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The effect of anterolateral ligament tear on the pivot shift phenomenon: a cadaveric study using navigation
Author(s):
Redler A. (Italy)
,
Redler A. (Italy)
Affiliations:
Monaco E.
,
Monaco E.
Affiliations:
Fabbri M.
,
Fabbri M.
Affiliations:
Mazza D.
,
Mazza D.
Affiliations:
Daggett M.
,
Daggett M.
Affiliations:
Lanzetti R.
,
Lanzetti R.
Affiliations:
De Carli A.
,
De Carli A.
Affiliations:
Ferretti A.
Ferretti A.
Affiliations:
ESSKA Academy. Redler A. May 9, 2018; 209380; P04-298
Dr. Andrea Redler
Dr. Andrea Redler
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Abstract
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Objectives: The aim of this study was to evaluate the effect of progressive lesions of the anterior cruciate ligament (ACL) and anterolateral ligament (ALL) on both the static anterior stability and the dynamic rotational stability of the knee. The hypothesis was that the ACL would be the primary anterior stabilizer of the knee while both the ACL and ALL would contribute to the dynamic rotational stability of the knee.

Methods: A total of eight knee were tested using a navigation system. The cadavers remained fully intact and no soft tissue was cut or removed from around the knee or adjacent joints to most closely match a normal human knee. The anterior stability of knee was measured through a Lachman test and the dynamic rotational stability was measured through the pivot-shift test during three different conditions: intact knee, ACL deficient knee and then ACL+ALL deficient knee. Results of each state were then compared using a Kruskal-Wallis H test and subsequent pairwise comparisons were performed using Dunn's procedure.

Results: Statistical analysis of the static anterior stability demonstrated statistically significant changes in anterior tibial translation (ATT) in the native versus ACL deficient knees (p< 0.05) but the addition of an ALL lesion did not further impact these changes in ATT (p >0.05). In the analysis of dynamic rotational control, ACL deficient knees demonstrated no significant difference in either ATT and for axial tibial translation (ATR) (p>0.05) compared to an intact knee during the pivot shift. Subsequent incision of the ALL did not further increase ATT compared to an intact or ACL deficient knee (p>0.05). Conversely, a significant effect on ATR was found when comparing the ACL+ALL deficient knee to the ACL deficient knee (p=0.017) and to the intact knee (p=0.018) during the pivot-shift test.

Conclusions: During a pivot shift test, a combined lesion of the ACL and ALL has a significant effect on ATR while an isolated lesion of the ACL has no effect on either ATT and ATR. During a Lachman test, an isolated lesion of the ACL has a significant effect on ATT but an additional lesion of the ALL does not impact the ATT.

Keywords:
ACL; ALL; navigation
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