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Titel:

Anterolateral rotational instability Anterior cruciate ligament, anterolateral complex or lateral meniscus?

Dokumenttyp:
Article
Autor(en):
Willinger, Lukas; Athwal, Kiron K.; Holthof, Sander; Imhoff, Andreas B.; Williams, Andy; Amis, Andrew A.
Abstract:
Background: Injuries of the anterior cruciate ligament (ACL), Kaplan fibers (KF), anterolateral capsule/anterolateral ligament (C/ALL), and lateral meniscus posterior root (LMPR) have been separately linked to anterolateral instability. The aim was to investigate the importance of these structures for knee stability. Methods: In this study 10 fresh-frozen human knees were robotically tested from 0 degrees to 90 degrees of flexion. An anteroposterior force of 88N, an internal-external rotational torque of 5N/m, and a valgus-varus torque of 8 N/m were applied and the kinematics of the intact knee were recorded. Another 10 knees were tested in a kinematics rig with optical tracking to measure knee laxity after sequentially severing the structures over 0 degrees-110 degrees of flexion. Results: The ACL was the primary restraint for anterior tibial translation (ATT); other structures were insignificant (< 10%). The KF and C/ALL resisted internal rotation (IR), achieving 44 +/- 23% (p< 0.01) and 14 +/- 13% (p< 0.05) at 90 degrees, respectively. The LMPR resisted valgus rotation but not IR. The ATT increased from 70 degrees to 100 degrees (p< 0.05) after ACL insufficiency (p< 0.001) and after severing the lateral structures. The pivot-shift maneuver increased anterolateral rotational instability after ACL transection from 0 degrees to 40 degrees (p< 0.05) and further after severing the lateral structures from 0 degrees to 100 degrees (p< 0.01). Conclusion: The anterolateral complex acts as a functional unit to provide rotational stability. The ACL is the primary stabilizer for ATT. The KFs are the most important IR restraint above 30 degrees of flexion. A combined KF and C/ALL injury substantially increased anterolateral rotational instability, while an isolated injury of the KF or C/ALL did not. An LMPR insufficiency did not cause significant instability with an intact ACL.
Zeitschriftentitel:
ARTHROSKOPIE
Jahr:
2023
Band / Volume:
36
Heft / Issue:
4
Seitenangaben Beitrag:
281-286
Volltext / DOI:
doi:10.1007/s00142-023-00614-1
Print-ISSN:
0933-7946
TUM Einrichtung:
Klinik und Poliklinik für Orthopädie und Sportorthopädie (Prof. von Eisenhart-Rothe)
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