history, need, how to reconstruct, when to reconstruct.
References: *Bonasia, Davide Edoardo et al. "Anterolateral Ligament Of The Knee: Back To The Future In Anterior Cruciate Ligament Reconstruction". Orthopedic Reviews 7.2 (2015)
Biomechanical Results of Lateral Extra-articular
Tenodesis Procedures of the Knee:
A Systematic Review. Erik L. Slette, B.A., Jacob D. Mikula, B.S., Jason M. Schon, B.S., Daniel C. Marchetti, B.A.,
Matthew M. Kheir, B.S., Travis Lee Turnbull, Ph.D., and Robert F. LaPrade, M.D., Ph.D.
Presentation on the Anterolateral Ligament (ALL) with information on diagnosis with ultrasound and treatment using an ultrasound guided, percutaneous, reconstruction and an internal brace
Deformity: It’s the position of a limb/Joint, from which it cannot be brought back to its normal anatomical position.
Described as abnormalities of :
Length
Angulation
Rotation
Translation
Combination
Presentation on the Anterolateral Ligament (ALL) with information on diagnosis with ultrasound and treatment using an ultrasound guided, percutaneous, reconstruction and an internal brace
Deformity: It’s the position of a limb/Joint, from which it cannot be brought back to its normal anatomical position.
Described as abnormalities of :
Length
Angulation
Rotation
Translation
Combination
MENISCUS REPAIR I Dr.RAJAT JANGIR JAIPUR
#aclsurgeryjaipur #aclsurgeryhindia #aclsurgerytaekwondo
Acl reconstruction in jaipur | Acl reconstruction in taekwondo | Acl injury in football player surgery | Acl reconstruction surgery in football | acl surgery | Acl surgery ke baad physiotherapy | Acl surgery in jaipur | acl surgery recovery | Best acl surgeon in jaipur | Best ligament doctor in hindi | Best acl surgeon in india | Meniscus repair surgery in jaipur | Sports injury doctor | Acl injury in football players | Acl injury in taekwondo | acl tear | Best knee surgeon in jaipur
#allinsideacl #internalbrace #drrajatjangir #bestaclsurgeon #aclexpert #bestkneesurgeon
To Know more about ACL Injury, Click the links below:
1. ACL surgery 7 different Techniques we do at our center - "Not single technique best for all"
https://youtu.be/oWkIr8IXvr8
2. Everything about ACL Injury tear surgery in Hindi I
https://youtu.be/bqpjkAkwZ14
3. Best Screw for ACL tear surgery in Hindi
https://youtu.be/1LGpU1NHiIs
4. ACL Injury Tear Surgery Recovery : All your questions & queries solved by Dr.Rajat Jangir
https://youtu.be/SIAPWiMbOqs
5. Partial ACL Tear Surgery or not ! ACL आधा टूटा हो तो क्या करें ?
https://youtu.be/NEJRPKskJTI
6. 5 Symptoms of ACL Injury tear इंजरी के पांच लक्षण ?
https://youtu.be/EXpgy19Jxzw
7. PRP injection therapy in Partial ACL TEARs
https://youtu.be/qyG1EYgS87E
Dr.RAJAT JANGIR(Asso Prof.)
Senior Consultant Arthroscopy and Joint Replacement
(Specialist in Shoulder Knee Hip Surgery)
Ligament and Joints Clinic
67/34 Mansarovar Jaipur
Whatsapp: shorturl.at/gnAEP
Appointment: +91 8104855900
Email: ligamentsurgeon@gmail.com
Google Page: https://g.page/KNEE-Shoulder-SURGERY?...
Facebook: https://www.facebook.com/Ligamentandj...
* Vast experience and specialisation in the field of Arthroscopy and sports surgery.
* M.S. orthopaedics from BJ Medical College, Civil hospital, Ahmedabad
* Fellowship in Arthroscopy and Sports injury with Prof Joon Ho Wang at Samsung Medical Center, South Korea
* Diploma in Sports Medicine from InternationaI Olympic Committee
* Invited as Athlete Medical Doctor at Rio Olympic 2016
* Done Rajasthan's first "All Inside Physeal Preserving ACL reconstruction" in 13 year old Athlete
Dr.Rajat is rated as one of the best orthopedic surgeon with with excellence in Knee Shoulder Arthroscopy surgeries as replacements'
High tibial osteotomy (HTO) is a common and widely accepted procedure in orthopaedic surgery. In the literature, we find descriptions of the technique dating back to the 50s, with Jackson (Jackson, 1958). However, it was not until the 70s, with the publications of Conventry (Coventry, 1969 and 1973) and Insall (Insall, 1975), that proximal tibial osteotomy became common practice as a treatment option for medial compartment osteoarthritis of the knee usually associated to varus deformity. At that time, closing wedge osteotomies were performed, despite the greater technical difficulty and risks involved, as there were no fixation materials available that could enable opening wedge osteotomy. Only after the development of medial wedge plate fixation that opening wedge osteotomy became applicable (Puddu, 2004).
The goals of HTO are:
1. To reduce knee pain by transferring weight-bearing loads to the relatively unaffected compartment;
2. To increase the life span of the knee joint, by slowing or stopping the destruction of the medial joint compartment. This could delay the need of a joint replacement.
TKA in valgus knee is challenging procedure seen in up to 10% of cases undergoing TKA. The procedure involves meticulous pre operative planning and intra operative soft tissue release along with modifications in bone cuts for proper implant placement and long term results
MENISCUS REPAIR I Dr.RAJAT JANGIR JAIPUR
#aclsurgeryjaipur #aclsurgeryhindia #aclsurgerytaekwondo
Acl reconstruction in jaipur | Acl reconstruction in taekwondo | Acl injury in football player surgery | Acl reconstruction surgery in football | acl surgery | Acl surgery ke baad physiotherapy | Acl surgery in jaipur | acl surgery recovery | Best acl surgeon in jaipur | Best ligament doctor in hindi | Best acl surgeon in india | Meniscus repair surgery in jaipur | Sports injury doctor | Acl injury in football players | Acl injury in taekwondo | acl tear | Best knee surgeon in jaipur
#allinsideacl #internalbrace #drrajatjangir #bestaclsurgeon #aclexpert #bestkneesurgeon
To Know more about ACL Injury, Click the links below:
1. ACL surgery 7 different Techniques we do at our center - "Not single technique best for all"
https://youtu.be/oWkIr8IXvr8
2. Everything about ACL Injury tear surgery in Hindi I
https://youtu.be/bqpjkAkwZ14
3. Best Screw for ACL tear surgery in Hindi
https://youtu.be/1LGpU1NHiIs
4. ACL Injury Tear Surgery Recovery : All your questions & queries solved by Dr.Rajat Jangir
https://youtu.be/SIAPWiMbOqs
5. Partial ACL Tear Surgery or not ! ACL आधा टूटा हो तो क्या करें ?
https://youtu.be/NEJRPKskJTI
6. 5 Symptoms of ACL Injury tear इंजरी के पांच लक्षण ?
https://youtu.be/EXpgy19Jxzw
7. PRP injection therapy in Partial ACL TEARs
https://youtu.be/qyG1EYgS87E
Dr.RAJAT JANGIR(Asso Prof.)
Senior Consultant Arthroscopy and Joint Replacement
(Specialist in Shoulder Knee Hip Surgery)
Ligament and Joints Clinic
67/34 Mansarovar Jaipur
Whatsapp: shorturl.at/gnAEP
Appointment: +91 8104855900
Email: ligamentsurgeon@gmail.com
Google Page: https://g.page/KNEE-Shoulder-SURGERY?...
Facebook: https://www.facebook.com/Ligamentandj...
* Vast experience and specialisation in the field of Arthroscopy and sports surgery.
* M.S. orthopaedics from BJ Medical College, Civil hospital, Ahmedabad
* Fellowship in Arthroscopy and Sports injury with Prof Joon Ho Wang at Samsung Medical Center, South Korea
* Diploma in Sports Medicine from InternationaI Olympic Committee
* Invited as Athlete Medical Doctor at Rio Olympic 2016
* Done Rajasthan's first "All Inside Physeal Preserving ACL reconstruction" in 13 year old Athlete
Dr.Rajat is rated as one of the best orthopedic surgeon with with excellence in Knee Shoulder Arthroscopy surgeries as replacements'
High tibial osteotomy (HTO) is a common and widely accepted procedure in orthopaedic surgery. In the literature, we find descriptions of the technique dating back to the 50s, with Jackson (Jackson, 1958). However, it was not until the 70s, with the publications of Conventry (Coventry, 1969 and 1973) and Insall (Insall, 1975), that proximal tibial osteotomy became common practice as a treatment option for medial compartment osteoarthritis of the knee usually associated to varus deformity. At that time, closing wedge osteotomies were performed, despite the greater technical difficulty and risks involved, as there were no fixation materials available that could enable opening wedge osteotomy. Only after the development of medial wedge plate fixation that opening wedge osteotomy became applicable (Puddu, 2004).
The goals of HTO are:
1. To reduce knee pain by transferring weight-bearing loads to the relatively unaffected compartment;
2. To increase the life span of the knee joint, by slowing or stopping the destruction of the medial joint compartment. This could delay the need of a joint replacement.
TKA in valgus knee is challenging procedure seen in up to 10% of cases undergoing TKA. The procedure involves meticulous pre operative planning and intra operative soft tissue release along with modifications in bone cuts for proper implant placement and long term results
Prof. Anisuddin Bhatti gave lectures to residents & Junior consultants on PostPolio Residual Paralysis part2 lower limb Reconstructive surgery on 17.04.202. Acknowledged for text and figures as such in reference list.
Dr. Anisuddin Bhatti Paediatric Orthopaedic Surgeon DR. Ziauddin University Karachi presented talk on Congenital Vertical Talus at AKU karachi on August 2023 in Orthopaedic Review course. Acknowledged for some text material & photo taken from Published literature.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
How to Give Better Lectures: Some Tips for Doctors
ALL (antero-lateral ligament) - extra articular ACL reconstruction - basics
1. Extra-Articular ACL – ALL
reconstruction
Presented by: Dr. Milind
Moderated by: Dr. Ajay
2. Introduction:
• Need - A subset of patients experienced some residual antero-
posterior and rotational instability after ACL reconstruction.*
• Anterolateral stabilizing structures in cases of anterior cruciate
ligament (ACL) injuries so came to be recognized.
• High incidence of ALL lesions in ACL-injured knees, with high-grade
pivot-shift (ROTATORY INSTABILITY), led us into the anatomy and
function of the ALL.
*Bonasia, Davide Edoardo et al. "Anterolateral Ligament Of The Knee: Back To The Future In Anterior
Cruciate Ligament Reconstruction". Orthopedic Reviews 7.2 (2015)
3. • Pivot shift test is considered most specific test for ACL injury
• Correlates best with functional instability after ACL injury and
reconstruction.
• However, some patients show a persistant pivot shift post ACL
reconstruction.
• Question arose: How can a centrally located ligament (ACL) restrict
Axial Rotation????
• Answer: ALL was the ligament responsible for rotatory stability.
4.
5. • It was concluded that ALL is an important internal rotatory stabilzer
between 30-90 degree, while ACL limited only ATT.**
• Sectioning of AMB+ PLB – grade 1 pivot positive
• Sectioning of ALL- grade 2 and above pivot positive
• Ruptured ALL is a pre requisite for Grade 3 Pivot Positive in ACL deficient
knee.
**Claes et al. , ISAKOS 2013, AAOS 2013.
6. Recent studies:
• Monaco et. Al (2012) concluded:
• Cutting the PL bundle did not increase anterior translation and rotation of the
knee.
• Cutting the AM bundle significantly increased the anteroposterior (AP)
translation at 30° and 60° (P=0.01), but did not increase rotation of the knee.
• Cutting the ALL increased anterior translation at 60° (P=0.04) and internal
rotation at 30°, 45°, and 60° (P=0.03).
• The authors concluded that cutting the ALL increased tibial rotation and could
be related to the pivot shift phenomenon.
• Pearsons et al. (2015) concluded: ALL to be an important stabilizer of
internal rotation at flexion angles >35°.
7. Brief history:
• In 1879, Paul Segond described a pearly, resistant, fibrous band
inserting on the anterolateral aspect of the proximal tibia.
• Segond fracture: avulsion fracture of LCL attachment at tibial
insertion
• Later called by different names:
• Anterior Band of LCL – Irvine et. al
• Anterior oblique band- Campos et. al
• Antero lateral ligament – Vieria et. al
8. Anatomy of the ALL:
• Origin: Fan like; Femoral epicondyle, anterior-
superior to LCL and posterior and proximal to
insertion of popliteus tendon.
• Insertion: thick capsular fold; midway between
the fibular head and the gerdy’s tubercle.
9. Diagnosis:
• MRI is the modality of choice. (3.0 T study
with 0.4 mm slice thickness and fat
suppression images)*
• Identification of ALL is easier at the
meniscal and tibial attachment, due to the
ALL’s close relationship with the insertion
of the LCL and popliteus tendon
proximally.
• Somewhat ill defined and sheet-like,
inseparable from the adjacent LCL
proximally and iliotibial band distally.
*Gossner J. The anterolateral ligament of the knee. Visibility on magnetic resonance imaging. Rev Bras Ortop 2014;9:98-9.
10. Treatment & indications of repair:
• Recommendation to add a lateral plasty to traditional ACL reconstruction
only in selected cases of:
• Marked rotational instability;
• In cases of high level athletes & contact athletes;
• In selected case of revision ACL surgery.
• Post ACL reconstruction- Symptomatic patients with clinical rotatory instability.
• *Bonasia, Davide Edoardo et al. "Anterolateral Ligament Of The Knee: Back To The Future In Anterior Cruciate Ligament
Reconstruction". Orthopedic Reviews 7.2 (2015)
• *Monaco E, Maestri B, Conteduca F, et al. Extra-articular ACL reconstruction and pivot shift: in vivo dynamic evaluation with navigation. Am
j Sports Med 2014;42:1669-74.
• *Saragaglia D, Pison A, Refaie R. Lateral tenodesis combined with anterior cruciate ligament reconstruction using a unique semitendinosus
and gracilis transplant. Int Orthop 2013;37:1575-81.
11. Techniques of repair:
• Main concept is reconstruction of ALL using either ITB, PTB graft, ST
&/or Gracilis graft.
• Peripheral location of the ALL is the main contributor to
Rotational/Axial stability in comparison to centrally located PL bundle.
• Various surgical procedures for lateral extra articular tenodesis have
been devised since 1967 when Lemaire described it first.
12. Lemaire’s Procedure:
• A strip of iliotibial band was
detached proximally
• Passed deep to the FCL, through a
femoral tunnel at the attachment
point of lateral gastrocnemius.
• The graft is passed deep to the
FCL a second time and fixed with
sutures to the iliotibial band with
the knee flexed to 30 degree and
held in external rotation
13. MacIntosh
procedure(1976):
• A strip of iliotibial band was detached
proximally and passed deep to the
FCL, through an osteoperiosteal
tunnel posterior to the FCL femoral
attachment.
• The graft was then looped through
the lateral intermuscular septum and
sutured back onto itself at the Gerdy
tubercle with the knee flexed to 90
and held in external rotation
14. Losee technique(1978)
A strip of iliotibial band was detached
proximally and passed through a femoral
tunnel that originated at the
attachment point of the lateral gastrocnemius
and ended anterodistal to the FCL femoral
insertion site.
The graft was then sutured at the Gerdy
tubercle with the knee flexed to 30 and held
in external rotation
15. Arnold & Coker (1979)
• A strip of iliotibial band was
detached proximally, passed
beneath the FCL and popliteus
tendon, and sutured to the
Gerdy tubercle with the knee
flexed to 90-100 and held in
external rotation
16. Ellison (1979):
• A distally detached strip of
iliotibial band with a bone flake
was passed deep to the FCL and
anchored in a bone trough
slightly anterior to its original
harvest site at the Gerdy
tubercle with the knee flexed to
90 and held in external rotation.
• The capsular structures were
reefed deep to the FCL
17. Wilson & Scranton:
• A strip of iliotibial band was
detached proximally, passed
deep to the FCL and lateral
gastrocnemius tendon, and
sutured back onto itself with
the knee flexed to 60 and held
in external rotation.
• This extra-articular
reconstruction was used in
conjunction with an intra-
articular ACL semitendinosus
graft reconstruction
18. Zarins and Rowe
technique:
The semitendinosus tendon was detached proximally and
passed through an obliquely oriented tibial tunnel,
across the knee joint, and over the lateral femoral condyle.
After passing over the lateral femoral condyle,
the graft was passed deep to the FCL and sutured onto the
iliotibial band. Similarly, the iliotibial band was
passed deep to the FCL and over the superior aspect of the
lateral femoral condyle.
After passing over the lateral femoral condyle, the graft
was passed across the knee joint, through the same
obliquely oriented tibial tunnel as the semitendinosus
tendon, and fixed with sutures to the semitendinosus
tendon with the knee flexed to 60 and held in external
rotation
19. Andrews procedure:
Two strips of iliotibial band were detached
proximally and sutured at their proximal
ends.
Then, the sutures were passed through 2
parallel tunnels, which originated at the
lateral femoral condyle and exited at the
medial femoral condyle.
After passing through the tunnels in the
lateral-to-medial direction, the suture were
tied together over the adductor tubercle. The
grafts were fixed with the knee flexed to 90
and held in external rotation.
20. Benam procedure:
• The lateral one-third of the
patellar tendon was harvested
proximally with a patellar bone
block, passed deep to the FCL,
and fixed with a staple within a
bony groove deep to the femoral
origin of the FCL with the knee
flexed to 45 and held in external
rotation
21. Muller procedure:
A strip of iliotibial band was
detached proximally and fixed with
2 cancellous screws to a point
anterior to the junction of the
femoral shaft and lateral femoral
condyle with the knee held in
external rotation
22. Marcacci and Zaffagnini
technique:
• Solves both purposes: ACL & ALL
reconstruction.
• Semitendinosus and gracilis tendons
were harvested proximally, sutured
together, and passed through a tibial
ACL reconstruction tunnel.
• The graft exited the tibial tunnel
intra-articularly and was passed
through the posterior aspect of the
femoral notch and over the top of
the lateral femoral condyle.
• The graft was then passed deep to
the iliotibial band and over the FCL
and was fixed distal to the Gerdy
tubercle. With the knee flexed to 90
and held in external rotation
23. Review of literature:
• Various studies have reported following conclusions:
• In the ACL-deficient knee, LET procedures overconstrained the knee
and restricted internal tibial rotation when compared with the native
state.
• In addition, isolated LET procedures did not return normal anterior
stability to the ACL-deficient knee but did significantly reduce anterior
tibial translation and intra-articular graft forces during anteriorly
directed loading.
24. Review of literature:
• 2006, Zaffagnini et al. quantitatively assessed in vivo static and dynamic
biomechanics of the knee before and after ACL reconstruction, comparing the
Marcacci technique with anatomic double-bundle technique.
• The Marcacci technique showed statistically better laxity reduction in
varus/valgus stress test at full extension and in internal/external rotation at 90° of
flexion.
• The lateral plasty better controlled the lateral compartment during drawer test
and varus/valgus stress test both at 0° and 30° of flexion and both the
compartments during internal/external rotation at 90° of flexion.
• On the other hand, pivot-shift phenomenon was better controlled by anatomic
double-bundle reconstruction.
• The authors also concluded that patellar tendon and Marcacci techniques can be
equivalent options for ACL reconstruction.
25. • In 2007, Monaco et al. compared lateral tenodesis (Arnold-Coker
procedure) plus single bundle ACL reconstruction (Group A) with
anatomic double bundle ACL reconstruction (Group B), in terms of
internal tibial rotation.
• A computer navigation system was used to evaluate the global
kinematic of the knee.
• No differences were found in terms of antero-posterior tibial
displacement and external rotation; however a significant reduction
in internal rotation of the tibia was found in group A compared with
group B (P=0.0001)
Review of literature:
26. • In 2014, Monaco et al. evaluated the role of lateral tenodesis on the
pivot shift effect.
• Twenty patients underwent anatomic single bundle ACL
reconstruction with the addition of extra-articular reconstruction.
showed that extra-articular reconstruction had little effect in reducing
ATT at 30° of flexion, but it was more effective than intra-articular
reconstruction in reducing ATR (Ax Tibial Rotn.)
• The authors concluded that anatomic ACL reconstruction and lateral
tenodesis were synergic in controlling the pivot-shift phenomenon
Review of literature:
27. • The concept of anterolateral laxity & anterolateral tenodesis for ALL
injuries is well known.
• Although isolated lateral plasties are obsolete, many surgeons are
currently combining a lateral tenodesis with traditional ACL
reconstruction.
• Whether or not these techniques produce better outcomes compared
with isolated ACL reconstruction is still under debate.
• No randomized controlled trials are available comparing the
traditional ACL reconstruction techniques isolated and combined with
lateral plasties.
Conclusion: