Robert LaPrade, MD, PhD recently completed a two-part study on the posterior cruciate ligament (PCL). As published in the American Journal of Sports Medicine, the first study analyzed the anatomy of the PCL, and the second study analyzed two different PCL reconstruction techniques.
The PCL is the strongest ligament in the knee and accounts for 3-37 percent of all knee injuries. Due to the low frequency of PCL injuries there has been little known on the PCL. The purpose of the first study was to determine the primary function of the isolated PCL bundles at varying degrees of knee flexion. The second part of the study analyzed the effectiveness of two different PCL reconstruction (PCLR) techniques: the anatomic single bundle (aSB), which is performed by >90% of sports surgeons, and the anatomic double-bundle (aDB).
To read more on these studies, please click here.
I wish to congratulate Dr. Steven Claes in his recent publication on "Anatomy of the Anterolateral Ligament of the Knee." This "rediscovery" of an important structure on the outside of the knee coincides with Dr. Claes' PhD defense in Belgium on Friday, November 8, 2013. I wish him the best of luck in his PhD defense. Click here to listen to Dr. LaPrade discuss the rediscovery of the anterolateral ligament on KLIF radio Dallas.The structure that Dr. Claes refers to as the anterolateral ligament has been called other names in the past. His group has gone into a much more detailed description of this ligament, and we look forward to further anatomic, clinically relevant biomechanical, MRI and clinical outcome studies to define if it does have importance for providing knee stability.
In the past, Dr. Ron Losse reconstructed the structure that Dr. Claes is referring to as the anterolateral ligament "ALL." The attachment points for the graft that Dr. Losse described coincides exactly with the location of Dr. Claes and his group's description of the ALL. In addition, his structure coincides with a thickening of what Dr. Jack Hughston called the mid-third lateral capsular ligament. All of these investigators, as well as others at other centers, have reported that this ligament is important in providing some stability to the knee. To date, we as a profession have not completely defined what all the structures around the knee do in providing stability to the knee. It is important to recognize that even in the best of circumstances a small, but sizeable, percentage of patients, ranging between 5% and 15%, still have some instability after suffering an ACL tear and undergoing an ACL reconstruction. There are many different anatomic or knee issues that could possibly be the cause of this. In some centers, a double-bundle ACL reconstruction is performed to try to minimize this risk, but to date there has not been shown to be any clinical significance between single and double-bundle ACL reconstructions either in the biomechanical lab or in clinical outcome studies. Other structures around the knee, such as the MCL and posterolateral corner structures, also have been found to have a rather significant role in providing stability to the knee and protecting a cruciate ligament reconstruction. The anterolateral ligament ALL, which our group has called the “mid-third lateral capsular ligament” may have some role in providing some rotational stability to the knee. I believe that further studies will be necessary to define this, define if this is something that is able to be diagnosed in patients who have this particular injury, validate if it does need to be reconstructed through clinical relevant biomechanical studies and then followed in patients to determine if outcomes are improved in patients who may require the surgery or not. In the past, most forms of extra-articular ACL constructions attempted to address the "anterolateral rotatory instability of the knee" which is present with an ACL tear. As arthroscopic instruments developed and surgeons became more adept at reconstructing the anterior cruciate ligament, most concurrent surgeries to reconstruct the anterolateral structures were abandoned because there was not found to be any difference between ACL reconstructed with or without these extra-articular structures. I believe that Dr. Claes' group is on the right path to determine if the small percentage of patients who still have some pivoting after an ACL reconstruction could possibly benefit from a reconstruction of the anterolateral ligament. However, further studies are necessary to validate this and all of us look forward to seeing the results of those studies over the next 5 to 10 years.
To see the Time Magazine article about this study, click here.
After suffering a knee dislocation last season, professional snowmobiling athlete Andrew Carlson is gearing up for the AMSOIL National Snocross Tour kick-off in Duluth, Minnesota. Coming off a success of wins during the previous ISOC season, Carlson’s injury came at a less than ideal time in his career. While racing at the Clash of Nations in Sweden last year, Carlson was in the lead on his last heat when disaster hit. As he was doubling through an icy whoop section, Carlson over jumped one of the doubles and dislocated his left knee.
Carlson tore seven structures, damaged the capsule, and the femur and tibia were completely dislocated, amplifying the complexity of the injury. Once Carlson was aware the severity of the injury he knew the doctor to treat his injury – Colorado knee specialist Dr. Robert LaPrade. After previously being treated by Dr. LaPrade for a knee injury, Carlson knew the quality of treatment he would receive.
After surgical reconstruction by Dr. LaPrade, Carlson had a long road ahead of him before he would be back racing. Carlson knew the best way to manage the recovery process was to focus on the short- term, starting with decreasing the swelling, regaining range of motion, and then focusing on strength and stability. Once the physical therapy process began, Carlson dedicated himself to a five-day-a-week regimen with the ultimate goal of being on the podium in Duluth, Minnesota.
Carlson has surprised both his physical therapist and trainer. He has regained his strength at a very rapid pace. He has been working his way back onto the snowmobile, each day getting more comfortable and confident. With patience and dedication, Andrew Carlson will once again stand on the podium, victorious.
To read the full interview with Andrew Carlson, please click here.
Photo credit: Gary Walton
For more information about Dr. Robert F. LaPrade, complex orthopedic knee surgeon, please contact his Vail, CO office at: 970.479.5881 or use this contact form: Contact Dr. Robert LaPrade - Knee Surgeon
181 West Meadow Drive, Suite 400Vail, CO 81657
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