lay between 30% and 55% of the AP length and between 40% and 51% of the ML length. RESULTS: Overall, 52 patients were included in the study (26 in each group). The mean tunnel positions were 36.8% ± 5.5% AP and 46.7% ± 2.9% ML in the RP group and 35.6% ± 4.8% AP and 47.3% ± 2.3% ML in the RA group. There were no significant differences in the mean AP (P = .134) and ML (P = .098) tunnel positions between the groups. Inter- and intraobserver reliability varied between fair to excellent and good to excellent, respectively. There was no significant difference in the rate of malposition between groups (RP group, 7.7%; RA group, 11.5%; P ≥ .999). CONCLUSION: Drilling entirely within the ACL tibial stump using a remnant-preserving reconstruction technique did not significantly change the rate of tunnel malposition when compared with stump ablation and utilization of standard landmarks.

An Overview of Anatomy and Imaging of the Anterolateral Structures of the Knee.

Despite several previous articles in the literature, never before have so many studies with regard to anterolateral knee structures been performed. The anterolateral knee complex consists briefly of the iliotibial band, with its proximal and distal attachments, the joint capsule, and the anterolateral ligament (ALL). The recently introduced ALL has several different descriptions, making it difficult to build a consensus with regard to its anatomy. An extensive description of these structures, particularly the iliotibial band and the ALL, with regard to anatomy and imaging, will be provided in this article.

Delayed treatment of a posterior cruciate ligament tibial insertion avulsion fracture in a child with open physis: a case report with a 4-year follow-up.

Posterior cruciate ligament avulsion fracture from its tibial insertion is a rare pathology in children. It is usually caused by high-energy traumas and its diagnosis is not always easy. Late diagnosis leads to late treatment, which can result in suboptimal results. We present a case of a 13-year-old boy hit by a car, who had a delay in diagnosis and treatment because of severe head trauma. The patient was treated 4 months after the trauma with open reduction and internal fixation of the avulsion fracture. After 4 years of follow-up, he has no complaints and has achieved good functional outcome.

Revision of total knee arthroplasty in a patient with contralateral transfemoral amputation: case report.

BACKGROUND: Knee arthroplasty is an efficient solution for osteoarthrosis in amputees. However, because of overload on the implant, it is apparently more subject to failure than in the non-amputated population. The aim of this case report is to show a failure of primary total knee arthroplasty contralateral to transfemoral amputation that required revision involving a tissue bank because of severely compromised knee bone. Surgical strategies, rehabilitation, and postoperative care for the operated limb and the contralateral prosthesis were demonstrated. CASE DESCRIPTION AND METHODS: A 60-year-old patient with early failure of total knee arthroplasty contralateral to transfemoral amputation underwent arthroplasty revision in which a graft from a tissue bank was used. After the revision, prosthesis length adjustment and exercise therapy were fundamental to the rehabilitation. FINDINGS AND OUTCOMES: The patient progressed well after the revision of the arthroplasty, with increases on the Knee Society Score and 36-Item Short Form Health Survey scales. CONCLUSION: Knee arthroplasty in amputees should be planned differently to that of the general population. For the procedure to be successful, there should be greater attention to implant stability, equalization of leg length, and a postoperative regimen including muscle strengthening and range of motion exercises to achieve the required knee flexion. CLINICAL RELEVANCE: This case report is important because it presents a challenging case of a unilateral transfemoral amputee with failed arthroplasty over the years in the contralateral limb. To our knowledge, such a case has not been described in the scientific literature. It would be helpful for surgeons and rehabilitation professionals to chart out a treatment protocol and also to prevent premature failure of the joint.