Skip to main content
SpringerLink
Log in

Anatomic dissection of the anterolateral ligament (ALL) in paired fresh-frozen cadaveric knee joints

  • Arthroscopy and Sports Medicine
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Different dissection studies as well as comparative studies about the anterolateral ligament of the knee (ALL) already exist and the structure’s topology and properties have been shown. However, most of the studies investigating the ligament were performed in embalmed knees, which is thought to change the structural integrity of ligaments and thus the topologic and dynamic measurements. Since the biomechanical function of the ALL is not fully understood until today and a correlation with the pivot shift phenomenon is yet speculative, further studies will have to clarify its definitive importance. Its function as a limiter of internal rotation and lateral meniscal extrusion leads to the assumption of a secondary knee stabilizer.

Methods

Twenty paired fresh-frozen cadaveric knees of ten donors have been dissected in a layerwise fashion. After identification of the ALL, topologic measurements were undertaken using a digital caliper.

Results

The ALL could be identified as a tender, pearly structure in front of the anterolateral joint capsule in only 60% of the dissected knee joints. Only 20% of donors had a bilateral ALL while 80% had an ALL only in one side. Mean length, thickness and width as well as topographic measurements were comparable to other available studies investigating fresh-frozen cadavers.

Conclusion

Anatomy and topography of the ALL seem to be highly variable, but consistent within certain borders. Prevalence has to be argued though as it strongly differs between studies. The impact of an ALL absence, even if only unilateral, needs to be investigated in clinical and imaging studies to finally clarify its importance.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Claes S, Vereecke E, Maes M et al (2013) Anatomy of the anterolateral ligament of the knee. J Anat 223:321–328. doi:10.1111/joa.12087

    Article  PubMed  PubMed Central  Google Scholar 

  2. Segond P (1879) Recherches cliniques et expérimentales sur les épanchements sanguins du genou par entorse. Progres Med 7:297–341

    Google Scholar 

  3. Roessler PP, Schüttler KF, Heyse TJ et al (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 136:305–313. doi:10.1007/s00402-015-2395-3

    Article  PubMed  Google Scholar 

  4. Guenther D, Griffith C, Lesniak B et al (2015) Anterolateral rotatory instability of the knee. Knee Surg Sports Traumatol Arthrosc 23:2909–2917. doi:10.1007/s00167-015-3616-6

    Article  PubMed  Google Scholar 

  5. Stijak L, Bumbaširević M, Radonjić V et al (2016) Anatomic description of the anterolateral ligament of the knee. Knee Surg Sports Traumatol Arthrosc 24:2083–2088. doi:10.1007/s00167-014-3422-6

    Article  PubMed  Google Scholar 

  6. Mohtadi NG, Chan DS, Dainty KN, Whelan DB (2011) Patellar tendon versus hamstring tendon autograft for anterior cruciate ligament rupture in adults. Cochrane Database Syst Rev CD005960. doi:10.1002/14651858.CD005960.pub2

  7. 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  PubMed  Google Scholar 

  8. Parsons EM, Gee AO, Spiekerman C, Cavanagh PR (2015) The biomechanical function of the anterolateral ligament of the knee. Am J Sports Med 43:669–674. doi:10.1177/0363546514562751

    Article  PubMed  PubMed Central  Google Scholar 

  9. Seebacher JR, Inglis AE, Marshall JL, Warren RF (1982) The structure of the posterolateral aspect of the knee. J Bone Joint Surg Am 64:536–541

    Article  CAS  PubMed  Google Scholar 

  10. Vincent JP, Magnussen RA, Gezmez F et al (2012) The anterolateral ligament of the human knee: an anatomic and histologic study. Knee Surg Sports Traumatol Arthrosc 20:147–152. doi:10.1007/s00167-011-1580-3

    Article  PubMed  Google Scholar 

  11. Helito CP, Demange MK, Bonadio MB et al (2013) Anatomy and histology of the knee anterolateral ligament. Orthop J Sports Med 1:2325967113513546. doi:10.1177/2325967113513546

    Article  PubMed  PubMed Central  Google Scholar 

  12. Dodds AL, Halewood C, Gupte CM et al (2014) The anterolateral ligament: Anatomy, length changes and association with the Segond fracture. Bone Joint J 96-B:325–331. doi:10.1302/0301-620X.96B3.33033

  13. Caterine S, Litchfield R, Johnson M et al (2015) A cadaveric study of the anterolateral ligament: re-introducing the lateral capsular ligament. Knee Surg Sports Traumatol Arthrosc 23:3186–3195. doi:10.1007/s00167-014-3117-z

    Article  PubMed  Google Scholar 

  14. Kosy JD, Soni A, Venkatesh R, Mandalia VI (2016) The anterolateral ligament of the knee: unwrapping the enigma. Anatomical study and comparison to previous reports. J Orthop Traumatol. doi:10.1007/s10195-016-0392-0

  15. Runer A, Birkmaier S, Pamminger M et al (2016) The anterolateral ligament of the knee: a dissection study. Knee 23:8–12. doi:10.1016/j.knee.2015.09.014

    Article  PubMed  Google Scholar 

  16. Shea KG, Polousky JD, Jacobs JC et al (2015) The anterolateral ligament of the knee. J Pediatr Orthop. doi:10.1097/bpo.0000000000000616

    Google Scholar 

  17. Ingham SJM, de Carvalho RT, Martins CAQ et al (2015) Anterolateral ligament anatomy: a comparative anatomical study. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-015-3956-2

    Google Scholar 

  18. Neyeloff JL, Fuchs SC, Moreira LB (2012) Meta-analyses and Forest plots using a microsoft excel spreadsheet: step-by-step guide focusing on descriptive data analysis. BMC Res Notes 5:52. doi:10.1186/1756-0500-5-52

    Article  PubMed  PubMed Central  Google Scholar 

  19. Henry BM, Tomaszewski KA, Walocha JA (2016) Methods of evidence-based anatomy: a guide to conducting systematic reviews and meta-analysis of anatomical studies. Ann Anat 205:16–21. doi:10.1016/j.aanat.2015.12.002

    Article  PubMed  Google Scholar 

  20. 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. doi:10.1007/s00256-015-2218-1

    Article  PubMed  Google Scholar 

  21. Helito CP, Bonadio MB, Soares TQ et al (2016) The meniscal insertion of the knee anterolateral ligament. Surg Radiol Anat 38:223–228. doi:10.1007/s00276-015-1533-5

    Article  PubMed  Google Scholar 

  22. Ling Y, Li C, Feng K et al (2016) Effects of fixation and preservation on tissue elastic properties measured by quantitative optical coherence elastography (OCE). J Biomech 49:1009–1015. doi:10.1016/j.jbiomech.2016.02.013

    Article  PubMed  Google Scholar 

  23. Bitar AC, Santos LAU, Croci AT et al (2010) Histological study of fresh versus frozen semitendinous muscle tendon allografts. Clinics (Sao Paulo) 65:297–303. doi:10.1590/S1807-59322010000300010

    Article  Google Scholar 

  24. Woo SL, Orlando CA, Camp JF, Akeson WH (1986) Effects of postmortem storage by freezing on ligament tensile behavior. J Biomech 19:399–404

    Article  CAS  PubMed  Google Scholar 

  25. Zens M, Niemeyer P, Ruhhammer J et al (2015) Length changes of the anterolateral ligament during passive knee motion: a human cadaveric study. Am J Sports Med 43:2545–2552. doi:10.1177/0363546515594373

    Article  PubMed  Google Scholar 

  26. Kittl C, Halewood C, Stephen JM et al (2015) Length change patterns in the lateral extra-articular structures of the knee and related reconstructions. Am J Sports Med 43:354–362. doi:10.1177/0363546514560993

    Article  PubMed  Google Scholar 

  27. Kostogiannis I, Ageberg E, Neuman P et al (2007) Activity level and subjective knee function 15 years after anterior cruciate ligament injury: a prospective, longitudinal study of nonreconstructed patients. Am J Sports Med 35:1135–1143. doi:10.1177/0363546507299238

    Article  PubMed  Google Scholar 

  28. Defrate LE, Papannagari R, Gill TJ et al (2006) The 6 degrees of freedom kinematics of the knee after anterior cruciate ligament deficiency: an in vivo imaging analysis. Am J Sports Med 34:1240–1246. doi:10.1177/0363546506287299

    Article  PubMed  Google Scholar 

  29. Walla DJ, Albright JP, McAuley E et al (1985) Hamstring control and the unstable anterior cruciate ligament-deficient knee. Am J Sports Med 13:34–39

    Article  CAS  PubMed  Google Scholar 

  30. Rodríguez-Roiz JM, Caballero M, Ares O et al (2015) Return to recreational sports activity after anterior cruciate ligament reconstruction: a one- to six-year follow-up study. Arch Orthop Trauma Surg 135:1117–1122. doi:10.1007/s00402-015-2240-8

    Article  PubMed  Google Scholar 

  31. Estes K, Cheruvu B, Lawless M et al (2015) Risk assessment for anterior cruciate ligament injury. Arch Orthop Trauma Surg 135:1437–1443. doi:10.1007/s00402-015-2292-9

    Article  CAS  PubMed  Google Scholar 

  32. Wang H, Fleischli JE, Nigel Zheng N (2012) Effect of lower limb dominance on knee joint kinematics after anterior cruciate ligament reconstruction. Clin Biomech (Bristol, Avon) 27:170–175. doi:10.1016/j.clinbiomech.2011.08.006

    Article  Google Scholar 

  33. Scanlan SF, Chaudhari AMW, Dyrby CO, Andriacchi TP (2010) Differences in tibial rotation during walking in ACL reconstructed and healthy contralateral knees. J Biomech 43:1817–1822. doi:10.1016/j.jbiomech.2010.02.010

    Article  PubMed  PubMed Central  Google Scholar 

  34. Tashman S, Kolowich P, Collon D et al (2007) Dynamic function of the ACL-reconstructed knee during running. Clin Orthop Relat Res 454:66–73. doi:10.1097/BLO.0b013e31802bab3e

    Article  PubMed  Google Scholar 

  35. Thambyah A, Nather A, Goh J (2006) Mechanical properties of articular cartilage covered by the meniscus. Osteoarthr Cartil 14:580–588. doi:10.1016/j.joca.2006.01.015

    Article  CAS  PubMed  Google Scholar 

  36. de Ruiter CJ, de Korte A, Schreven S, de Haan A (2010) Leg dominancy in relation to fast isometric torque production and squat jump height. Eur J Appl Physiol 108:247–255. doi:10.1007/s00421-009-1209-0

    Article  PubMed  Google Scholar 

  37. Ergün M, İşlegen Ç, Taşkiran E (2004) A cross-sectional analysis of sagittal knee laxity and isokinetic muscle strength in soccer players. Int J Sports Med 25:594–598. doi:10.1055/s-2004-821116

    Article  PubMed  Google Scholar 

  38. Hagino T, Ochiai S, Senga S et al (2015) Meniscal tears associated with anterior cruciate ligament injury. Arch Orthop Trauma Surg 135:1701–1706. doi:10.1007/s00402-015-2309-4

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedics and Trauma Surgery, University Hospital Bonn, Sigmund-Freud-Straße 25, 53127, Bonn, Germany

    Philip P. Roessler, Sascha Gravius & Dieter C. Wirtz

  2. Center for Orthopaedics and Trauma Surgery, University Hospital Marburg, Marburg, Germany

    Karl F. Schüttler, Thomas J. Heyse & Turgay Efe

  3. Department of Sporttraumatology-Knee- and Shoulder-Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt Am Main, Germany

    Thomas Stein

  4. Department of Sports Science, University of Bielefeld, Bielefeld, Germany

    Thomas Stein

  5. Institute of Molecular and Cellular Anatomy, RWTH Aachen University, Aachen, Germany

    Andreas Prescher

  6. Orthopaedicum Lich, Lich, Germany

    Turgay Efe

Authors
  1. Philip P. Roessler
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Karl F. Schüttler
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Thomas Stein
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sascha Gravius
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Thomas J. Heyse
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Andreas Prescher
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Dieter C. Wirtz
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Turgay Efe
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Philip P. Roessler.

Ethics declarations

Conflict of interest

The authors declare that there is no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Roessler, P.P., Schüttler, K.F., Stein, T. et al. Anatomic dissection of the anterolateral ligament (ALL) in paired fresh-frozen cadaveric knee joints. Arch Orthop Trauma Surg 137, 249–255 (2017). https://doi.org/10.1007/s00402-016-2617-3

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00402-016-2617-3

Keywords

Search

Navigation