Good morning, it's a pleasure to be here with you. I'm Dr. Matias Costa Paz from Argentina, and I will speak about the indication of anterolateral ligament reconstruction in soccer player. First of all, thank you, Mike and Dean, for the kind invitation. And I work at the Hospital Italiano from Buenos Aires, Argentina, and if we talk about soccer or football, we have some iconic sportsmen like Maradona or Lionel Messi. So the principal function of the anterolateral ligament is to control the internal rotation, as you can see in this video. Regarding surgical technique, in our group, we perform modified LEMUR, as you can see here, and also, in a few cases, we use allograft reconstructions. This technique summarizes some problems, such as gown complications, lateral pain, less quad strength, and lateral component over-constraint. The objective of this presentation is to define indications for anterolateral ligament reconstructions during ACL surgery in soccer players. But you have to take into account if it is a player of elite versus recreational, and if it is ACL primary or revision. There are some parameters for the indication, such as surgeon's experience and criteria, and some researcher indications and risk factors for ACL tears. We perform this paper with the SLARD, and we publish at the Journal of ISACOS, and these four parameters or variables, like pivot shift, high grade, young under 25 years old, pivot sports, and hyperlaxity, they are the principal criteria. But we conclude that anterolateral reconstruction lies in the combination of factors and not in one variable alone. So if you have this particular case, this is a 20 years old soccer player, high pivot shift, hyperlax, body mass index 35, please up your hand who will perform ACL revision plus lead. Only one, two, five, okay. Most of the people will agree with me. We performed the revision, as you can see in this video, plus the reconstruction of the anterolateral, and the result was pretty good. So if we speak about ACL revision, reduced graft rupture rates, as you can see in these papers, especially Alessio Mazzola, who performs in soccer players especially. So we publish this paper also to, this is our numbers, to reduce 5.5 between 17 alone to revision. That ACL primary plus lead improve rotation stability, no improve anterior translation, no modify result report by the patient. So the literature in these revisions, they say that you have to select the case. So if we have another case, primary ACL rupture, 35 years, acute year, pivot low grade, hyperlaxity, recreational soccer player, and in Argentina we have a lot of these, just one per week, and for us it's an uncertain treatment. What would you do? In this orient, who, raise your hand who performed an anterolateral? Yeah? Okay. So perhaps for, in this particular case, it is useful to, for us, we describe a guideline to define indications during ACL surgery with 15 parameters, 6 major and 9 minor, and if you reach 10 points, we suggest an anterolateral reconstruction. We publish this guideline in these journals, and the guideline have 5 major criteria, pivot, contact, elite, young people, hyperlaxity, and we give 2 points. And you have a revision, we have 5 points, and the minor criteria, it will be KT177 more than 8 millimeters, chronic stability, lesion of the meniscus, instability of the contralateral knee, body mass index more than 30, tibial slope more than 12, anterior translation severe, lateral femoral knot sign, and second fracture. So you have 10 points or more, for us, it's absolutely indication of anterolateral reconstruction. Between 8 and 10, the surgeons and the patient will be decided, perhaps. These parameters will have support at the literature. For example, increase lateral tibial plateau slope predispose male college football players to anterior cruciate ligament surgery. So these parameters are available for the literature. So if we go back to these patients, for us, what would you do? So for us, we reach in this guideline only 4 points. So for our group, we don't perform an anterolateral reconstruction. In summary, there are some groups of surgeons who will perform in 100% of his patients, like Sonori Cotet, Stefano Safanini, Andy Williams, but we have to know that perhaps they have the population of all professional players. But in our cases, it's not all professional players. So we are agreed that in elite soccer players, primary and revision ACL, we are at the late. But in, yeah, but recreational soccer player in revision, we said yes also. But recreational soccer player primary ACL rupture, we have to select the patient to perform anterolateral reconstructions. We should carefully analyze these 15 parameters, select the surgical technique, consider the use of the guide to define indication of anterolateral reconstructions. Last results suggest lower re-rupture with this procedure. So we hope to see you in Buenos Aires, Argentina the next month. Thank you very much.

anterolateral ligament reconstruction

soccer players

surgical techniques

ACL revision

recreational soccer players