ACL Reconstruction with Extra-articular Plasty

  • David Dejour
  • Stefano Zaffagnini
  • Panagiotis G. Ntagiopoulos
  • Alberto Grassi
  • Giulio Maria Marcheggiani Muccioli
  • Maurilio Marcacci
Chapter

Abstract

Chronic anterior cruciate ligament (ACL) laxity, and in particular rotational laxity associated with a severe positive pivot-shift test (PST), has been associated to the combined damage of the ACL and the posterolateral structures of the knee [6, 26, 32]. Other authors have also recorded possible evidence of damage of these structures along with ACL tears with the presence of the “Segond fracture” that results from avulsion of the iliotibial band (ITB) or the “anterior oblique band” of the lateral collateral ligament (LCL) [8]. Further evidence of the gross instability after ACL and lateral structures damage is the lateral tibial subluxation and the subsequent “bone bruising” observed in magnetic resonance imaging [11, 37]. As Dodds and Amis have recently published, these posterolateral structures may not have been yet directly identified, but probably act as secondary restraints to the PST, supplementing the primary restraint role of the ACL in anteroposterior laxity, with emphasis on rotatory laxity and internal rotation [15]. The persistence of this rotatory laxity has been reported even after cases of uneventful ACL reconstruction, suggesting that a single-bundle intra-articular reconstruction could not be sufficient to completely restore rotational knee stability in certain patients [38].

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Copyright information

© ESSKA 2014

Authors and Affiliations

  • David Dejour
    • 1
  • Stefano Zaffagnini
    • 2
  • Panagiotis G. Ntagiopoulos
    • 1
  • Alberto Grassi
    • 2
  • Giulio Maria Marcheggiani Muccioli
    • 2
  • Maurilio Marcacci
    • 2
  1. 1.Department of Knee Surgery and Sports MedicineLyon-Ortho-Clinic, Clinique de la SauvegardeLyonFrance
  2. 2.Clinica Ortopedia e Traumatologica II, Laboratorio di Biomeccanica ed Innovazione TecnologicaIstituto Ortopedico RizzoliBolognaItaly

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