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Anterolateral And Knee

Mithun Nambiar, James Randolph Onggo, Anthony Jacobson
Lipoma arborescens (LA) is a rare condition with synovial membrane lipomatous proliferation. It most commonly affects the knee joint, in the suprapatellar pouch. It can present as a painful knee with an effusion. Diagnosis is via MRI demonstrating a synovial mass with frond-like appearance, and histology showing mature adipose cells, with an overlying synovial membrane. Treatment options include non-operative measures with analgesia, or operative intervention to resect the lesion. We describe a unique case of LA present in the anterolateral knee joint, presenting with persistent painful clicking in the knee...
February 7, 2019: BMJ Case Reports
Nobuaki Miyaji, Yuichi Hoshino, Toshikazu Tanaka, Kyohei Nishida, Daisuke Araki, Noriyuki Kanzaki, Takehiko Matsushita, Ryosuke Kuroda
PURPOSE: The purpose of this study was to quantitatively compare the results of pivot-shift test between knees with anterior cruciate ligament (ACL) injury with and without anterolateral capsule (ALC) injury detected on MRI. ALC injury was hypothesized to worsen rotatory knee laxity. METHODS: 82 patients with unilateral ACL injury were enrolled in this study. The pivot-shift test was performed under anesthesia before ACL reconstruction. Two evaluations were conducted simultaneously: IKDC clinical grading and the quantitative evaluation using an electromagnetic measurement system that determined tibial acceleration (m/s2 )...
February 4, 2019: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
Eduardo Frois Temponi, Adnan Saithna, Lúcio Honório de Carvalho, Bruno Presses Teixeira, Bertrand Sonnery-Cottet
Background: Combined partial lateral collateral and complete anterolateral ligament (PLCCALL) injuries are a specific injury pattern seen in Brazilian jiu-jitsu (BJJ) because of the knee varus-flexion mechanism that frequently occurs during grappling. Purpose/Hypothesis: The purpose of this study was to evaluate the incidence of this injury pattern in a series of BJJ athletes with an acute knee injury and to evaluate clinical and functional outcomes after nonoperative management at a minimum follow-up of 1 year...
January 2019: Orthopaedic Journal of Sports Medicine
Jason A Grassbaugh, Eric K Turner
The anterolateral ligament of the knee continues to create a spirited debate within orthopaedics. This can be traced as far back as 1879, when Segond initially described a "pearly, resistant, fibrous band" of the anterolateral aspect of the knee. More recently, much orthopaedic research has been aimed at not only the clinical significance-but defining its very existence. At times, it seems akin to a modern-day search for Bigfoot-some see it, some do not. The authors of this commentary are becoming less skeptical of the anterolateral ligament's existence but remain in search of its surgical significance...
February 2019: Arthroscopy: the Journal of Arthroscopic & related Surgery
David A Pula
The anterior lateral complex is commonly associated with anterior cruciate ligament (ACL) injury. This has been evident since the description of the Segond fracture and by the use of lateral extra-articular tenodesis for ACL injury. Although lateral extra-articular tenodesis has been mostly given up owing to a preference for anatomic ACL reconstructions, it is gaining interest as an adjunct to ACL reconstruction. To determine the need for an anterolateral procedure we need to be able to identify those patients with deficiency in the anterolateral complex...
February 2019: Arthroscopy: the Journal of Arthroscopic & related Surgery
Bertrand Sonnery-Cottet, Thais Dutra Vieira, Herve Ouanezar
In the context of anterior cruciate ligament reconstruction surgery, anterolateral ligament reconstruction is now recognized as a reliable option to control rotatory instability and should be considered in the knee surgeon's modern armamentarium. By highlighting its daily practical application, this infographic presents the indications for this specific additional lateral augmentation, the anatomic and biomechanical principles that underline its rationale, and the clinical outcomes from recent large series...
February 2019: Arthroscopy: the Journal of Arthroscopic & related Surgery
James H Lubowitz, Jefferson C Brand, Michael J Rossi
In 2018, Letters to the Editor of Arthroscopy were heated and helped point out the broiling topics in our field including ankle arthroscopy distraction technique versus no-distraction and dorsiflexion, knee anterolateral ligament reconstruction versus lateral extraarticular tenodesis, hip labral primary repair versus primary reconstruction, and shoulder stabilization technique cost-effectiveness.
February 2019: Arthroscopy: the Journal of Arthroscopic & related Surgery
Cristian Jette, Jaume Pomés, Sergi Sastre, David Gutierrez, Manuel Llusa, Andrés Combalia
PURPOSE: To determine the best angle to drill the femoral tunnels of an anterolateral ligament (ALL) anatomic reconstruction combined with a single-bundle anterior cruciate ligament (ACL) reconstruction to avoid tunnel collisions and cortical disruption. METHODS: Ten cadaveric knees were studied. Single-bundle anatomic ACL femoral tunnels were arthroscopically drilled. The starting point of the ALL femoral tunnel was located posterior and superior to the lateral epicondyle...
February 2, 2019: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
Thomas Neri, Rodolphe Testa, Loic Laurendon, Margaux Dehon, Sven Putnis, Samuel Grasso, David A Parker, Frederic Farizon, Remi Philippot
BACKGROUND: The variation of the anterolateral ligament (ALL) length during knee motion is still unclear, and the knee position in which a reconstruction graft should be tensioned remains controversial. The objective of this study was to determine the variation of the ALL length during knee motion using a three-dimensional optoelectronic system. METHODS: Kinematic analyses of 20 cadaveric knees were performed using a Motion Analysis® system. The variability of the measurements made during the five acquisition cycles was studied...
January 24, 2019: Clinical Biomechanics
Yibei Wang, Shiqi Li, Daorong Xu, Lei Qian, Chunyu Jiang, Maoqing Fu, Peidong Sun, Jun Ouyang
BACKGROUND: Injuries of the anterolateral ligament (ALL) are fairly common in patients with ruptures of the anterior cruciate ligament (ACL). Before considering repair or reconstruction of the ALL, the lack of knowledge with regard to the biomechanical behavior of this ligament must be considered. The purpose of this study was to analyze the strain of the ALL induced by tibial internal rotation at different flexion angles and find out the strain distribution features. METHODS: The ALLs of ten fresh-frozen cadaver knees were dissected...
January 29, 2019: Knee
Nikolaus Rosenstiel, Cesar Praz, Hervé Ouanezar, Adnan Saithna, Yann Fournier, Jean-Philippe Hager, Mathieu Thaunat, Bertrand Sonnery-Cottet
PURPOSE: To evaluate clinical outcomes in professional athletes after combined anterior cruciate ligament (ACL) and anterolateral ligament (ALL) reconstruction at a minimum follow-up of 2 years. METHODS: A retrospective analysis of prospectively collected data from the SANTI Study Group database was performed. All professional athletes who underwent primary combined ACL and ALL reconstruction between January 2011 and March 2016 were included. Patient assessment included physical examination, pre- and postoperative subjective and objective International Knee Documentation Committee (IKDC), Tegner activity scale, and Lysholm scores...
January 29, 2019: Arthroscopy: the Journal of Arthroscopic & related Surgery
Q F Gao, X F Zhang, W F Zhang, B Ma, X T Niu, Y J Ma, Z B Li, N Liu
Objective: To investigate the clinical effects of perforating branch flaps of medial vastus muscle in repairing secondary wounds in donor sites of free anterolateral femoral perforator flaps. Methods: From August 2014 to December 2016, 12 patients (8 males and 4 females, aged 35-72 years) with skin and soft tissue defects of extremities associated with tendon and bone exposure were treated in Hanzhong Central Hospital. The sizes of the primary wounds after debridement were 10 cm×8 cm-22 cm×14 cm, and the wounds were repaired with 12 cm×10 cm-24 cm×16 cm free anterolateral femoral perforator flaps...
January 20, 2019: Zhonghua Shao Shang za Zhi, Zhonghua Shaoshang Zazhi, Chinese Journal of Burns
Joseph K Kendal, Damian Clark, David Longino, Travis E Marion, Richard Buckley, Prism S Schneider, Ryan Martin
Posterolateral tibial plateau (PLTP) fractures are often associated with anterior cruciate ligament (ACL) incompetence, such as tibial eminence fractures. Both occur from a pivot shift like mechanism. Malreductions of the tibial plateau most frequently occur in the posterolateral quadrant. Acquiring adequate intraoperative visualization of the PLTP poses a challenge. We hypothesized that visualization of PLTP could be improved by positioning the knee at 110 degrees of flexion with the addition of a varus anterolateral rotatory vector...
January 24, 2019: Journal of Knee Surgery
Pietro G di Summa, Gianluca Sapino, Mario Cherubino, Giorgio De Santis, Sebastien Durand, Patrice Zaugg, Olivier Bauquis, Wassim Raffoul
BACKGROUND: We evaluated composite anterolateral thigh (ALT) flaps including vascularized fascia lata (FL), for stable soft tissue coverage and tendons restoration at various joint levels in a one-stage procedure. METHODS: We performed a retrospective investigation including 21 "functional" ALT flaps between November 2006 and December 2016. In all patients included, FL was shaped to anatomical reproduce a tendon structure. Functional analysis included range of motion and force assessment...
January 22, 2019: Microsurgery
Elena Lucattelli, Luca Delcroix, Carla Baldrighi, Sara Tanini, Marco Innocenti
Quadriceps tendon re-rupture after surgical repair is an overall estimated 2% complication. We report a case of reconstruction in a large tendon and soft tissue defect using a reverse-flow anterolateral thigh (ALT) perforator flap including fascia lata in a 75-year-old man presented with septic necrosis of a reconstructed quadriceps tendon. A reverse-flow ALT flap was transferred to the knee defect; the fascia lata was sutured to the residual tendon. Post-operative flap congestion and infection were successfully treated with debridement and conservative treatment...
January 21, 2019: Microsurgery
Richard Meehan, Chris Wilson, Eric Hoffman, Lynne Altimier, Maryanne Kaessner, Elizabeth A Regan
Synovial fluid based biomarker research has been limited by the small volumes of synovial fluid from the knees of some patients. We used ultrasound (US) to determine if synovial fluid could be displaced into an access port during pneumatic compression to 100 mmHg. Forty knees from thirty-seven consecutive arthritis patients with rheumatoid arthritis -25, osteoarthritis -8, psoriatic arthritis -2, and 1 each with systemic lupus erythematosus and gout were evaluated. This group of 28 females and 9 males with a median age of 59 years and an average body mass index of 26...
January 15, 2019: Journal of Orthopaedic Research: Official Publication of the Orthopaedic Research Society
Dhong Won Lee, Jin Goo Kim, Seung Ik Cho, Du Han Kim
BACKGROUND: Although the cause of rotational instability after revision anterior cruciate ligament reconstruction (ACLR) is multifactorial, the rationale of adding an extra-articular procedure is based on its ability to restrict rotational instability. PURPOSE: To assess the effect of anterolateral ligament (ALL) reconstruction on revision ACLR. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: A total of 87 patients who underwent revision ACLR between March 2011 and July 2014 with a follow-up of more than 3 years were included in this retrospective study...
January 14, 2019: American Journal of Sports Medicine
Yong-Beom Park, Han-Jun Lee, Du-Hyun Ro, Geun Young Lee, Sujin Kim, Seong Hwan Kim
PURPOSE: To investigate the prevalence of the anterolateral ligament (ALL) injuries and its role in rotatory laxity in acute anterior cruciate ligament (ACL)-injured knees. METHODS: Two-hundred and ninety-six consecutive patients with acute ACL injuries were evaluated retrospectively, excluding those with other ligament injury and undetectable path of ALL in MRI. Patients were divided into two groups based on the degree of ACL injury in arthroscopy (complete versus partial group)...
January 11, 2019: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
Jérôme Murgier, Brian M Devitt, Julie Sevre, Julian A Feller, Etienne Cavaignac
Paul Segond was a French surgeon who was in practice at the end of the 19th century. A prodigious anatomist, scientist, and surgeon in his day, he is best known for his treatise on the origin of traumatic hemarthrosis of the knee following injury. In this detailed description of the anatomy of the anterolateral aspect of the knee, he describes "a pearly, resistant, fibrous band that is placed under extreme tension when the knee is forcefully rotated internally," which has more recently been described as the anterolateral ligament or a capsular thickening contributing to the anterolateral complex of the knee...
January 3, 2019: Arthroscopy: the Journal of Arthroscopic & related Surgery
Diego Ariel de Lima, Camilo Partezani Helito, Lana Lacerda de Lima, Daniel de Castro Silva, Maria Luzete Costa Cavalcante, José Alberto Dias Leite
PURPOSE: To conduct a systematic literature review to search for studies on the anatomy of the anterolateral ligament (ALL) of the knee, presenting the most accepted findings, as well as the evolution of anatomic information on this structure. METHODS: We reviewed the PubMed, MEDLINE, and ClinicalKey databases for anatomic studies on the ALL, involving cadaveric, histologic, and biochemical dissection and/or anatomic imaging. The primary data researched were the presence of the ligament; measures of length, width, and thickness; ligament path; insertions; number of bands; histologic assessment; and innervation...
January 3, 2019: Arthroscopy: the Journal of Arthroscopic & related Surgery
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