Anatomy and Histology of the Knee Anterolateral Ligament (original) (raw)
Related papers
The American Journal of Sports Medicine
In 1879, Paul Segond described an avulsion fracture (now known as a Segond fracture) at the anterolateral proximal tibia with the presence of a fibrous band at the location of this fracture. Although references to this ligament were occasionally made in the anatomy literature after Segond’s discovery, it was not until 2012 that Vincent et al named this ligament what we know it as today, the anterolateral ligament (ALL) of the knee. The ALL originates near the lateral epicondyle of the distal femur and inserts on the proximal tibia near Gerdy’s tubercle. The ALL exists as a ligamentous structure that comes under tension during internal rotation at 30°. In the majority of specimens, the ALL can be visualized as a ligamentous structure, whereas in some cases it may only be palpated as bundles of more tense capsular tissue when internal rotation is applied. Biomechanical studies have shown that the ALL functions as a secondary stabilizer to the anterior cruciate ligament (ACL) in resist...
The Structure and Function of the Anterolateral Ligament of the Knee: A Systematic Review
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2015
Purpose: The purpose of this systematic review was to evaluate the anatomic structure and function of the anterolateral ligament (ALL) of the knee. Methods: The Medline, Embase, and Cochrane databases were screened for all studies related to the ALL of the knee. Two reviewers independently reviewed all eligible articles and the references of these articles. Inclusion and exclusion criteria were applied to all searched studies. Quality assessment was completed for the included studies. Results: Nineteen studies were identified for final analysis. Pooled analysis identified the ALL in 430 of 449 knees (96%) examined. The ligament was found to originate from the region of the lateral femoral epicondyle and insert on the proximal tibia midway between the Gerdy tubercle and the fibular head. The ALL was found to be 34.1 to 41.5 mm in length, 5.1 to 8.3 mm in width above the lateral meniscus, and 8.9 to 11.2 mm in width below the lateral meniscus. By use of magnetic resonance imaging, the ALL was identified in 93% of knees examined (clinical, 64 of 70; cadaveric, 16 of 16). In one case study the ligament was clearly visualized by ultrasound examination. Histologic analysis across 3 studies showed characteristics consistent with ligamentous tissue. Though not shown in biomechanical studies, it is hypothesized that the ALL provides anterolateral stability to the knee, preventing anterolateral subluxation of the proximal tibia on the femur. One study identified a network of peripheral nerves, suggesting a proprioceptive function of the ALL. Conclusions: This systematic review shows the ALL to be a distinct structure with a consistent origin and insertion sites. The ALL is an extra-articular structure with a clear course from the lateral femoral epicondyle region, running anteroinferiorly, to the proximal tibia at a site midway between the Gerdy tubercle and the head of the fibula. The function of this ligament is theorized to provide anterolateral knee stability. Level of Evidence: Level IV, systematic review of cadaveric and imaging studies.
Knee surgery & related research, 2019
Residual knee instability and low rates of return to previous sport are major concerns after anterior cruciate ligament (ACL) reconstruction. To improve outcomes, surgical methods, such as the anatomical single-bundle technique or the double-bundle technique, were developed. However, these reconstruction techniques failed to adequately overcome these problems, and, therefore, new potential answers continue to be of great interest. Based on recent anatomical and biomechanical studies emphasizing the role of the anterolateral ligament (ALL) in rotational stability, novel surgical methods including ALL reconstruction and anterolateral tenodesis have been introduced with the possibility of resolving residual instability after ACL reconstruction. However, there is still little consensus on many aspects of the ALL, including: several anatomical issues, appropriate indications for ALL surgery, and the optimal surgical method and graft choice for reconstruction surgery. Therefore, further studies are necessary to advance our knowledge of the ALL and its contribution to knee stability.
Anterolateral ligament of the knee: myth or reality?
Surgical and radiologic anatomy : SRA, 2016
A ligament of the knee has recently drawn the attention: the rediscovered anterolateral ligament (ALL) of the knee. The tibial insertion of the ALL is torn off in the Segond fracture, pathognomonic of the anterior cruciate ligament tear. The ALL originates from the lateral femoral epicondyle and has fibers inserting on the lateral meniscus. It attaches distally to the tibial plateau, midway between the tip of the fibular head and Gerdy's tubercle. The purpose of this study was to evaluate the visibility of the ALL using routine MRI (1.5T) protocol. In the first part of our study 10 cadaveric knee joints were examined using MR imaging to evaluate the visibility of the ALL. These cadaveric knees have been dissected to assess the presence of the ALL and to evaluate the accordance between MRI and anatomic dissection. In the second part of the study, 61 knee MRI of patients were examined to evaluate the visibility of the ALL using axial and coronal DP-FS weighted sequences. In all ca...
The anterolateral ligament of the human knee: an anatomic and histologic study
Knee Surgery, Sports …, 2012
Purpose The functional anatomy of the knee is frequently studied but remains incompletely understood. Numerous authors have described a structure in the lateral knee connecting the lateral femoral condyle with the lateral meniscus and tibial plateau. The goal of this study is to define the incidence, anatomy, and histology of this structure, the anterolateral ligament. Methods The incidence of the ligament was determined in 30 consecutive patients undergoing total knee arthroplasty (TKA) for medial compartment osteoarthritis. The anatomy and histology were evaluated using 10 cadaveric knees. Results The anterolateral ligament was noted to be present in all 40 knees. In all cases, it was noted to take origin near or on the popliteus tendon insertion and insert into the lateral meniscus and tibial plateau 5 mm distal to the articular surface and posterior to Gerdy's Tubercle. The average width of the relatively flat structure was 8.2 ± 1.5 mm, and the average length was 34.1 ± 3.4 mm. Histologic analysis revealed a discreet structure with a fibrous core surrounded by synovium. Fibers blended with the popliteus at its origin and with the lateral meniscus as it passed distally. Conclusions The anterolateral ligament may play a role in preventing anterior tibial translation. The role, if any, of this structure in meniscal stability and the pathology of meniscal tears remain unclear.
Anatomical study on the anterolateral ligament of the knee
Revista Brasileira de Ortopedia (English Edition), 2013
Objective:Describe the knee anterolateral ligament (ALL) and establish its anatomical marks of origin and insertion. Methods: Dissection of the anterolateral aspect of the knee was performed in six cadavers. After isolation of the ALL, its lenght, width and thickness were measured as its places of origin and insertion. The ALL origin was documented in relation to the lateral collateral ligament (LCL) origin and the insertion was documented in relation to the Gerdy tubercle, fibullar head and lateral meniscus.
The archives of bone and joint surgery, 2020
Ever since its description, anterolateral ligament (ALL) of the knee joint remains as the hotspot of controversies. Though it has been described under various descriptions, the structure gained its limelight when it was christened as anterolateral ligament by Claes in 2013. The main reason for the controversies around it is the lack of concrete evidences regarding its attachments, morphology, biomechanical aspects and radiological appearance. Similarly the role of ALL in pivot shift phenomenon also remains as a point of debate. The advocates of ALL suggest that because of its ability to modulate internal rotation and attachment to the lateral meniscus, ALL contributes to the pivot shift phenomenon. Similarly, the orientation of ALL stands as the reason for varied documentation with respect to imaging techniques. With the growing body of evidence, it is imperative to fix our stand regarding the structure because, if found to be morphologically persistent, it can be used for concomita...
Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2017
Persistent rotatory knee laxity is increasingly recognized as a common finding after anterior cruciate ligament (ACL) reconstruction. While the reasons behind rotator knee laxity are multifactorial, the impact of the anterolateral knee structures is significant. As such, substantial focus has been directed toward better understanding these structures, including their anatomy, biomechanics, in vivo function, injury patterns, and the ideal procedures with which to address any rotatory knee laxity that results from damage to these structures. However, the complexity of lateral knee anatomy, varying dissection techniques, differing specimen preparation methods, inconsistent sectioning techniques in biomechanical studies, and confusing terminology have led to discrepancies in published studies on the topic. Furthermore, anatomical and functional descriptions have varied widely. As such, we have assembled a panel of expert surgeons and scientists to discuss the roles of the anterolateral ...
The Anterolateral Ligament of the Knee: Emerging Interest for Reconstructive Surgery
International Journal of Approximate Reasoning, 2018
Address for Correspondence: Dr. Anita Rahul Gune, MS Anatomy, D.G.O (CPS), Associate Professor, Dept. of Anatomy, Dr. D.Y.Patil Medical College, Kolhapur 416006.Maharashtra, India. Phone 0231 2658770, 9922108770, E-Mail: anitargune@gmail.com Background: The anterolateral ligament (ALL) originates from the lateral epicondyle of the femur and inserts on the tibia in between Gerdy’s tubercle (GT) and fibula head (FH). The ALL exists as a ligamentous structure that becomes taut if tibia is rotated 30° medially. It has been suggested that the ALL of the knee has importance in limiting rotational instability, and reconstruction of the same along with anterior cruciate ligament (ACL) may prevent a continued pivot-shift following surgery. We describe our experience of cadaveric dissection with reference to other published. Materials and Methods: This study was conducted in Department of Anatomy, D.Y.Patil Medical College, Kolhapur from 2016 to 2018. The ALL was identified in 14 Females and ...