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Isometric Anterolateral Ligament Reconstruction via Semitendinosus Tendon and Adjustable Suspensory Cortical Fixation

March 01, 2020

Contributors: Yong In; In Jun Koh, MD, PhD; Mansoo Kim

Many patients who have undergone anterior cruciate ligament reconstruction experience persistent instability and have a positive pivot shift test. The anatomy and function of the anterolateral ligament (ALL) may be a solution. The ALL is an important restraint to internal tibial rotation. The ALL plays an important role in improving the results of isolated anterior cruciate ligament reconstruction by affording better rotational stability. Indications for ALL reconstruction include patients undergoing a revision procedure who have a high-grade pivot shift and patients undergoing a challenging primary procedure who have a high-grade pivot shift, hyperlaxity, or hyperextension. This video introduces and describes the clinical results of our novel technique for isometric ALL reconstruction with the use of semitendinosus tendon and an adjustable-length loop suspensory cortical fixation device for tibial fixation. Between March 2018 and December 2018, five consecutive ALL reconstruction procedures were performed. The minimum follow-up was 6 months. Clinical outcomes were evaluated using the Lysholm Knee Scale and the pivot shift test. The mean Lysholm Knee Scale score improved from 57 to 91, which was a significant improvement. Preoperatively, all five patients had a grade 5 pivot shift test. Postoperatively, all five patients had a negative pivot shift test. No intraoperative or postoperative complications occurred. Our novel technique for isometric reconstruction of the ALL with the use of autogenous hamstring tendon and an adjustable-loop length suspensory fixation device affords good stability and satisfactory results in patients with anterolateral rotational instability of the knee.

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