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Anterolateral Ligament Knee
- 2. Background 2 Founder –Oklahoma Sports Science and Orthopedics Specialty –Orthopedic-Knee –Orthopedic-Shoulder –Sports Medicine Medical School –University of Oklahoma College of Medicine Residency –University of Oklahoma Health Sciences Center Fellowship –Sports Medicine – Rush Presbyterian, Chicago
- 3. Anterolateral Ligament 3 Most Recent and Relevant Scientific and Clinical Evidence
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- 27. Indication for Reconstruction of ALL • Primary ACL Reconstruction with ALL selected indications • High grade pivot shift at clinical exam • High-risk athletes (professional, soccer, basket) • Hyperlaxity • Revision ACL reconstruction with ALL 27
- 28. This explains: • Why the pivot shift gets worse over time after untreated ACL # • Why reconstructed ACL’s can still show a residual pivot • The nature of the Segond fracture 28
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- 33. The graft 33
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- 35. The knee did NOT survive the graft 35
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Editor's Notes
- This project has revolutionized my thought process on ACL INJURIES. ACL INJURIES MADE SIMPLE! I have tremendous passion for treatment of ACL INJURIES.
- I founded SPORTS SCIENCES. Trained at ou then fellowship at rush in chicago in sports medicine
- Since october 2014 3 articles to now 24 articles on ALL
- GIVEN THIS BOOK BY MY ARTHEX REP arthrex.com
- My goal since my fellowship! BTB VS. HAMSTRING Current ACLR does NOT restore normal knee kinematics!!!the goal of acl surgery is to reproduce the anatomy and biomechanics of the native acl!!
- As of october ;14 decided to research ot! Read dr claes thesis(it was logical with meticulous research). The goal of this doctoral research project was to unravel the issue of persistent rotational instability after contemporary ACLR. Brett intro tom anstead intro dr pat smith and dr chris hasty
- 9 femur 12 tibia sites
- WE MISSED IT!!!! Dr. feagin says ’you may not be seeing it but its seeing you!!) ’acl controls anterior posterior ALL CONTROLS ITR AND AFFECTS PIVOT SHIFT This makes the complex simple!!
- “why we disagree with dr fu on the pivot shift’ THIS VIDEO IS AN OUTSTANDING CONTRIBUTION TO THE UNDERSTANDING OF ALRI OF THE KNEE.it changed my view on the pivot shift!! With anatomy , pathology, and mri correlations gives us a comprehensive understanding of the anterolateral ligament, its form function and dysfunction. It allows us TO DIAGNOSE PROPERLY AND TREAT PROPERLY THE ALL INJURY. This reduces laxity or failure after ACLR
- Scope started in 1980’s and slowed down extraarticular procedures and studies.
- Hughston capsular plication pat smith “REPAIR WHAT IS TORN!:
- AAOS 2013 intro ALL into us. Systematically he presented ANATOMICAL PATHOLOGICAL and MRI correlations giving us COMPREHENSIVE usable information on ALL CLAES WAS THE FIRST TO HYPOTHESIZE THE ALL’s IMPORTANCE OF CONTROLLING ITR WHICH AFFECTS THE PIVOT SHIFT
- A POSITIVE PIVOT SHIFT IN 25% of ACLR
- The all is a distinct ligamentous structure of the knee!! INTACT ALL PROTECTS LM,LFC AND CARTILAGE IN GENERAL
- Simple physics forces on acl SIX TIMES MORE than ALL ALL PROVIDES A BETTER LEVER ARM FOR CONTROLLING
- ALL MEASUREMENTS
- FEMORAL INSERTION IS LFE TIBIAL INSERTION IS ½ between GERDYS TUBERCLE AND FIBULAR HEAD
- CLAES ET AL performed SEQUENTIAL CUTTING STUDIES ALL CAUSED SIGNIFICANT INCREASE INTERNAL TIBIAL ROTATION(ITR). Cutting ACL did little for ITR This study pioneered the BIOMECHANICSOF THE ALL. ALL is #1 restraint to ITR and AFFECTS THE PIVOT SHIFT
- CLEARLY THE SEGOND FRACTUE IS AN ALL AVULSION INJURY!!!!
- Front view coronal
- Hard to mri because of oblique path
- Claes recommends altering mri coronal view or using ultrasound
- #1 indication is ACL REVISION and or HIGH GRADE PIVOT SHIFT
- FIND LOCATION FOR TIBIAL SOCKET FIRST
- FIBER LOOP TIBIA FIX AT 60 degrees Do NOT OVERCONSTRAIN
- NO PIVOT EVEN ON REVISIONS OR CHRONIC ACL’S
- REVISIONS 2-3 PIVOT SHIFT HYPERLAXITY(hyperextension >10*
- This is a breakthrough for the DIAGNOSIS and TREATMENT PROBLEMATIC ROTATIONAL INSTABILITY(the pivot shift) EXPLAINS---some aclr still pivot, chronic acl pivot over time,segond causation
- This is an anatomic based reconstruction!!
- Need to focus on BOTH INTRAARTICULAR AND EXTRAARTICULAR STABILIZERS(medial AND lateral) REPAIR WHAT IS TORN!!
- More labs and outcomes. Critique ourselves over and over!! This was a ROADMAP from CONCEPT to SURGICAL PROCEDURE
- DYNAMIC VALGUS leads to MASSIVE FAILURE
- HAMSTRING WITH MODIFIED ANDREWS IT BAND TENODESIS
- SURVIVED THE KNEE
- THE KNEE DID NOT SURVIVE THE GRAFT
- This is a breakthrough for the DIAGNOSIS ans TREATMENT OF problematic rotational knee instability(the pivot shift)
- Think different! The ALL WORKS IN SYNERGY WITH THE ACL
- ACL INJUREIES are common SEVERE injuries often with long term sequelae. The natural history of acl injury is related to biochemical and biomechanical processes. I am very excited to continue this research with current and FUTURE surgeons!! The future=NO FAILURES!!! When you stop learning you die!!!