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  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Nine freshly\u2010frozen cadaveric knees were sectioned sequentially to create ACL deficiency and ACL\u2010ALS deficiency, using intact knees before sectioning as controls. When ITB was tensioned with 30 N, 4 separate aspects of knee instability were tested as follows: anterior translation in 90 N anterior load, isolated internal rotation in 5 N\u00b7m internal rotational torque from 0\u00b0 to 90\u00b0 in 15\u00b0 increments, and anterolateral translation and internal rotation during a simulated pivot\u2010shift test at 0\u00b0, 15\u00b0, 30\u00b0, and 45\u00b0. The contribution of ACL deficiency alone and additional ALS deficiency to knee instability were evaluated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The addition of an ALS lesion produced no significant exacerbation of either anterior translational or pivot shift instability in ACL\u2010deficient knees. Additional ALS deficiency in an ACL\u2010deficient knee resulted in a significant increase in isolated internal rotation from 45\u00b0 to 90\u00b0 (\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0= .001 at 45\u00b0 and\n                      <jats:italic>P<\/jats:italic>\n                      &lt; .001 in other cases). After sequentially sectioning, the contribution to instability of additional ALS deficiency to the entire instability in ACL\u2010ALS\u2013deficient knees was significantly smaller than that of ACL deficiency alone during anterior load and pivot\u2010shift test (\n                      <jats:italic>P<\/jats:italic>\n                      &lt; .001 in all cases), but significantly contributed more to isolated internal rotational instability at 60\u00b0 (\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0= .011) and 90\u00b0 (\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0= .015).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>When ITB was tensioned, ALS played a minor role in controlling both anterior or pivot shift stability in ACL\u2010deficient knees but a major role in restraining isolated internal rotation from 45\u00b0 to 90\u00b0.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Relevance<\/jats:title>\n                    <jats:p>In the condition of functional ITB, concomitant ALS injury might not exacerbate anterior and pivot\u2010shift instability after ACL rupture, while affecting isolated internal rotation stability at higher flexion.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1016\/j.arthro.2020.10.038","type":"journal-article","created":{"date-parts":[[2020,11,20]],"date-time":"2020-11-20T16:17:58Z","timestamp":1605889078000},"page":"1182-1191","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":11,"title":["A Secondary Injury of the Anterolateral Structure Plays a Minor Role in Anterior and Anterolateral Instability of Anterior Cruciate Ligament\u2010Deficient Knees in the Case of Functional Iliotibial Band"],"prefix":"10.1002","volume":"37","author":[{"given":"Junjie","family":"Xu","sequence":"first","affiliation":[{"name":"Department of Sports Medicine Shanghai Jiao Tong University Affiliated Sixth People's Hospital Shanghai China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kang","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Sports Medicine Shanghai Jiao Tong University Affiliated Sixth People's Hospital Shanghai China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wei","family":"Su","sequence":"additional","affiliation":[{"name":"Department of Sports Medicine Shanghai Jiao Tong University Affiliated Sixth People's Hospital Shanghai China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jia","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Sports Medicine Shanghai Jiao Tong University Affiliated Sixth People's Hospital Shanghai China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaoyu","family":"Yan","sequence":"additional","affiliation":[{"name":"Department of Sports Medicine Shanghai Jiao Tong University Affiliated Sixth People's Hospital Shanghai China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiakuo","family":"Yu","sequence":"additional","affiliation":[{"name":"Knee Surgery Department of the Institute of Sports Medicine &amp; 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