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The anterolateral ligament of the knee is not a solid structure in human fetuses

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Abstract

Purpose

The purpose of this study was to investigate if the anterolateral ligament of the knee (ALL) is present in the human fetus and describe its topography along with other structures of the region.

Methods

Forty human fetuses knee joints, at mean age 34 weeks (± 2.57 weeks), fixed in 10% formalin, were submitted to cross-sectional dissection and mesoscopic analysis.

Results

The ALL was not identified, although the usual topography of the region was identified in all specimens: skin, subcutaneous tissue, iliotibial tract (ITT), fibular collateral ligament, popliteal muscle tendon, lateral meniscus, patellar ligament, infrapatellar fat pad, lateral patellar retinaculum, knee joint capsule, lateral inferior genicular vessels, and the biceps femoris tendon. The ITT reveals anterior (n = 12) and lateral thickening (n = 17) in some specimens. This thickening was found in both knees of the same subject in 6/20 specimens.

Conclusion

The anterolateral ligament of the knee is not a congenital or solid structure. Our results suggest that the ALL may be a deep layer of the ITT or part of the knee joint capsule, or its identification is evaluator dependent.

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References

  1. Segond P-F (1879) Recherches cliniques et expérimentales sur les épanchements sanguins du genou par entorse, par Paul Segond, ... Bureaux du "Progrès médical, Paris

  2. Murgier J, Devitt BM, Sevre J, Feller JA, Cavaignac E (2019) The origin of the knee anterolateral ligament discovery: a translation of segond’s original work with commentary. Arthrosc J Arthrosc Relat Surg 35:684–690. https://doi.org/10.1016/j.arthro.2018.10.003

    Article  Google Scholar 

  3. 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 219:381–386. https://doi.org/10.1148/radiology.219.2.r01ma23381

    Article  CAS  PubMed  Google Scholar 

  4. Haims AH, Medvecky MJ, Pavlovich R, Katz LD (2003) MR imaging of the anatomy of and injuries to the lateral and posterolateral aspects of the knee. AJR Am J Roentgenol 180:647–653. https://doi.org/10.2214/ajr.180.3.1800647

    Article  PubMed  Google Scholar 

  5. Hughston JC, Andrews JR, Cross MJ, Moschi A (1976) Classification of knee ligament instabilities. Part II. The lateral compartment. J Bone Joint Surg Am 58:173–179

    Article  CAS  Google Scholar 

  6. Irvine GB, Dias JJ, Finlay DB (1987) Segond fractures of the lateral tibial condyle: brief report. J Bone Joint Surg Br 69:613–614

    Article  CAS  Google Scholar 

  7. Johnson LL (1979) Lateral capsualr ligament complex: anatomical and surgical considerations. Am J Sports Med 7:156–160. https://doi.org/10.1177/036354657900700302

    Article  CAS  PubMed  Google Scholar 

  8. Moorman CT, LaPrade RF (2005) Anatomy and biomechanics of the posterolateral corner of the knee. J Knee Surg 18:137–145

    Article  Google Scholar 

  9. Cruells Vieira EL, Vieira EÁ, Teixeira da Silva R, dos Santos Berlfein PA, Abdalla RJ, Cohen M (2007) An anatomic study of the iliotibial tract. Arthrosc J Arthrosc Relat Surg 23:269–274. https://doi.org/10.1016/j.arthro.2006.11.019

    Article  Google Scholar 

  10. Claes S, Vereecke E, Maes M, Victor J, Verdonk P, Bellemans J (2013) Anatomy of the anterolateral ligament of the knee. J Anat 223:321–328. https://doi.org/10.1111/joa.12087

    Article  PubMed  PubMed Central  Google Scholar 

  11. Daggett M, Ockuly AC, Cullen M, Busch K, Lutz C, Imbert P, Sonnery-Cottet B (2016) Femoral origin of the anterolateral ligament: an anatomic analysis. Arthrosc J Arthrosc Relat Surg 32:835–841. https://doi.org/10.1016/j.arthro.2015.10.006

    Article  Google Scholar 

  12. Dodds AL, Halewood C, Gupte CM, Williams A, Amis AA (2014) The anterolateral ligament: anatomy, length changes and association with the Segond fracture. Bone Jt J 96:325–331. https://doi.org/10.1302/0301-620X.96B3.33033

    Article  Google Scholar 

  13. Helito CP, Demange MK, Bonadio MB, Tírico LEP, Gobbi RG, Pécora JR, Camanho GL (2013) Anatomy and histology of the knee anterolateral ligament. Orthop J Sports Med 1:232596711351354. https://doi.org/10.1177/2325967113513546

    Article  Google Scholar 

  14. Kosy JD, Mandalia VI, Anaspure R (2015) Characterization of the anatomy of the anterolateral ligament of the knee using magnetic resonance imaging. Skeletal Radiol 44:1647–1653. https://doi.org/10.1007/s00256-015-2218-1

    Article  PubMed  Google Scholar 

  15. Porrino J, Maloney E, Richardson M, Mulcahy H, Ha A, Chew FS (2015) The anterolateral ligament of the knee: MRI appearance, association with the Segond fracture, and historical perspective. AJR Am J Roentgenol 204:367–373. https://doi.org/10.2214/AJR.14.12693

    Article  PubMed  Google Scholar 

  16. Vincent J-P, 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 20:147–152. https://doi.org/10.1007/s00167-011-1580-3

    Article  PubMed  Google Scholar 

  17. Ariel de Lima D, Helito CP, Lacerda de Lima L, de Castro SD, Costa Cavalcante ML, Dias Leite JA (2019) Anatomy of the anterolateral ligament of the knee: a systematic review. Arthrosc J Arthrosc Relat Surg 35:670–681. https://doi.org/10.1016/j.arthro.2018.09.006

    Article  Google Scholar 

  18. Helito CP, do Prado Torres JA, Bonadio MB, Aragão JA, de Oliveira LN, Natalino RJM, Pécora JR, Camanho GL, Demange MK (2017) Anterolateral ligament of the fetal knee: an anatomic and histological study. Am J Sports Med 45:91–96. https://doi.org/10.1177/0363546516664888

    Article  PubMed  Google Scholar 

  19. Capo J, Kaplan DJ, Fralinger DJ, Adler RS, Campbell KA, Jazrawi LM, Alaia MJ (2017) Ultrasonographic visualization and assessment of the anterolateral ligament. Knee Surg Sports Traumatol Arthrosc 25:3134–3139. https://doi.org/10.1007/s00167-016-4215-x

    Article  PubMed  Google Scholar 

  20. Fardin PBA, de Lizardo JHF, da Baptista JS (2017) Study of the anterolateral ligament of the knee in formalin-embedded cadavers. Acta Ortopédica Bras 25:89–92. https://doi.org/10.1590/1413-785220172502162204

    Article  Google Scholar 

  21. Stijak L, Bumbaširević M, Radonjić V, Kadija M, Puškaš L, Milovanović D, Filipović B (2016) Anatomic description of the anterolateral ligament of the knee. Knee Surg Sports Traumatol Arthrosc 24:2083–2088. https://doi.org/10.1007/s00167-014-3422-6

    Article  PubMed  Google Scholar 

  22. Shea KG, Yen Y-M, Ganley TJ (2016) The anterolateral ligament of the knee: an inconsistent finding in pediatric cadaveric specimens. J Pediatr Orthop 36:4

    Article  Google Scholar 

  23. Shea KG, Milewski MD, Cannamela PC, Ganley TJ, Fabricant PD, Terhune EB, Styhl AC, Anderson AF, Polousky JD (2017) Anterolateral ligament of the knee shows variable anatomy in pediatric specimens. Clin Orthop Relat Res 475:1583–1591. https://doi.org/10.1007/s11999-016-5123-6

    Article  PubMed  Google Scholar 

  24. Toro-Ibarguen AN, Pretell-Mazzini J, Pérez E, Pedrajas I, Cano-Egea JM, Ramón Sanudo J (2017) The anterolateral ligament: a cadaveric study in fetuses: anterolateral ligament: a cadaveric study in fetuses. Clin Anat 30:625–634. https://doi.org/10.1002/ca.22887

    Article  PubMed  Google Scholar 

  25. Sabzevari S, Rahnemai-Azar AA, Albers M, Linde M, Smolinski P, Fu FH (2017) Anatomic and histological investigation of the anterolateral capsular complex in the fetal knee. Am J Sports Med 45:1383–1387. https://doi.org/10.1177/0363546517692534

    Article  PubMed  Google Scholar 

  26. Kittl C, Inderhaug E, Williams A, Amis AA (2018) Biomechanics of the anterolateral structures of the knee. Clin Sports Med 37:21–31. https://doi.org/10.1016/j.csm.2017.07.004

    Article  PubMed  Google Scholar 

  27. Brockmeyer M, Orth P, Höfer D, Seil R, Paulsen F, Menger MD, Kohn D, Tschernig T (2019) The anatomy of the anterolateral structures of the knee—a histologic and macroscopic approach. Knee 26:636–646. https://doi.org/10.1016/j.knee.2019.02.017

    Article  PubMed  Google Scholar 

  28. Moore KL, Persaud TVN, Torchia MG (2016) Embriologia Clínic—10a Ed. Accessed 15 Aug 2019

  29. O’Rahilly R, Müller F, Streeter GL (1987) Developmental stages in human embryos: including a revision of Streeter’s “Horizons” and a survey of the Carnegie collection. Carnegie Institution of Washington, Washington, D.C.

    Google Scholar 

  30. Gardner E, O’Rahilly R (1968) The early development of the knee joint in staged human embryos. J Anat 102:289–299

    CAS  PubMed  PubMed Central  Google Scholar 

  31. Gray DJ, Gardner E (1950) Prenatal development of the human knee and superior tibiofibular joints. Am J Anat 86:235–287. https://doi.org/10.1002/aja.1000860204

    Article  CAS  PubMed  Google Scholar 

  32. Helito CP, Bonadio MB, Soares TQ, da Mota e Albuquerque RF, Natalino RJM, Pécora JR, Camanho GL, Demange MK (2016) The meniscal insertion of the knee anterolateral ligament. Surg Radiol Anat 38:223–228. https://doi.org/10.1007/s00276-015-1533-5

    Article  PubMed  Google Scholar 

  33. Junqueira LC, Carneiro J (2017) Junqueira e CarnerioHistologia básica 13.ed. Histologia básica: texto e atlas. 13. ed. Rio de Janeiro: Guanabara Koogan. Accessed 15 Aug 2019

  34. Tena-Arregui J, Barrio-Asensio C, Viejo-Tirado F, Puerta-Fonollá J, Murillo-González J (2003) Arthroscopic study of the knee joint in fetuses. Arthrosc J Arthrosc Relat Surg 19:862–868. https://doi.org/10.1016/S0749-8063(03)00739-4

    Article  Google Scholar 

  35. Kuikka P-I, Kiuru MJ, Niva MH, Kröger H, Pihlajamäki HK (2006) Sensitivity of routine 1.0-Tesla magnetic resonance imaging versus arthroscopy as gold standard in fresh traumatic chondral lesions of the knee in young adults. Arthrosc J Arthrosc Relat Surg 22:1033–1039. https://doi.org/10.1016/j.arthro.2006.06.021

    Article  Google Scholar 

  36. Schoth F, Kraemer N, Niendorf T, Hohl C, Gunther RW, Krombach GA (2008) Comparison of image quality in magnetic resonance imaging of the knee at 1.5 and 3.0 Tesla using 32-channel receiver coils. Eur Radiol 18:2258–2264. https://doi.org/10.1007/s00330-008-0972-3

    Article  CAS  PubMed  Google Scholar 

  37. Coquart B, Le Corroller T, Laurent PE, Ollivier M, Pradel V, Champsaur P, Guenoun D (2016) Anterolateral ligament of the knee: myth or reality? Surg Radiol Anat 38:955–962. https://doi.org/10.1007/s00276-016-1657-2

    Article  CAS  PubMed  Google Scholar 

  38. Macchi V, Porzionato A, Morra A, Stecco C, Tortorella C, Menegolo M, Grignon B, De Caro R (2016) The anterolateral ligament of the knee: a radiologic and histotopographic study. Surg Radiol Anat 38:341–348. https://doi.org/10.1007/s00276-015-1566-9

    Article  PubMed  Google Scholar 

  39. Moore KL, Dalley AF (2000) Anatomia orientada para a clínica (7a. ed.). Grupo Gen—Guanabara Koogan

  40. Getgood A, ALC Consensus Group, Brown C, Lording T, Amis A, Claes S, Geeslin A, Musahl V (2019) The anterolateral complex of the knee: results from the International ALC Consensus Group Meeting. Knee Surg Sports Traumatol Arthrosc 27:166–176. https://doi.org/10.1007/s00167-018-5072-6

    Article  Google Scholar 

  41. Balta JY, Cronin M, Cryan JF, O’Mahony SM (2015) Human preservation techniques in anatomy: a 21st century medical education perspective: human preservation techniques in anatomy. Clin Anat 28:725–734. https://doi.org/10.1002/ca.22585

    Article  PubMed  Google Scholar 

  42. Brockmeyer M, Höfer D, Schäfer K, Seil R, Becker K, Paulsen F, Kohn D, Tschernig T (2017) The anterolateral ligament (ALL) of the knee—part of the iliotibial tract or a truly separate structure? Ann Anat Anat Anz 212:1–3. https://doi.org/10.1016/j.aanat.2017.02.010

    Article  Google Scholar 

  43. Parker M, Smith HF (2018) Anatomical variation in the anterolateral ligament of the knee and a new dissection technique for embalmed cadaveric specimens. Anat Sci Int 93:177–187. https://doi.org/10.1007/s12565-016-0386-2

    Article  PubMed  Google Scholar 

  44. Potu BK, Salem AH, Abu-Hijleh MF (2016) Morphology of anterolateral ligament of the knee: a cadaveric observation with clinical insight. Adv Med 2016:1–4. https://doi.org/10.1155/2016/9182863

    Article  Google Scholar 

  45. Runer A, Birkmaier S, Pamminger M, Reider S, Herbst E, Künzel K-H, Brenner E, Fink C (2016) The anterolateral ligament of the knee: a dissection study. Knee 23:8–12. https://doi.org/10.1016/j.knee.2015.09.014

    Article  PubMed  Google Scholar 

  46. Haizuka Y, Nagase M, Takashino S, Kobayashi Y, Fujikura Y, Matsumura G (2018) A new substitute for formalin: application to embalming cadavers. Clin Anat N Y N 31:90–98. https://doi.org/10.1002/ca.23011

    Article  Google Scholar 

  47. Musahl V, Rahnemai-Azar AA, van Eck CF, Guenther D, Fu FH (2016) Anterolateral ligament of the knee, fact or fiction? Knee Surg Sports Traumatol Arthrosc 24:2–3. https://doi.org/10.1007/s00167-015-3913-0

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors greatly appreciate the technicians of the Department of Morphology (Universidade Federal do Espirito Santo) for their assistance with the materials. The authors also would like to state gratitude for the anonymous families who generously donated the bodies so that this study could be carried out.

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The authors have no funding to report.

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Authors and Affiliations

  1. Laboratory of Applied Morphology–LEMA, Universidade Federal Do Espirito Santo, Av. Marechal Campos, 1468, Maruipe, Vitoria, Espirito Santo, 29043-900, Brazil

    Fernanda Vieira Botelho Delpupo, Juliana Hott de Fúcio Lizardo & Josemberg da Silva Baptista

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  1. Fernanda Vieira Botelho Delpupo
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  2. Juliana Hott de Fúcio Lizardo
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  3. Josemberg da Silva Baptista
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All the authors performed the data analysis/interpretation, drafted the manuscript, criticized and review the versions of the manuscript, and approved the final version of the paper. The first author was responsible for data acquisition.

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Correspondence to Josemberg da Silva Baptista.

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Delpupo, F.V.B., de Fúcio Lizardo, J.H. & Baptista, J.d. The anterolateral ligament of the knee is not a solid structure in human fetuses. Surg Radiol Anat 43, 1117–1122 (2021). https://doi.org/10.1007/s00276-020-02665-7

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