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Table 2 Biomechanical studies reviewed

From: Biomechanical function of the anterolateral ligament of the knee: a systematic review

Study/yearAge (years)Sequence of experimental protocolTorque appliedKey findings
Noyes et al. 2017 [13]44 ± 8Intact-ACL section-ALL section-ITB section
Intact-ACL section-ITB section-ALL section
IR (5 Nm), AD (100 N),
AD+IR + VG (100 N + 5 Nm or 1 + 7 Nm)
ACL section alone produced increased PS and AD. Further section of ALL or ITB separately produced minor increase in AT (< 2 mm) and IR (< 3°).
Concurrent section of ALL and ITB resulted in conversion to a grade-3 PS.
Inderhaug et al. 2017 [10]57Intact-ACL section-ALL sectionIR (5 Nm), AD (90 N), AD+IR (90 N + 5 Nm)Significant increase in AT and IR with additional section of ALL to ACL.
Drews et al. 2017 [14]57Intact-ACL section-ALL sectionAD (134 N), VG + IR (10 Nm + 4 Nm)ALL does not function under passive motion and with no influence on tibial rotation.
Sonnery-Cottet et al. 2016 [15]76.4Intact-ACL section-ALL section. On the contralateral limb, reverse orderIR (2 Nm) using the navigation systemALL is involved in rotational control at varying degrees of knee flexion. Concomitant to an ACL or ITB transection, sectioning of ALL further increased rotational laxity.
Thein et al. 2016 [16]43 ± 15Intact-ACL section-ALL sectionAD (134 N), VG + IR (8 N + 4 Nm)Minor increase in AT (2–3 mm) in AD and PS with section of ALL to ACL.
Spencer et al. 2016 [17]74 ± 12Intact-ACL section-ALL sectionAD (90 N), VG + IR (10 N + 5 Nm)ALL section had no significant impact on AT in ACL-deficient knees. ALL section had significant impact only on early PS in ACL-deficient knees.
Ruiz et al. 2016 [12]76Intact-ACL section-ALL section
Intact-ALL section-ACL section
IR (0–8 Nm)IR increased significantly after each stage of section.
Rasmussen et al. 2016 [18]49.3Intact-ACL section-ALL sectionAD+IR (88 N + 5 Nm), VG + IR (10 N + 5 Nm)Significant increase in AT at 0°, 15°, 30°, and 60° of knee flexion,
and in IR at all flexion angles when PS force applied after ALL section.
Bonanzinga et al. 2016 [7]79 ± 5Intact-ACL section-ALL sectionAD (max manual),
AD+IR + VR (manual)
No further increase in AT was found after ALL section.
Significant increase of IR at 30° and 90° flexion only after additional
ALL sectioning. ACL- and ALL-sectioned knees have significantly more
acceleration of PS than that in intact knees.
Saiegh et al. 2015 [19]42Intact-ACL section-ALL sectionAD (120 N), VG (40–50 N) + manual axial compressionNo change in AT or IR after subsequent sectioning of ALL.
Parsons et al. 2015 [20]76.3Intact-ACL section-LCL section-ALL sectionAD (134 N), IR (5 Nm)ALL is important stabilizer of internal rotation at flexion angles greater than 35°. The ACL is the primary resister during anterior draw at all flexion angles and during internal rotation at flexion angles less than 35°
Monaco et al. 2012 [11]72Intact-ACL section-ALL sectionAD (manual),
AD+IR + VR (manual)
5.5° increase of IR at 30° flexion after additional ALL sectioning. No significant increase of AT after additional ALL sectioning.
  1. ACL anterior cruciate ligament, ALL anterolateral ligament, LCL lateral collateral ligament, ITB iliotibial band, PS pivot shift, IR internal tibial rotation, AD anterior drawer, VG valgus, AT anterior tibial translation