2017 ISAKOS Biennial Congress ePoster #1107

 

Biomechanical Evaluation of the Flat (Fascia Lata Anterolateral Tenodesis) Technique for Anatomical Anterolateral Complex Reconstruction of the Knee

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

Orthopaedic Unit, Kirk Kilgour Sports Injury Center , Rome, Italy, ITALY

FDA Status Cleared

Summary

Double bundle ALL reconstruction with fascia lata is able to restore rotation of the knee during the pivot shift test in an ACL deficient knee. AP translation is strongly correlated to ACL and is not restored by ALL reconstruction procedures.

Abstract

Introduction

Anterolateral rotatory instability of the knee is a combination of anterior translation and internal rotation of the tibia, that clinically presents with a positive pivot-shift. Persistent rotational instability is related to poor functional outcome and patient's dissatisfaction. Modern anatomical ACL reconstruction still are insufficient to completely restore normal knee joint biomechanics and rotatory stability. Recent studies have shown that such rotational instability is correlated to injuries of the anterolateral complex (ALC) , in addition to ACL tear. Despite extra-articular plasty have been used to control pivot-shift phenomenon, recently different techniques for anatomical reconstruction of the Anterolateral ligament (ALL) have been proposed. The aim the study is to present biomechanical results of the FLAT (fascia lata anterolateral tenodesis) technique for anatomical ALL reconstruction using fascia lata.

Methods

7 cadaveric knees were used to asses anteroposterior translation (AP) and rotation (ROT) of the knee using a navigation system (Orthopilot 2.0, BBraun Aesculap).
each specimen was tested in different condition:
-intact knee
-ACL tear
-ALL tear
-Single bundle non-anatomical ALL reconstruction
-Double bundle ALC reconstruction (FLAT technique)
-Single bundle anatomical ALL reconstruction
At each step of the procedure, navigation was used to calculate AP translation and ROT during pivot shift (dynamic evaluation)
Statistical analysis was performed to evaluate the effect of each step correlating the two variables (AP, ROT) of the study respect to the intact knee condition.

Results

ACL and ALL tears produced a significative effect on AP translation.
None of the reconstructive procedures restored AP translation of the intact knee.
ACL tear had no effect on ROT, while ALL lesion determined a significant increase in ROT.
Single bundle non anatomical ALL reconstruction did not restore rotation as the intact state. Both double bundle and single bundle anatomical reconstruction did.

Discussion

Results

of the present study seems to confirm the effect of the lesion of the ALL on the rotational stability of the knee, producing a significative effect on rotation during the pivot shift test, with no effect on AP translation. Lesion of the ACL produced a significative effect only on the AP translation, and none of the reconstructive procedures of the ALL could restore normal AP translation. Double bundle and single anatomical bundle ALL reconstructions seem to better restore rotation during the pivot shift test than single non anatomical bundle reconstruction.
Double bundle ALL reconstruction with fascia lata such as single bundle anatomical reconstruction is able to restore rotation of the knee during the pivot shift test in an ACL deficient knee. AP translation is strongly correlated to ACL and is not restored by the ALL reconstruction procedures.