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World J Clin Cases. Aug 26, 2022; 10(24): 8463-8473
Published online Aug 26, 2022. doi: 10.12998/wjcc.v10.i24.8463
Graft choices for anterolateral ligament knee reconstruction surgery: Current concepts
Byron Chalidis, Charalampos Pitsilos, Dimitrios Kitridis, Panagiotis Givissis
Byron Chalidis, Dimitrios Kitridis, Panagiotis Givissis, 1st Orthopaedic Department, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki 57010, Greece
Charalampos Pitsilos, 2nd Orthopaedic Department, Aristotle University of Thessaloniki, School of Medicine, Thessaloniki 54635, Greece
Author contributions: Chalidis B and Kitridis D designed the research; Pitsilos C analyzed the data; Chalidis B and Pitsilos C wrote the paper; Givissis P supervised the paper; All authors read and approved the final manuscript.
Conflict-of-interest statement: There is no conflict of interest associated with any of the senior author or other coauthors contributed their efforts in this manuscript.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Byron Chalidis, MD, PhD, Assistant Professor, 1st Orthopaedic Department, Aristotle University of Thessaloniki, School of Medicine, Exohi, Thessaloniki 57010, Greece. byronchalidis@gmail.com
Received: March 21, 2022
Peer-review started: March 21, 2022
First decision: June 7, 2022
Revised: June 26, 2022
Accepted: July 18, 2022
Article in press: July 18, 2022
Published online: August 26, 2022
Processing time: 147 Days and 3.7 Hours
Abstract

The anterolateral ligament (ALL) is a primary structure of the anterolateral complex of the knee that contributes to internal rotational stability of the joint. Injury of the ALL is commonly associated with rupture of the anterior cruciate ligament. If left untreated, ALL lesions may lead to residual anterolateral rotational instability of the knee after anterior cruciate ligament reconstruction, which is a common cause of anterior cruciate ligament graft failure. The function of the ALL can be restored by lateral extraarticular tenodesis or anterolateral ligament reconstruction (ALLR). In the lateral extraarticular tenodesis procedure, a strip of the iliotibial band is placed in a non-anatomical position to restrain the internal rotation of the tibia, while in ALLR, a free graft is fixed at the insertion points of the native ALL. Gracilis and semitendinosus grafts have mainly been utilized for ALLR, but other autografts have also been suggested. Furthermore, allografts and synthetic grafts have been applied to minimize donor-site morbidity and maximize the size and strength of the graft. Nevertheless, there has been no strong evidence to fully support one method over another thus far. The present review presents a detailed description of the graft choices for ALLR and the current literature available in regard to the effectiveness and outcomes of published surgical techniques.

Keywords: Anterolateral ligament; Reconstruction; Lateral extraarticular tenodesis; Anterior cruciate ligament; Hamstrings; Gracilis; Semitendinosus

Core Tip: There is no convincing evidence regarding the biomechanical and functional superiority of either lateral extraarticular tenodesis or anterolateral ligament reconstruction procedures during anterior cruciate ligament reconstruction. Although hamstrings remain the most common graft choice for anterolateral ligament reconstruction, other autografts as well as allografts and synthetic grafts have been applied. Further research and comparative studies should be carried out to identify the most effective graft material and technique for the restoration of rotational knee stability in the presence of residual instability after anterior cruciate ligament reconstruction.