Background:

Recently reported anterolateral structure reconstructions (ALSRs) to augment intra-articular anterior cruciate ligament reconstruction (ACLR) use various femoral attachment sites, and their biomechanical effects are still unknown.

Hypothesis:

ALSR concomitant with ACLR would control anterolateral rotational instability better than ACLR alone, and if ALSR had different femoral attachment sites, there would be different effects on its control of anterolateral rotational instability.

Study Design:

Controlled laboratory study.

Methods:

Twelve fresh-frozen hemipelvis lower limbs were included. Anterior tibial translation during the Lachman test and tibial acceleration during the pivot-shift test were measured with a 3-dimensional electromagnetic measurement system in situations with the (1) ACL and ALS intact, (2) ACL and ALS cut, (3) ALSR without ACLR (ALSR alone), (4) ACLR without ALSR (ACLR alone), and (5) ALSR with ACLR. Three femoral attachment sites were used for ALSR: F1, 2 mm anterior and 2 mm distal to the lateral epicondyle; F2, 4 mm posterior and 8 mm proximal to the lateral epicondyle; and F3, over-the-top position for the lateral extra-articular tenodesis. The Steel test and Wilcoxon signed rank test were used for statistical analysis.

Results:

Anterior tibial translation during the Lachman test in the ACL and ALS–cut state was significantly larger than it was in the ACL and ALS–intact state, while its difference disappeared after ACLR. As for the pivot-shift test, additional ALSR with F2 to ACLR significantly decreased the acceleration (P = .046), although additional ALSR with F1 and F3 showed no significant effect.

Conclusion:

ALSR with the femoral attachment site 4 mm posterior and 8 mm proximal to the lateral epicondyle in addition to ACLR played a role in reducing anterolateral rotational instability the most effectively among the measured attachment sites.

Clinical Relevance:

The present data will contribute to determine the appropriate femoral attachment site for ALSR to better control anterolateral rotational instability after ACL reconstruction.

中文翻译：

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具有不同股骨附着位点的额外前外侧结构重建对前交叉韧带重建的生物力学效应。

背景：

最近报道的增加关节内前交叉韧带重建（ACLR）的前外侧结构重建（ALSR）使用了各种股骨附着位点，其生物力学作用仍是未知的。

假设：

伴有ACLR的ALSR比单独使用ACLR更好地控制前外侧旋转不稳定性，如果ALSR具有不同的股骨附着部位，则其对前外侧旋转不稳定性的控制也会有不同的影响。

学习规划：

对照实验室研究。

方法：

包括十二个新鲜冷冻的半骨盆下肢。在（1）ACL和ALS完好，（2）ACL和ALS切开，（3）ALSR完好无损的情况下，使用3维电磁测量系统测量了Lachman测试期间的胫骨前平移和枢轴位移测试期间的胫骨加速度（4）不使用ALSR的ACLR（仅ACLR）和（5）带有ACLR的ALSR。三个股骨附着部位用于ALSR：F1，前上2 2 mm，外侧上con远端2 mm。F2，后上4 4 mm，外侧上con近端8 mm；F3，外侧关节外侧腱固定的上方位置。使用钢检验和威尔科克森符号秩检验进行统计分析。

结果：

在ACL和ALS切除状态的Lachman测试期间，胫骨前移明显大于ACL和ALS切除状态的胫骨前移，而在ACLR后，胫骨前移不明显。至于枢轴位移测试，附加了F2和ACLR的ALSR显着降低了加速度（P = .046），尽管附加了F1和F3的ALSR没有显着影响。

结论：

除ACLR外，ALSR的股骨附着位点在后方4 mm处，且靠近上epi外侧8 mm，在测量的附着位点中最有效地减少了前外侧旋转不稳定性。

临床相关性：

本数据将有助于确定合适的股骨附着部位，以更好地控制ACL重建后的前外侧旋转不稳。