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

The introduced snail Melanoides Tuberculatus (Muller, 1774) (Mollusca: Thiaridae) in aquatic ecosystems of the Brazilian Semiarid Northeast (Piranhas-Assu River basin, State of Rio Grande do Norte)

Records of the gastropod Melanoides tuberculatus (Müller, 1774), family Thiaridae, in the Piranhas-Assu River basin in Rio Grande do Norte reveal the dispersal of this native Southeast Asian and East African species into aquatic environments of the Brazilian semiarid region, including artificial environments (reservoirs) and lotic systems. The eutrophic conditions of the local waterbodies appear to favor the present situation, where this invasive species reaches extremely high densities, sometimes over 10,000 ind.m-2 as in Armando Ribeiro Gonçalves Reservoir. These observations indicate the immediate need for new studies on the spatial distribution of the species and its potential impact on the biodiversity and water quality of the waterbodies of the semiarid region of the state. Implantation of regular and systematic monitoring of the aquatic resources of the region is urgently required