Consensus Meeting, co-chaired by Bertrand Sonnery-Cottet and Steven Claes, and held at the Santy Centre in Lyon, November 2015.
We had a very interesting meeting in 2016 - the Anterolateral Ligament Experts Meeting – which was held in Lyon. Bertrand Sonnery-Cottet and Steven Claes were our hosts, and there were approximately 40 European and 2 or 3 US Surgeons there - all surgeons who really believed in extra-articular reconstruction and wanted both to learn more about the ALL and also to contribute.
The object was to provide informative lectures about the basic science, anatomy, radiology, biomechanics and surgical technique, and then try to come to a consensus on what would be the best surgical technique and write a consensus paper at some point later in 2016.
Steven Claes was there and he spoke obviously about his PhD and the work that he’s done, and in particular the work that he’s done with Rob LaPrade when he went to Vail and did some further biomechanical studies there. I think those studies were very useful.
The landmark papers with regard to the anterolateral ligament were discussed as well as the lessons that we’ve learned since December 2015 in terms of the anatomy, because there has been subsequent debate with regards to exactly where the femoral socket position should be. I think we have now come to a consensus that it should be very slightly proximal and posterior to where we had been making it and we think this is important, although we are happy with the position on the tibia.
So surgeons who do this surgery have now moved to a slightly different position on the femur just a few millimeters away from the original - 8mm proximal and 6mm posterior - while on the tibia the position remains. One of the papers that I think has been very useful involved the biomechanical research done by Andrew Williams and Andrew Amis, indicating that this new point is a better location. This was very much backed up by other authors who have repeated this work - most notably Rob LaPrade and Steven Claes, who themselves did a further anatomy study in Vail, Colorado, and came up with a similar result.
Bertrand Sonnery-Cottet has also done his own anatomical work, and he too has found a slightly more proximal and posterior position to be better. The main reason for this is that the ALL goes tight in extension where it needs to be working, but goes slack in flexion where it doesn’t need to be working, and by moving the position on the femur to this new location slightly proximal and posterior that is what we achieve. So that contribution was very useful and is the basis of his 'Delta ALL' technique.
There is no doubt we’re about to start talking about the anterolateral corner of the knee - with the ALL being the most anterior part of that, and with the LCL being the posterior element of the triangle. The triangle makes its point at the lateral epicondyle or just behind it, and then the inferior part of that triangle is really the deep capsule, making up this very important thickened part of the capsule that controls anterolateral rotatory instability of the knee.
Members of the Expert Group