Plantaris tendon: a novel graft for anterolateral ligament reconstruction and additional reinforcement for anterior cruc
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Plantaris tendon: a novel graft for anterolateral ligament reconstruction and additional reinforcement for anterior cruciate ligament autografts in combined reconstructive procedures Mario Josipović1 · Josip Vlaić2 · Jure Serdar1 · Marko Šimunović3 · Dinko Nizić4 · Zdravko Schauperl5 · Ivan Bojanić1 · Mislav Jelić1 Received: 13 September 2019 / Accepted: 23 January 2020 © European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2020
Abstract The anterolateral ligament is recently recognized as an important structure in restoring rotational stability of the anterior cruciate ligament-deficient knee. Biomechanical and clinical studies confirmed the benefits of concurrent anterior cruciate ligament and anterolateral ligament reconstruction. However, present techniques mostly use hamstring tendons autografts and therefore additionally disrupt the knee biomechanics. The plantaris tendon is a well known and accessible graft and has excellent biomechanical properties for anterolateral ligament reconstruction. The present paper describes a new combined anterior cruciate ligament and anterolateral ligament reconstruction technique using plantaris tendon and semitendinosus tendon. Level of evidence V (Case report). Keywords Anterolateral ligament · Plantaris tendon · Anterior cruciate ligament · Arthroscopy · Hamstring sparing Abbreviations 2PL Double plantaris tendon 3STT Triple semitendinosus tendon ACL Anterior cruciate ligament ALL Anterolateral ligament FH Fibular head GT Gracilis tendon * Mislav Jelić [email protected] 1
Department of Orthopaedic Surgery, University Hospital Centre Zagreb, School of Medicine, University of Zagreb, Salata 6‑7, 10000 Zagreb, Croatia
2
Division of Paediatric Orthopaedic Surgery, Children’s Hospital Zagreb, Ulica Vjekoslava Klaica 16, 10000 Zagreb, Croatia
3
Department of Radiology, University Hospital Centre Zagreb, University of Zagreb School of Medicine, Kispaticeva ulica 12, 10000 Zagreb, Croatia
4
Department of Radiology and Ultrasound Diagnostics, Special Hospital for Pulmonary Diseases, Rockefellerova 3, 10000 Zagreb, Croatia
5
Department of Materials, Faculty of Mechanical Engineering and Naval Architecture, University of Zagreb, Ulica Ivana Lucica 5, 10000 Zagreb, Croatia
GTB Gerdy’s tubercle LE Lateral epicondyle PL Plantaris tendon STT Semitendinosus tendon
Introduction Biomechanical studies showed that kinematics of ACL reconstructed knee, regarding rotational stability, is closer to kinematics of ACL-deficient knee than that of ACL-intact knee [1, 9, 11, 19]. Therefore, the importance of anterolateral knee structures, namely anterolateral ligament (ALL), in providing rotational stability is recently recognized [1, 6, 8, 18, 25]. Several surgical techniques have been proposed for combined ACL and ALL reconstruction, most of which utilize autologous two hamstrings tendons, semitendinosus (STT) and gracilis (GT) [7]. Since hamstrings are ACL agonists their harvesting increases the risk of ACL graft ru
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