Orthopaedic surgeon says anterolateral ligament not “new” but promising for ACL injuries

While anterior cruciate ligament (ACL) reconstruction surgery is a widely accepted and proven procedure, according to a renowned orthopaedic surgeon at Western University, there is still an unacceptably high re-injury rate in young patients returning to pivoting sports like basketball, volleyball and soccer.

In an attempt to address this ongoing concern, there has been renewed interest in the anterolateral capsule of the knee, particularly through the recent work of orthopaedic surgeons Dr. Steven Claes and Dr. Johan Bellemans of the University Hospitals Leuven in Belgium.

“The Belgian researchers have successfully defined the detailed anatomy of the anterolateral ligament (ALL), however, it is not a new ligament as many media reports have suggested,” says Dr. Al Getgood, an associate professor at Western’s Schulich School of Medicine &Dentistry and an orthopedic surgeon at the Fowler Kennedy Sport Medicine Clinic, specializing in disorders of the knee and shoulder. “ALL has been described many times in the past, as far back as the late 1800s, however, only recently has its function and its role in ACL injury and reconstruction been better understood.”

Dr. Getgood and his colleagues at Western’s Interdisciplinary Development Initiative in Bone & Joint Health are now working in collaboration with the Belgian researchers on trying to further understand the function of ALL.

“My research group at Fowler Kennedy and Western have been working on further dissection and histological analysis of the ligament as well as performing MRI (magnetic resonance imaging) and micro CT (computed tomography) in collaboration with the Robarts Research Institute to better characterise the tissue. Furthermore, our future biomechanical studies will tell us the best way to reconstruct the ligament.”

Dr. Getgood will deliver a presentation titled “Avoiding Complications in ACL Reconstruction” on Saturday, November 9 in Toronto at the Ontario Orthopaedic Association Annual General Meeting, which will in part focus on recognizing increased rotational instability caused by anterolateral capsule/ligament deficiency in combination with ACL injury.

“Reconstructing the anterolateral ligament could theoretically produce improved outcomes following surgery and reduce failures,” says Dr. Getgood.

In 2014, Dr. Getgood is leading a multicentre randomized study through a grant award from the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports medicine (ISAKOS) and the Orthopaedic Research and Education Foundation (OREF). The study will involve six centres in Canada and Europe studying whether or not the addition of ALL reconstruction to standard ACL reconstruction will help to reduce graft failure after ACL surgery.

“It is the hope that this new procedure will help reduce failure rates and improve the function and quality of life of so many of the young active people that we see with this injury,” says Dr. Getgood.

Commentary reflects the perspective and scholarly interest of Western faculty members and is not an articulation of official university policy on issues being addressed.