{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T01:16:20Z","timestamp":1793236580362,"version":"4.5.0"},"reference-count":45,"publisher":"SAGE Publications","issue":"5","license":[{"start":{"date-parts":[[2023,3,14]],"date-time":"2023-03-14T00:00:00Z","timestamp":1678752000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2023,3,14]],"date-time":"2023-03-14T00:00:00Z","timestamp":1678752000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100009026","name":"Smith and Nephew","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100009026","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Society for Arthroscopy and Joint Surgery"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Am J Sports Med"],"published-print":{"date-parts":[[2023,4]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Injuries to the anterior cruciate ligament (ACL), Kaplan fibers (KFs), anterolateral capsule\/ligament (C\/ALL), and lateral meniscus posterior root (LMPR) have been separately linked to anterolateral instability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>To investigate the contributions of the ACL, KFs, C\/ALL, and LMPR to knee stability and to measure instabilities resulting from their injury.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design:<\/jats:title>\n                    <jats:p>Controlled laboratory study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      Ten fresh-frozen human knees were tested robotically to determine restraints of knee laxity at 0\u00b0 to 90\u00b0 of flexion. An 88-N anterior-posterior force (anterior and posterior tibial translation), 5-N\u00b7m internal-external rotation, and 8-N\u00b7m valgus-varus torque were imposed and intact kinematics recorded. The kinematics were replayed after sequentially cutting the structures (order varied) to calculate their contributions to stability. Another 10 knees were tested in a kinematics rig with optical tracking to measure instabilities after sequentially cutting the structures across 0\u00b0 to 100\u00b0 of flexion. One- and 2-way repeated-measures analyses of variance with Bonferroni correction were used to find significance (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .05) for the robotic and kinematics tests.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      The ACL was the primary restraint for anterior tibial translation; other structures were insignificant (&lt;10% contribution). The KFs and C\/ALL resisted internal rotation, reaching 44% \u00b1 23% (mean \u00b1 SD;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .01) and 14% \u00b1 13% (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .05) at 90\u00b0. The LMPR resisted valgus but not internal rotation. Anterior tibial translation increased after ACL transection (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001) and after cutting the lateral structures from 70\u00b0 to 100\u00b0 (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .05). Pivot-shift loading increased anterolateral rotational instability after ACL transection from 0\u00b0 to 40\u00b0 (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .05) and further after cutting the lateral structures from 0\u00b0 to 100\u00b0 (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .01).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>The anterolateral complex acts as a functional unit to provide rotatory stability. The ACL is the primary stabilizer for anterior tibial translation. The KFs are the most important internal rotation restraint &gt;30\u00b0 of flexion. Combined KFs + C\/ALL injury substantially increased anterolateral rotational instability while isolated injury of either did not. LMPR deficiency did not cause significant instability with the ACL intact.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Relevance:<\/jats:title>\n                    <jats:p>This study is a comprehensive biomechanical sectioning investigation of the knee stability contributions of the ACL, anterolateral complex, and LMPR and the instability after their transection. The ACL is significant in controlling internal rotation only in extension. In flexion, the KFs are dominant, synergistic with the C\/ALL. LMPR tear has an insignificant effect with the ACL intact.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/03635465231161071","type":"journal-article","created":{"date-parts":[[2023,3,14]],"date-time":"2023-03-14T18:12:11Z","timestamp":1678817531000},"page":"1136-1145","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":74,"title":["Role of the Anterior Cruciate Ligament, Anterolateral Complex, and Lateral Meniscus Posterior Root in Anterolateral Rotatory Knee Instability: A Biomechanical Study"],"prefix":"10.1177","volume":"51","author":[{"given":"Lukas","family":"Willinger","sequence":"first","affiliation":[{"name":"Klinikum rechts der Isar, Technical University of Munich, Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kiron K.","family":"Athwal","sequence":"additional","affiliation":[{"name":"Imperial College London, London, 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