Anatomical features and significance of the anterolateral ligament of the knee
- 138 Downloads
The anterolateral ligament (ALL) was discovered in 1879. For over 130 years, this anatomical structure did not enjoy much attention, but the situation started to change when a number of researchers described its contribution to the rotational stability of the knee joint.
Purpose of the study
To estimate the occurrence of the ALL and describe the aspects of its anatomy that should be factored into the outcome of stabilizing surgeries of the knee joint.
Materials and methods
The study was conducted in 60 knee specimens of 30 unfixed human cadavers. Once the anterolateral ligament was identified, we assessed its relationships with the body of the lateral meniscus, the lateral collateral ligament to which it is attached mainly by connective tissue fibers, and the lateral inferior genicular blood vessels. We also identified ALL attachment points on the lateral epicondyle of the femur and the lateral condyle of the tibia.
ALL has been identified in 56.6% of the dissected knee pairs in both knees. ALL was present in 66.7% of female joints (24 of 36 specimens) and in 41.6% of male joints (10 of 24 specimens). The average length of the ALL was 38.5 ± 4.4 mm. The average width near the joint space was 4.45 ± 0.85 mm. The attachment point on the lateral epicondyle of the femur varied: it was posterior-proximal to the lateral collateral ligament in 64.7% of the dissected knees, anterior to the lateral collateral ligament in 23.5% of cases, and on the popliteus tendon insertion or next to it in 11.8% of cases. The point of the anterolateral ligament’s attachment on the lateral condyle of the tibia typically lied halfway between the fibular head and Gerdy’s tubercle.
The best site for a bone tunnel is the region on the lateral epicondyle of the femur, lying posterior and proximal to the origin of the lateral collateral ligament. The identified anatomical pattern in the course of the lateral inferior genicular vessels will help to spare these important blood suppliers in the course of a reconstructive surgery of the anterolateral knee joint region.
KeywordsAnterolateral ligament Anatomy Sport Back to sport Anterior cruciate ligament
Compliance with ethical standards
The authors declare that they have no competing interests.
This article does not contain any studies with human participants or animals performed by any of the authors.
- 1.Segond P (1879) Recherches cliniques et experimentales sur les epanchements sanguins du genou par entorse. Prog Med 7:297–299 319–321, 340–341Google Scholar
- 8.LaPrade RF, Gilbert TJ, Bollom TS, Wentorf F, Chaljub G (2000) The magnetic resonance imaging appearance of individual structures of the posterolateral knee: a prospective study of normal knees and knees with surgically verified grade III injuries. Am J Sports Med 28:191–199CrossRefPubMedGoogle Scholar
- 12.Sonnery-Cottet B, Daggett M, Fayard J-M, Ferretti A, Helito CP, Lind M, Monaco E, Castro de Pádua VB, Thaunat M, Wilson A, Zaffagnini S, Zijl J, Claes S (2017) Anterolateral Ligament Expert Group consensus paper on the management of internal rotation and instability of the anterior cruciate ligament-deficient knee. Journal of Orthopaedics and traumatology. Official Journal of the Italian Society of Orthop Traumatol 18(2):91–106. https://doi.org/10.1007/s10195-017-0449-8. CrossRefGoogle Scholar
- 13.Rasmussen MT, Nitri M, Williams BT, Moulton SG, Cruz RS, Dornan GJ, Goldsmith MT, LaPrade RF (2016) An in vitro robotic assessment of the anterolateral ligament, part 1: secondary role of the anterolateral ligament in the setting of an anterior cruciate ligament injury. Am J Sports Med 44(3):585–592. https://doi.org/10.1177/0363546515618387 CrossRefPubMedGoogle Scholar
- 17.Potu BK, Salem AH, Abu-Hijleh MF (2016) Morphology of anterolateral ligament of the knee: a cadaveric observation with clinical insight. Adv Med 9182863. https://doi.org/10.1155/2016/9182863
- 23.Andernord D, Desai N, Bjornsson H, Ylander M, Karlsson J, Samuelsson K (2015) Patient predictors of early revision surgery after anterior cruciate ligament reconstruction: a cohort study of 16,930 patients with 2-year follow-up. Am J Sports Med 43(1):121–127. https://doi.org/10.1177/0363546514552788 CrossRefPubMedGoogle Scholar
- 27.Roessler PP, Schuttler KF, Heyse TJ, Wirtz DC, Efe T (2016) The anterolateral ligament (ALL) and its role in rotational extra-articular stability of the knee joint: a review of anatomy and surgical concepts. Arch Orthop Trauma Surg 136(3):305–313. https://doi.org/10.1007/s00402-015-2395-3 CrossRefPubMedGoogle Scholar
- 28.Helito CP, Demange MK, Bonadio MB, Tirico LE, Gobbi RG, Pecora JR, Camanho GL (2014) Radiographic landmarks for locating the femoral origin and tibial insertion of the knee anterolateral ligament. Am J Sports Med 42(10):2356–2362. https://doi.org/10.1177/0363546514543770 CrossRefPubMedGoogle Scholar