Association between a Concomitant Anterolateral Ligament Tear and Pivot Shift Before and After Single-Bundle Anterior Cruciate Ligament Reconstruction: A Retrospective Cohort Study

Albert Lesmana; Antonio A. Rivera

doi:10.3889/oamjms.2022.9230

Authors

Albert Lesmana Department of Orthopedic Surgery, Makati Medical Center, Makati, Philippines
Antonio A. Rivera Department of Orthopedic Surgery, Makati Medical Center, Makati, Philippines

DOI:

https://doi.org/10.3889/oamjms.2022.9230

Keywords:

Anterolateral ligament injury, Anterior cruciate ligament injury, Single-bundle acute anterior cruciate ligament reconstruction, Pivot shift

Abstract

BACKGROUND: Regardless of the type of intra-articular anterior cruciate ligament (ACL) reconstruction performed, a certain degree of rotatory instability is often seen after surgery. Recent studies suggest that the anterolateral ligament (ALL) plays a significant role in maintaining stability during internal rotation of the tibia at high knee flexion angles. Unrecognized damage to the ALL may potentially be associated with a positive pivot shift despite a surgically reconstructed ACL being done.

AIM: The primary objective of this study was to determine whether a concomitant ALL tear is associated with a high-grade pivot shift before and after ACL reconstruction.

METHODS: This study was a retrospective cohort study of patients that underwent single-bundle ACL reconstruction surgery in our institution from October 2014 to March 2017. One hundred and forty-four patients were included in this study. All data were extracted from the department of ACL registry. All knee MRIs were reviewed by the author and coauthor to determine the integrity of the ALL. Subjects were divided into two groups based on the grade of pivot shift before surgery. The prevalence of ALL tear based on MRI was further compared between high-grade and low-grade pivot-shift groups.

RESULTS: Overall, the prevalence of a concomitant ALL tear was 70.83%. Comparing the prevalence of concomitant ALL tear between the high-grade pivot-shift group (73.11%) and low-grade pivot-shift group (60%), we had insufficient evidence to demonstrate an association between pre-surgery high-grade pivot shift and concomitant ALL tear. After surgery, none of the patients had a high-grade pivot shift or was positive for Lachman’s test.

CONCLUSION: There is a high prevalence of concomitant ALL tear in patients with torn ACL. We have insufficient evidence to demonstrate an association between the presence of a torn ALL and high-grade pivot shift before and after single-bundle ACL reconstruction.

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References

Ibrahim SA, Hamido F, Al Misfer AK, Mahgoob A, Ghafar SA, Alhran H. Anterior cruciate ligament reconstruction using autologous hamstring double bundle graft compared with single bundle procedures. J Bone Joint Surg Br. 2009;91(10):1310-5. https://doi.org/10.1302/0301-620x.91b10.21886 PMid:19794165 DOI: https://doi.org/10.1302/0301-620X.91B10.21886

Frobell RB, Roos HP, Roos EM, Roemer FW, Ranstam J, Lohmander LS. Treatment for acute anterior cruciate ligament tear: Five year outcome of randomized trial. Br Med J. 2013;346:f232. https://doi.org/10.1136/bmj.f232 PMid:23349407 DOI: https://doi.org/10.1136/bmj.f232

Ferretti A, Monaco E, Vadala A. Rotatory instability of the knee after ACL tear and reconstruction. J Orthop Traumatol. 2014;15(2):75-9. https://doi.org/10.1007/s10195-013-0254-y PMid:23917728 DOI: https://doi.org/10.1007/s10195-013-0254-y

Gang C, Wang S. Comparison of single-bundle versus double-bundle anterior cruciate ligament reconstruction after a minimum of 3-year follow-up: A meta-analysis of randomized controlled trials. Int J Clin Exp Med. 2015;8(9):14604-14. https://doi.org/10.1186/s13018-018-0753-x PMid:26628943 DOI: https://doi.org/10.1186/s13018-018-0753-x

Helito CP, Bonadio MS, Rozas JS, Wey JM, Pereira CA, Cardoso TP, et al. Biomechanical study of strength and stiffness of the knee anterolateral ligament. BMC Musculoskelet Disord. 2016;17:193. https://doi.org/10.1186/s12891-016-1052-5 PMid:27129387 DOI: https://doi.org/10.1186/s12891-016-1052-5

Parsons EM, Gee AO, Spiekerman C, Cavanagh PR. The biomechanical function of the anterolateral ligament of the knee. Am J Sports Med. 2015;43(3):669-74. https://doi.org/10.1177/0363546514562751 PMid:25556221 DOI: https://doi.org/10.1177/0363546514562751

Pomajzl R, Maerz T, Shams C, Guettler J, Bicos J. A review of the anterolateral ligament of the knee: Current knowledge regarding its incidence, anatomy, biomechanics, and surgical dissection. Arthroscopy. 2015;31(3):583-91. https://doi.org/10.1016/j.arthro.2014.09.010 PMid:25447415 DOI: https://doi.org/10.1016/j.arthro.2014.09.010

Van der Watt L, Khan M, Rothrauff BB, Ayeni OR, Musahl V, Getgood A, et al. The structure and function of the anterolateral ligament of the knee: A systematic review. Arthroscopy. 2015;31(3):569-82. https://doi.org/10.1016/j.arthro.2014.12.015 PMid:25744324 DOI: https://doi.org/10.1016/j.arthro.2014.12.015

Helito CP, Demange MK, Helito PV, Costa HP, Bonadio MB, Pecora JR, et al. Evaluation of the anterolateral ligament of the knee by means of magnetic resonance examination. Rev Bras Orthop. 2015;50(2):214-9. https://doi.org/10.1016/j.rboe.2015.03.009 PMid:26229919 DOI: https://doi.org/10.1016/j.rboe.2015.03.009

Helito CP, Helito PV, Costa HP, Demange MK, Bordalo- Rodrigues M. Assessment of the anterolateral ligament of the knee by magnetic resonance imaging in acute injuries of the anterior cruciate ligament. Arthroscopy. 2017;33(1):140-6. https://doi.org/10.1016/j.arthro.2016.05.009 PMid:27324971 DOI: https://doi.org/10.1016/j.arthro.2016.05.009

Claes S, Vereecke E, Maes M, Victor J, Verdonk P, Bellemans J. Anatomy of the anterolateral ligament of the knee. J Anat. 2013;223(4):321-8. https://doi.org/10.1111/joa.12087 PMid:23906341 DOI: https://doi.org/10.1111/joa.12087

Dodds AL, Gupte CM, Halewood C, Williams A, Amis AA. The anterolateral ligament: Anatomy, length changes and association with the segond fracture. Bone Joint J. 2014;96- B(3):325-31. https://doi.org/10.1302/0301-620x.96b3.33033 PMid:24589786 DOI: https://doi.org/10.1302/0301-620X.96B3.33033

Kosy JD, Soni A, Venkatesh R, Mandali VI. The anterolateral ligament of the knee: Unwrapping the enigma. Anatomical study and comparison to previous reports. J Orthop Traumatol. 2016;17(4):303-8. https://doi.org/10.1007/s10195-016-0392-0 PMid:26861760 DOI: https://doi.org/10.1007/s10195-016-0392-0

Thein R, Boorman-Padgett J, Stone K, Wickiewicz TL, Imhauser CW, Pearle AD. Biomechanical assessment of the anterolateral ligament of the knee: A secondary restraint in simulated tests of the pivot shift and of anterior stability. J Bone Joint Surg Am. 2016;98(11):937-43. https://doi.org/10.2106/jbjs.15.00344 PMid:27252438 DOI: https://doi.org/10.2106/JBJS.15.00344

Rahnemai-Azar AA, Miller RM, Guenther D, Fu FH, Lesniak BP, Musahl V, et al. Structural properties of anterolateral capsule and illiotibial band of the knee. Am J Sports Med. 2016;44(4):892-7. https://doi.org/10.1177/0363546515623500 PMid:26811306 DOI: https://doi.org/10.1177/0363546515623500

Song GY, Zhang H, Wu G, Zhang J, Liu X, Xue Z, et al. Patients with high-grade pivot-shift phenomenon are associated with higher prevalence of anterolateral ligament injury after acute anterior cruciate ligament injuries. Knee Surg Sports Traumatol Arthrosc. 2017;24(4):1111-6. https://doi.org/10.1007/s00167-017-4492-z PMid:28243704 DOI: https://doi.org/10.1007/s00167-017-4492-z

Sonnery-Cottet B, Thaunat M, Freychet B, Pupim BH, Murphy CG, Claes S. Outcome of a combined anterior cruciate ligament and anterolateral ligament reconstruction with a minimum of 2-year follow-up. Am J Sports Med. 2015;43(7):1598-605. https://doi.org/10.1177/0363546515571571 PMid:25740835 DOI: https://doi.org/10.1177/0363546515571571

Rezende FC, De Moraes VY, Martimbianco AL, Luzo MV, Da Silveira Franciozi CE, Belloti JC. Does combined intra-and extraarticular ACL reconstruction improve function and stability? A meta-analysis. Clin Orthop Relat Res. 2015;473(8):2609-18. https://doi.org/10.1007/s11999-015-4285-y PMid:25845949 DOI: https://doi.org/10.1007/s11999-015-4285-y