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ALL (Anterolateral Ligament) Reconstruction

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Published on Nov 20, 2013

This video demonstrates combined ACL reconstruction, using the 'All-Inside' technique with a single quadrupled semitendinosis, with an anatomic reconstruction of the anterolateral ligament (ALL) using the spared Gracillis tendon as a free graft. This is based upon the anatomy described by Dr Steven Claes, Prof. Johan Bellemans et al in their recent publication in the Journal of Anatomy. (1)

Following cadaveric work that was carried out between Dr Claes, Prof. Bellemans and myself, we have devised a surgical technique which we are now performing on selected patients. Steven very kindly joined me to shoot this video at the North Hampshire Hospital in Basingstoke. The video demonstrates our minimally invasive procedure for reconstructing "the anterolateral corner of the knee". For many years I have carried out a lateral tenodesis using a modified MacIntosh procedure for revision ACL cases and primaries with a high-grade pivot shift. Most knee surgeons are familiar with the Macintosh procedure which is an excellent option but is non anatomic. It is done through an extensile approach and involves taking a long strip of ITB to provide a check to excessive abnormal internal rotation of the knee.

With the anatomy and biomechanics that Steven has demonstrated, we have been able to develop a truly minimally invasive approach to carry out the ALL reconstruction.

The sockets are made via stab incisions and a free Gracillis graft is used for the new ALL ligament. The early results are looking very promising. We have performed over 30 cases in the last six months and there have been no complications relating to the surgery. In particular, there have been no failures, no residual clinical laxity, and no complaints of discomfort on the lateral side of the knee or any restriction of movement. It is obviously too early to draw any long-term conclusions but we believe this represents an excellent minimally invasive option for carrying out reconstruction of the anterolateral ligament.

1. Claes S, Vereecke E, Maes M, Victor J, Verdonk P, Bellemans J. Anatomy of the anterolateral ligament of the knee. Journal of Anatomy. 2013;223(4):321-8.

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