Role of the Anterior Cruciate Ligament, Anterolateral Complex, and Lateral Meniscus Posterior Root in Anterolateral Rotatory Knee Instability: A Biomechanical Study. 2023

Lukas Willinger, and Kiron K Athwal, and Sander Holthof, and Andreas B Imhoff, and Andy Williams, and Andrew A Amis
Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.

Injuries to the anterior cruciate ligament (ACL), Kaplan fibers (KFs), anterolateral capsule/ligament (C/ALL), and lateral meniscus posterior root (LMPR) have been separately linked to anterolateral instability. To investigate the contributions of the ACL, KFs, C/ALL, and LMPR to knee stability and to measure instabilities resulting from their injury. Controlled laboratory study. Ten fresh-frozen human knees were tested robotically to determine restraints of knee laxity at 0° to 90° of flexion. An 88-N anterior-posterior force (anterior and posterior tibial translation), 5-N·m internal-external rotation, and 8-N·m valgus-varus torque were imposed and intact kinematics recorded. The kinematics were replayed after sequentially cutting the structures (order varied) to calculate their contributions to stability. Another 10 knees were tested in a kinematics rig with optical tracking to measure instabilities after sequentially cutting the structures across 0° to 100° of flexion. One- and 2-way repeated-measures analyses of variance with Bonferroni correction were used to find significance (P < .05) for the robotic and kinematics tests. The ACL was the primary restraint for anterior tibial translation; other structures were insignificant (<10% contribution). The KFs and C/ALL resisted internal rotation, reaching 44% ± 23% (mean ± SD; P < .01) and 14% ± 13% (P < .05) at 90°. The LMPR resisted valgus but not internal rotation. Anterior tibial translation increased after ACL transection (P < .001) and after cutting the lateral structures from 70° to 100° (P < .05). Pivot-shift loading increased anterolateral rotational instability after ACL transection from 0° to 40° (P < .05) and further after cutting the lateral structures from 0° to 100° (P < .01). The anterolateral complex acts as a functional unit to provide rotatory stability. The ACL is the primary stabilizer for anterior tibial translation. The KFs are the most important internal rotation restraint >30° of flexion. Combined KFs + C/ALL injury substantially increased anterolateral rotational instability while isolated injury of either did not. LMPR deficiency did not cause significant instability with the ACL intact. This study is a comprehensive biomechanical sectioning investigation of the knee stability contributions of the ACL, anterolateral complex, and LMPR and the instability after their transection. The ACL is significant in controlling internal rotation only in extension. In flexion, the KFs are dominant, synergistic with the C/ALL. LMPR tear has an insignificant effect with the ACL intact.

UI MeSH Term Description Entries
D007593 Joint Instability Lack of stability of a joint or joint prosthesis. Hypermobility, Joint,Instability, Joint,Laxity, Joint,Hypermobilities, Joint,Instabilities, Joint,Joint Hypermobilities,Joint Hypermobility,Joint Instabilities,Joint Laxities,Joint Laxity,Laxities, Joint
D007719 Knee Joint A synovial hinge connection formed between the bones of the FEMUR; TIBIA; and PATELLA. Superior Tibiofibular Joint,Joint, Knee,Joint, Superior Tibiofibular,Knee Joints,Superior Tibiofibular Joints,Tibiofibular Joint, Superior
D008592 Menisci, Tibial The interarticular fibrocartilages of the superior surface of the tibia. Lateral Menisci,Medial Menisci,Menisci, Lateral,Menisci, Medial,Semilunar Cartilages,Tibial Menisci,Meniscus, Medial,Meniscus, Tibial,Tibial Meniscus,Cartilage, Semilunar,Cartilages, Semilunar,Lateral Meniscus,Medial Meniscus,Meniscus, Lateral,Semilunar Cartilage
D002102 Cadaver A dead body, usually a human body. Corpse,Cadavers,Corpses
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000070598 Anterior Cruciate Ligament Injuries Sprain or tear injuries to the ANTERIOR CRUCIATE LIGAMENT of the knee. ACL Injuries,ACL Tears,Anterior Cruciate Ligament Injury,Anterior Cruciate Ligament Tear,Anterior Cruciate Ligament Tears,ACL Injury,ACL Tear,Injuries, ACL,Injury, ACL,Tear, ACL,Tears, ACL
D001696 Biomechanical Phenomena The properties, processes, and behavior of biological systems under the action of mechanical forces. Biomechanics,Kinematics,Biomechanic Phenomena,Mechanobiological Phenomena,Biomechanic,Biomechanic Phenomenas,Phenomena, Biomechanic,Phenomena, Biomechanical,Phenomena, Mechanobiological,Phenomenas, Biomechanic
D016059 Range of Motion, Articular The distance and direction to which a bone joint can be extended. Range of motion is a function of the condition of the joints, muscles, and connective tissues involved. Joint flexibility can be improved through appropriate MUSCLE STRETCHING EXERCISES. Passive Range of Motion,Joint Flexibility,Joint Range of Motion,Range of Motion,Flexibility, Joint
D016118 Anterior Cruciate Ligament A strong ligament of the knee that originates from the posteromedial portion of the lateral condyle of the femur, passes anteriorly and inferiorly between the condyles, and attaches to the depression in front of the intercondylar eminence of the tibia. Cruciate Ligament, Anterior,Anterior Cranial Cruciate Ligament,Cranial Cruciate Ligament,Anterior Cruciate Ligaments,Cranial Cruciate Ligaments,Cruciate Ligament, Cranial,Cruciate Ligaments, Anterior,Cruciate Ligaments, Cranial,Ligament, Anterior Cruciate,Ligament, Cranial Cruciate,Ligaments, Anterior Cruciate,Ligaments, Cranial Cruciate
D059549 Anterior Cruciate Ligament Reconstruction Rebuilding of the ANTERIOR CRUCIATE LIGAMENT to restore functional stability of the knee. AUTOGRAFTING or ALLOGRAFTING of tissues is often used.

Related Publications

Lukas Willinger, and Kiron K Athwal, and Sander Holthof, and Andreas B Imhoff, and Andy Williams, and Andrew A Amis
April 2018, Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA,
Lukas Willinger, and Kiron K Athwal, and Sander Holthof, and Andreas B Imhoff, and Andy Williams, and Andrew A Amis
December 2019, Current reviews in musculoskeletal medicine,
Lukas Willinger, and Kiron K Athwal, and Sander Holthof, and Andreas B Imhoff, and Andy Williams, and Andrew A Amis
March 2020, The Knee,
Lukas Willinger, and Kiron K Athwal, and Sander Holthof, and Andreas B Imhoff, and Andy Williams, and Andrew A Amis
January 1985, Archives of orthopaedic and traumatic surgery. Archiv fur orthopadische und Unfall-Chirurgie,
Lukas Willinger, and Kiron K Athwal, and Sander Holthof, and Andreas B Imhoff, and Andy Williams, and Andrew A Amis
January 2016, Connective tissue research,
Lukas Willinger, and Kiron K Athwal, and Sander Holthof, and Andreas B Imhoff, and Andy Williams, and Andrew A Amis
February 1991, Acta orthopaedica Scandinavica,
Lukas Willinger, and Kiron K Athwal, and Sander Holthof, and Andreas B Imhoff, and Andy Williams, and Andrew A Amis
January 2010, Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chinese journal of reparative and reconstructive surgery,
Lukas Willinger, and Kiron K Athwal, and Sander Holthof, and Andreas B Imhoff, and Andy Williams, and Andrew A Amis
March 2022, Orthopaedic journal of sports medicine,
Lukas Willinger, and Kiron K Athwal, and Sander Holthof, and Andreas B Imhoff, and Andy Williams, and Andrew A Amis
September 2020, Orthopaedics & traumatology, surgery & research : OTSR,
Lukas Willinger, and Kiron K Athwal, and Sander Holthof, and Andreas B Imhoff, and Andy Williams, and Andrew A Amis
November 2023, The journal of knee surgery,
Copied contents to your clipboard!