Anterolateral Ligament Expert Group consensus paper on the management of internal rotation and instability of the anterior cruciate ligament - deficient knee

Purpose of this paper is to provide an overview of the latest research on the anterolateral ligament (ALL) and present the consensus of the ALL Expert Group on the anatomy, radiographic landmarks, biomechanics, clinical and radiographic diagnosis, lesion classification, surgical technique and clinical outcomes. A consensus on controversial subjects surrounding the ALL and anterolateral knee instability has been established based on the opinion of experts, the latest publications on the subject and an exchange of experiences during the ALL Experts Meeting (November 2015, Lyon, France). The ALL is found deep to the iliotibial band. The femoral origin is just posterior and proximal to the lateral epicondyle; the tibial attachment is 21.6 mm posterior to Gerdy's tubercle and 4-10 mm below the tibial joint line. On a lateral radiographic view the femoral origin is located in the postero-inferior quadrant and the tibial attachment is close to the centre of the proximal tibial plateau. Favourable isometry of an ALL reconstruction is seen when the femoral position is proximal and posterior to the lateral epicondyle, with the ALL being tight upon extension and lax upon flexion. The ALL can be visualised on ultrasound, or on T2-weighted coronal MRI scans with proton density fat-suppressed evaluation. The ALL injury is associated with a Segond fracture, and often occurs in conjunction with acute anterior cruciate ligament (ACL) injury. Recognition and repair of the ALL lesions should be considered to improve the control of rotational stability provided by ACL reconstruction. For high-risk patients, a combined ACL and ALL reconstruction improves rotational control and reduces the rate of re-rupture, without increased postoperative complication rates compared to ACL-only reconstruction. In conclusion this paper provides a contemporary consensus on all studied features of the ALL. The findings warrant future research in order to further test these early observations, with the ultimate goal of improving the long-term outcomes of ACL-injured patients. Level of evidence Level V-Expert opinion

Ricostruzione con STG a Singolo Fascio – Tecnica Transtibiale, Transportale, Over The Top

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Anatomic double-bundle anterior cruciate ligament reconstruction leaving hamstrings tibial insertion intact: technical note.

his article describes an anatomic, double-bundle, arthroscopic anterior cruciate ligament reconstruction technique with hamstrings using second-generation out-in retrograde femoral drills, second-generation cortical femoral suspensory fixation devices with adjustable graft loop length, standard out-in tibial drills, and titanium low-profile tibial staples. Grafts choice is autologous gracilis and semitendinosus tendons. They are harvested through the single minimally invasive tibial incision maintaining their tibial insertion. Sutures are tightened at the free proximal tendon ends to obtain a sufficient strength to traction. The grafts are reflected in two separate loops and linked to femoral adjustable TightRope graft loops. With this method, grafts length can be customized to the anatomy of every knee and their tension can be increased even after graft fixation. The preservation of tendons tibial insertion could improve the neoligamentization process, acting as a tenodesis

Sostituti Meniscali collagenici: Tecnica e risultati

E' estremamente importante preservare il menisco quanto pi\uf9 possibile per evitare la progressione della degenerazione articolare del ginocchio. In effetti, un numero considerevole di pazienti soffre a causa degli effetti in seguito ad una meniscectomia artroscopica anche parziale.Stone, Steadman e Rodkey hanno sviluppato un nuovo tipo di scaffold in collagene I per sostituire il menisco in caso di rotture parziali/subtotali irreparabili: il CMI (Collagen Meniscus Implant). Dopo 13 anni di buoni risultati nell\u2019uso del CMI mediale, nel 2006 abbiamo iniziato uno studio multicentrico europeo per valutarne l'efficacia e l'efficacia di uno scaffol meniscale equivalente appositamente progettato per riparare i difetti parziali/subtotati del menisco laterale (Lateral CMI). In questo articolo si descrivono le indicazioni per l\u2019impianto di uno scaffol meniscale collagenico, l'evoluzione della tecnica chirurgica (da una tecnica di sutura artroscopica \u201cin-out\u201d ad una \u201call-inside\u201d) nei nostri 13 anni di esperienza e una breve relazione sui nostri risultati clinici

Soft Tissue Balancing of the Knee Flexion

Soft tissue balancing in primary total knee arthroplasty is proposed as a practical text for the management of soft tissue balancing, presenting step-by-step descriptions of surgical technique. The next was intended to be a pragmatic reference for students, residents, fellows and attending surgeons engaged in the treatment of patients who have undergone knee replacement surgery. This book uses \u201chow to\u201d approach for many of the complex issues confronting us in total knee arthroplasty, written by some expert Authors. It is devoted to issues relating to primary total knee arthroplasty \u2013 from simple to the most complex. The first and second chapters include the primary technique in knee arthroplasty outlining tips and pearls during the surgical procedure. Some of the chapters emphasize principles of primary in cruciate retaining and posterior stabilized implants underlining the differences in soft tissue balancing and showing the use of navigation system. The last chapters show \u201chow to\u201d perform the soft tissue balancing in different deformities, such as varus and valgus, flexed and stiff knees. Last, but not least, the final chapter draws attention in extensor mechanism issues