2017 ISAKOS Biennial Congress ePoster #1085

 

Anatomic Reconstruction of Anterolateral Complex with a Strip of ITB: Clinical Results at 1 Year of Follow-Up

Andrea Redler, Prof. MD PhD, Rome ITALY
Edoardo Monaco, MD, Rome ITALY
Mattia Fabbri, MD, Rome ITALY
Daniele Mazza, MD, Rome ITALY
Angelo De Carli, MD, Rome ITALY
Andrea Ferretti, Prof., Rome, RM ITALY

Sant'Andrea hospital, Rome, italy, ITALY

FDA Status Cleared

Summary

The proposed combined ACL and anatomic ALL reconstruction seem to be an effective procedure without specific complication at a minimum follow-up of 1 year

Abstract

The ligaments of the lateral aspect of the knee acting as secondary restraints of the ACL deficient knee, whose deficiency could result in only fair control of pivot shift phenomenon after ACL reconstruction, have recently regained new interest. Many Authors have further investigated the anatomy of the so called "anterolateral ligament" (ALL) and anterolateral complex, advocating an important role of this structure in controlling internal rotation of the knee. According to previous biomechanical studies, it is now well recognized that pivot-shift phenomenon following the ACL tear is also related to injury or relaxation of the secondary restraints. Although the recent literature have focused on anatomy and biomechanics of the ALL of the knee, there is a lack of study addressing clinical outcome after ALL anatomic reconstruction. Therefore, the aim of this study was to report on preliminary results of combined ACL and ALL anatomic reconstruction at a minimum of one year of follow-up.

Methods

12 patients underwent a combined ACL and ALL anatomic reconstruction with a strip of Ileo-tibial band. Indication to perform a combined procedure were: Pivot-shift graded 3, high level of sport activity and pivoting sport. Patients were assessed pre and postoperatively with IKDC score, Lysholm score and Tegner activity scale. Moreover an instrumented knee testing was performed with KT-1000. Complications including graft failure were also recorded.
All patients underwent the same surgical procedure: DGST graft using an out-in technique. After ACL reconstruction, the lateral compartment was approached with an "hockey-stick" incision. A strip of ITB measuring 12 x 0.5 cm was harvested leaving its distal insertion at Gerdy's tubercle. After femoral and tibial insertions of the ALL were identified, the harvested ITB was used to perform an anatomic ALL reconstruction with two cannulated anchors, fixing the graft in knee full extension.

Results

The mean follow-up was 14±2 months. At the last follow-up, all patients had a full range of motion. The Lysholm, subjective IKDC and objective IKDC were significantly improved compared to pre-operative (p<0.01). The Tegner activity scale at the last-follow up showed no significant difference compared to pre-operative condition (p>0.05), with a return to sport activity after a mean of 8±1 months. The mean differential anterior laxity was 9±0.9 mm before surgery and significantly decreased to 1±0.5 mm at the last follow-up (p>0.01). Post-operatively, 11 patients had a negative Pivot-shift and 1 patient had a grade 1 Pivot-shift, with a significant improvement compared to pre-operative condition. No complications or re-ruptures were registered.

Conclusion

The proposed combined ACL and anatomic ALL reconstruction seem to be an effective procedure without specific complication at a minimum follow-up of 1 year. Longer term and comparative follow-up studies are necessary to determine if this proposed technique improve the results of ACL treatment.