Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 25, Issue 4, pp 1048–1054 | Cite as

Anterolateral ligament anatomy: a comparative anatomical study

  • Sheila Jean McNeill Ingham
  • Rogerio Teixeira de Carvalho
  • Cesar A. Q. Martins
  • Pisit Lertwanich
  • Rene Jorge Abdalla
  • Patrick Smolinski
  • C. Owen Lovejoy
  • Freddie H. FuEmail author



Some anatomical studies have indicated that the anterolateral ligament (ALL) of the knee is distinct ligamentous structure in humans. The purpose of this study is to compare the lateral anatomy of the knee among human and various animal specimens.


Fifty-eight fresh-frozen knee specimens, from 24 different animal species, were used for this anatomical study. The same researchers dissected all the specimens in this study, and dissections were performed in a careful and standardized manner.


An ALL was not found in any of the 58 knees dissected. Another interesting finding in this study is that some primate species (the prosimians: the red and black and white lemurs) have two LCLs.


The clinical relevance of this study is the lack of isolation of the ALL as a unique structure in animal species. Therefore, precaution is recommended before assessing the need for surgery to reconstruct the ALL as a singular ligament.


Knee Anatomical study Anterolateral ligament Comparative anatomy 



The authors thank Cindy Stadler DVM and the Pittsburgh Zoo staff for all their help with the animal species. We also thank Monica Linde-Rosen for all the help with the laboratory work. This study was financed by a grant from the Heinz Endowments.


  1. 1.
    Campos JC, Chung CB, Lektrakul N, Pedowitz R, Trudell D, Yu J, Resnick D (2001) Pathogenesis of the Segond fracture: anatomic and MR imaging evidence of an iliotibial tract or anterior oblique band avulsion. Radiology 219(2):381–386CrossRefPubMedGoogle Scholar
  2. 2.
    Carr A (2015) Arthroscopic surgery for degenerative knee. BMJ 350:h2983. doi: 10.1136/bmj.h2983 CrossRefPubMedGoogle Scholar
  3. 3.
    Caterine S, Litchfield R, Johnson M, Chronik B, Getgood A (2014) A cadaveric study of the anterolateral ligament: re-introducing the lateral capsular ligament. Knee Surg Sports Traumatol Arthrosc. doi: 10.1007/s00167-014-3117-z Google Scholar
  4. 4.
    Claes S, Luyckx T, Vereecke E, Bellemans J (2014) The Segond fracture: a bony injury of the anterolateral ligament of the knee. Arthroscopy 30(11):1475–1482CrossRefPubMedGoogle Scholar
  5. 5.
    Claes S, Vereecke E, Maes M, Victor J, Verdonk P, Bellemans J (2013) Anatomy of the anterolateral ligament of the knee. J Anatomy 223(4):321–328CrossRefGoogle Scholar
  6. 6.
    Davis DS, Post WR (1997) Segond fracture: lateral capsular ligament avulsion. J Orthop Sports Phys Ther 25(2):103–106CrossRefPubMedGoogle Scholar
  7. 7.
    De Maeseneer M, Boulet C, Willekens I, Lenchik L, De Mey J, Cattrysse E, Shahabpour M (2015) Segond fracture: involvement of the iliotibial band, anterolateral ligament, and anterior arm of the biceps femoris in knee trauma. Skeletal Radiol 44(3):413–421CrossRefPubMedGoogle Scholar
  8. 8.
    Dietz GW, Wilcox DM, Montgomery JB (1986) Segond tibial condyle fracture: lateral capsular ligament avulsion. Radiology 159(2):467–469CrossRefPubMedGoogle Scholar
  9. 9.
    Dodds AL, Halewood C, Gupte CM, Williams A, Amis AA (2014) The anterolateral ligament: anatomy, length changes and association with the Segond fracture. Bone Joint J 96-B(3):325–331CrossRefPubMedGoogle Scholar
  10. 10.
    Dombrowski ME, Costello JM, Ohashi B, Murawski CD, Rothrauff BB, Arilla FV, Friel NA, Fu FH, Debski RE, Musahl V (2015) Macroscopic anatomical, histological and magnetic resonance imaging correlation of the lateral capsule of the knee. Knee Surg Sports Traumatol Arthrosc. doi: 10.1007/s00167-015-3517-8 PubMedGoogle Scholar
  11. 11.
    Espregueira M, da Silva MV (2006) Anatomy of the lateral collateral ligament: a cadaver and histological study. Knee Surg Sports Traumatol Arthrosc 14(3):221–228CrossRefGoogle Scholar
  12. 12.
    Goldman AB, Pavlov H, Rubenstein D (1988) The Segond fracture of the proximal tibia: a small avulsion that reflects major ligamentous damage. AJR Am J Roentgenol 151(6):1163–1167CrossRefPubMedGoogle Scholar
  13. 13.
    Haims AH, Medvecky MJ, Pavlovich R Jr, Katz LD (2003) MR imaging of the anatomy of and injuries to the lateral and posterolateral aspects of the knee. AJR Am J Roentgenol 180(3):647–653CrossRefPubMedGoogle Scholar
  14. 14.
    Hatsushika D, Nimura A, Mochizuki T, Yamaguchi K, Muneta T, Akita K (2013) Attachments of separate small bundles of human posterior cruciate ligament: an anatomic study. Knee Surg Sports Traumatol Arthrosc 21(5):998–1004CrossRefPubMedGoogle Scholar
  15. 15.
    Helito CP, Demange MK, Bonadio MB, Tirico LE, Gobbi RG, Pécora JR, Camanho GL (2013) Anatomy and histology of the knee anterolateral ligament. Orthop J Sports Med 1(7):2325967113513546CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Helito CP, Helito PV, Costa HP, Bordalo-Rodrigues M, Pecora JR, Camanho GL, Demange MK (2014) MRI evaluation of the anterolateral ligament of the knee: assessment in routine 1.5-T scans. Skeletal Radiol 43(10):1421–1427CrossRefPubMedGoogle Scholar
  17. 17.
    Hughston JC (1973) A surgical approach to the medial and posterior ligaments of the knee. Clin Orthop Relat Res 91:29–33CrossRefGoogle Scholar
  18. 18.
    Hughston JC, Andrews JR, Cross MJ, Moschi A (1976) Classification of knee ligament instabilities. Part I. The medial compartment and cruciate ligaments. J Bone Joint Surg Am 58(2):159–172CrossRefPubMedGoogle Scholar
  19. 19.
    Hughston JC, Andrews JR, Cross MJ, Moschi A (1976) Classification of knee ligament instabilities. Part II. The lateral compartment. J Bone Joint Surg Am 58(2):173–179CrossRefPubMedGoogle Scholar
  20. 20.
    Hughston JC, Eilers AF (1973) The role of the posterior oblique ligament in repairs of acute medial (collateral) ligament tears of the knee. J Bone Joint Surg Am 55(5):923–940CrossRefPubMedGoogle Scholar
  21. 21.
    Irvine GB, Dias JJ, Finlay DB (1987) Segond fractures of the lateral tibial condyle: brief report. J Bone Joint Surg Br 69(4):613–614PubMedGoogle Scholar
  22. 22.
    Johnson LL (1979) Lateral capsular ligament complex: anatomical and surgical considerations. Am J Sports Med 7(3):156–160CrossRefPubMedGoogle Scholar
  23. 23.
    LaPrade RF, Ly TV, Wentorf FA, Engebretsen L (2003) The posterolateral attachments of the knee: a qualitative and quantitative morphologic analysis of the fibular collateral ligament, popliteus tendon, popliteofibular ligament, and lateral gastrocnemius tendon. Am J Sports Med 31(6):854–860PubMedGoogle Scholar
  24. 24.
    LaPrade RF, Spiridonov SI, Coobs BR, Ruckert PR, Griffith CJ (2010) Fibular collateral ligament anatomical reconstructions: a prospective outcomes study. Am J Sports Med 38(10):2005–2011CrossRefPubMedGoogle Scholar
  25. 25.
    LaPrade RF, Wozniczka JK, Stellmaker MP, Wijdicks CA (2010) Analysis of the static function of the popliteus tendon and evaluation of an anatomic reconstruction: the “fifth ligament” of the knee. Am J Sports Med 38(3):543–549CrossRefPubMedGoogle Scholar
  26. 26.
    Lubowitz JH, Provencher MT, Brand JC, Rossi MJ (2014) The knee anterolateral ligament. Arthroscopy 30(11):1385–1388CrossRefPubMedGoogle Scholar
  27. 27.
    Moorman CT 3rd, LaPrade RF (2005) Anatomy and biomechanics of the posterolateral corner of the knee. J Knee Surg 18(2):137–145CrossRefPubMedGoogle Scholar
  28. 28.
    Parsons EM, Gee AO, Spiekerman C, Cavanagh PR (2015) The biomechanical function of the anterolateral ligament of the knee. Am J Sports Med 43(3):669–674CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Pomajzl R, Maerz T, Shams C, Guettler J, Bicos J (2015) A review of the anterolateral ligament of the knee: current knowledge regarding its incidence, anatomy, biomechanics, and surgical dissection. Arthroscopy 31(3):583–591CrossRefPubMedGoogle Scholar
  30. 30.
    Proffen BL, McElfresh M, Fleming BC, Murray MM (2012) A comparative anatomical study of the human knee and six animal species. Knee 19(4):493–499CrossRefPubMedGoogle Scholar
  31. 31.
    Seebacher JR, Inglis AE, Marshall JL, Warren RF (1982) The structure of the posterolateral aspect of the knee. J Bone Joint Surg Am 64(4):536–541CrossRefPubMedGoogle Scholar
  32. 32.
    Segond P (1879) Recherches cliniques et experimentales sur les epanchements sanguins du genou par entorse. Prog Med 7:297–299, 319–221, 340–291Google Scholar
  33. 33.
    Smith TD, Deleon VB, Rosenberger AL (2013) At birth, tarsiers lack a postorbital bar or septum. Anat Rec 296(3):365–377CrossRefGoogle Scholar
  34. 34.
    Spencer L, Burkhart TA, Tran MN, Rezansoff AJ, Deo S, Caterine S, Getgood AM (2015) Biomechanical analysis of simulated clinical testing and reconstruction of the anterolateral ligament of the knee. Am J Sports Med 43(9):2189–2197CrossRefPubMedGoogle Scholar
  35. 35.
    Stijak L, Bumbasirevic M, Radonjic V, Kadija M, Puskas L, Milovanovic D, Filipovic B (2014) Anatomic description of the anterolateral ligament of the knee. Knee Surg Sports Traumatol Arthrosc. doi: 10.1007/s00167-014-3422-6 Google Scholar
  36. 36.
    Takeda S, Tajima G, Fujino K, Yan J, Kamei Y, Maruyama M, Kikuchi S, Doita M (2014) Morphology of the femoral insertion of the lateral collateral ligament and popliteus tendon. Knee Surg Sports Traumatol Arthrosc. doi: 10.1007/s00167-014-3059-5 Google Scholar
  37. 37.
    Taneja AK, Miranda FC, Braga CA, Gill CM, Hartmann LG, Santos DC, Rosemberg LA (2015) MRI features of the anterolateral ligament of the knee. Skeletal Radiol 44(3):403–410CrossRefPubMedGoogle Scholar
  38. 38.
    Tantisricharoenkul G, Linde-Rosen M, Araujo P, Zhou J, Smolinski P, Fu FH (2014) Anterior cruciate ligament: an anatomical exploration in humans and in a selection of animal species. Knee Surg Sports Traumatol Arthrosc 22(5):961–971CrossRefPubMedGoogle Scholar
  39. 39.
    Terry GC, LaPrade RF (1996) The posterolateral aspect of the knee. Anatomy and surgical approach. Am J Sports Med 24(6):732–739CrossRefPubMedGoogle Scholar
  40. 40.
    Van Hoof T, Cromheecke M, Tampere T, D’Herde K, Victor J, Verdonk PC (2013) The posterior cruciate ligament: a study on its bony and soft tissue anatomy using novel 3D CT technology. Knee Surg Sports Traumatol Arthrosc 21(5):1005–1010CrossRefPubMedGoogle Scholar
  41. 41.
    Vieira EL, Vieira EA, da Silva RT, Berlfein PA, Abdalla RJ, Cohen M (2007) An anatomic study of the iliotibial tract. Arthroscopy 23(3):269–274CrossRefPubMedGoogle Scholar
  42. 42.
    Vincent JP, Magnussen RA, Gezmez F, Uguen A, Jacobi M, Weppe F, Al-Saati MF, Lustig S, Demey G, Servien E, Neyret P (2012) The anterolateral ligament of the human knee: an anatomic and histologic study. Knee Surg Sports Traumatol Arthrosc 20(1):147–152CrossRefPubMedGoogle Scholar

Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2015

Authors and Affiliations

  • Sheila Jean McNeill Ingham
    • 1
    • 2
  • Rogerio Teixeira de Carvalho
    • 2
  • Cesar A. Q. Martins
    • 1
  • Pisit Lertwanich
    • 1
    • 3
  • Rene Jorge Abdalla
    • 2
  • Patrick Smolinski
    • 4
  • C. Owen Lovejoy
    • 5
  • Freddie H. Fu
    • 1
    • 4
    Email author
  1. 1.Department of Orthopaedic SurgeryUniversity of Pittsburgh School of MedicinePittsburghUSA
  2. 2.Department of Orthopaedic SurgeryFederal University of São PauloSão PauloBrazil
  3. 3.Department of Orthopaedic Surgery, Faculty of Medicine Siriraj HospitalMahidol UniversityBangkokThailand
  4. 4.Department of Mechanical Engineering and Material ScienceUniversity of PittsburghPittsburghUSA
  5. 5.Department of Anthropology, School of Biomedical SciencesKent State UniversityKentUSA

Personalised recommendations