Although the importance of the anterolateral stabilizing structures of the knee in the setting of anterior cruciate ligament (ACL) injuries has been recognized since many years, most of orthopedic surgeons do not take into consideration the anterolateral structures when performing an ACL reconstruction. Anatomic single or double bundle ACL reconstruction will improve knee stability, but a small subset of patients may experience some residual anteroposterior and rotational instability. For this reason, some researchers have turned again towards the anterolateral aspect of the knee and specifically the anterolateral ligament. The goal of this review is to summarize the existing knowledge regarding the anterolateral ligament of the knee, including anatomy, histology, biomechanics and imaging. In addition, the most common anterolateral reconstruction/tenodesis techniques are described together with their respective clinical outcomes.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4508556PMC
http://dx.doi.org/10.4081/or.2015.5773DOI Listing

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Background: There has been increased interest in lateral extra-articular procedures, such as anterolateral ligament reconstruction (ALLR) or lateral extra-articular tenodesis (LET), to reduce anterolateral rotation instability of the knee after anterior cruciate ligament reconstruction (ACLR). Despite promising surgical outcomes with these techniques, their impact on knee strength recovery is unknown.

Hypothesis: Patients undergoing lateral extra-articular procedures at the time of ACLR would have impaired thigh muscle strength at 6 to 9 months after surgery.

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Article Synopsis
  • Up to 27% of ACL reconstructions show ongoing instability, affecting athletes' ability to return to sports and increasing injury risks, leading researchers to compare isolated ACL repairs versus those combined with ALL reconstruction.
  • An observational study with 236 patients narrowed down to 74 ACL and 37 ACL+ALL participants was conducted to evaluate knee stability and surgical outcomes, using methods like paired score matching for pseudo-randomization.
  • Results indicated that ALL reinforcement improved pivot shift test outcomes (p=0.007), but no significant differences were found in other assessments, including pain, complications, and return to sports performance.
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January 2025

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Background: Additional anterolateral ligament (ALL) reconstruction has been associated with improved clinical outcomes and reduced failure rates in anterior cruciate ligament (ACL) reconstruction. Despite the excellent clinical results reported, there is still a heated debate about its indications. Currently, the indications are mainly based on the patient's clinical criteria and not the imaging diagnosis of the injury of this ligament.

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