本文的目的是对前外侧韧带(ALL)的最新研究进行概述,并提出ALL专家组在解剖学上的共识,射线照相地标,生物力学,临床和影像学诊断,病变分类,手术技术和临床结果。根据专家的意见,已经就围绕ALL和膝关节前外侧不稳定的有争议的主题达成共识,关于这一主题的最新出版物和所有专家会议期间的经验交流(2015年11月,里昂,法国)。ALL被发现在髂胫带深处。股骨起源位于外侧上髁的后部和近端;胫骨附着在Gerdy结节后方21.6mm,胫骨关节线下方4-10mm。在侧面射线照相视图上,股骨起源位于后下象限,胫骨附件靠近胫骨近端平台的中心。当股骨位置位于外侧上髁的近端和后部时,可以看到ALL重建的有利等轴测图,所有在伸展时都很紧,在屈曲时都很松懈。ALL可以在超声波上可视化,或在T2加权冠状MRI扫描上进行质子密度脂肪抑制评估。ALL损伤与Segond骨折有关,常伴有急性前交叉韧带(ACL)损伤。应考虑识别和修复ALL病变,以改善ACL重建提供的旋转稳定性控制。对于高危患者,ACL和ALL重建的组合改善了旋转控制并降低了再破裂率,与仅ACL重建相比,术后并发症发生率没有增加。总之,本文就ALL的所有研究特征提供了当代共识。这些发现值得未来的研究,以便进一步测试这些早期观察,最终目标是改善ACL损伤患者的长期预后。证据级别V级专家意见。
Purpose of this paper is to provide an overview of the latest research on the anterolateral ligament (ALL) and present the
consensus of the ALL Expert Group on the anatomy, radiographic landmarks, biomechanics, clinical and radiographic diagnosis, lesion classification, surgical technique and clinical outcomes. A
consensus on controversial subjects surrounding the ALL and anterolateral knee instability has been established based on the opinion of experts, the latest publications on the subject and an exchange of experiences during the ALL Experts Meeting (November 2015, Lyon, France). The ALL is found deep to the iliotibial band. The femoral origin is just posterior and proximal to the lateral epicondyle; the tibial attachment is 21.6 mm posterior to Gerdy\'s tubercle and 4-10 mm below the tibial joint line. On a lateral radiographic view the femoral origin is located in the postero-inferior quadrant and the tibial attachment is close to the centre of the proximal tibial plateau. Favourable isometry of an ALL reconstruction is seen when the femoral position is proximal and posterior to the lateral epicondyle, with the ALL being tight upon extension and lax upon flexion. The ALL can be visualised on ultrasound, or on T2-weighted coronal MRI scans with proton density fat-suppressed evaluation. The ALL injury is associated with a Segond fracture, and often occurs in conjunction with acute anterior cruciate ligament (ACL) injury. Recognition and repair of the ALL lesions should be considered to improve the control of rotational stability provided by ACL reconstruction. For high-risk patients, a combined ACL and ALL reconstruction improves rotational control and reduces the rate of re-rupture, without increased postoperative complication rates compared to ACL-only reconstruction. In conclusion this paper provides a contemporary
consensus on all studied features of the ALL. The findings warrant future research in order to further test these early observations, with the ultimate goal of improving the long-term outcomes of ACL-injured patients. Level of evidence Level V-Expert opinion.