Discovery of the anterolateral ligament of the knee: 2017 update

2017 ◽  
Vol 65 (2) ◽  
Keyword(s):  
Anterolateral Ligament ◽  
Knee Ligament ◽  
Ligamentous Structure

In 2013, the publication of Steven Claes [1] on the anterolateral ligament (ALL) in the “Journal of Anatomy” caused an important media buzz, highlighting a “new knee ligament”. The problem for the surgeons in 2017 is therefore whether this ALL is really a ligamentous structure in its own right, if it has a role in the rotatory control of the knee and especially if it must be restored during a reconstruction of the ACL.

scholarly journals Anterolateral Ligament (ALL) — Myth or Reality?

2017 ◽  
Vol 2 (s3) ◽  
pp. 12-16
Author(s):  
Mihai Roman ◽  
Octav Russu ◽  
Radu Prejbeanu ◽  
Adrian Todor ◽  
Vlad Predescu ◽  
...  
Keyword(s):  
Cruciate Ligament ◽  
Surgical Techniques ◽  
Anterolateral Ligament ◽  
Anterior Tibial Translation ◽  
Anterior Tibial ◽  
Long Time ◽  
Ligamentous Structure ◽  
Anterior Cruciate ◽  
Patient Selection Criteria ◽  
Tibial Translation

AbstractAlthough the anterolateral ligament (ALL) was described a long time ago, recent research shows a lot of interest regarding this structure. There is a high variability concerning its anatomy, especially its capsular/extracapsular situation and insertion sites. There is also some controversy about its ligamentous structure. It seems that it has a biomechanical role in restricting anterior tibial translation and internal rotation. The ALL complex seems to have a clinical significance, and a relationship with the pivot shift has been described. Although there are promising results recently, the surgical techniques of ALL reconstruction, in addition to anterior cruciate ligament reconstruction, have to be further investigated. A precise indication algorithm and patient selection criteria need to be established.

scholarly journals Morphology of Anterolateral Ligament of the Knee: A Cadaveric Observation with Clinical Insight

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Bhagath Kumar Potu ◽  
Abdel Halim Salem ◽  
Marwan F. Abu-Hijleh
Keyword(s):  
Tibial Plateau ◽  
Histological Analysis ◽  
Femoral Condyle ◽  
Lateral Meniscus ◽  
Anterolateral Ligament ◽  
Structure Relationship ◽  
Ligamentous Structure ◽  
Different Populations ◽  
And Function ◽  
Gerdy’S Tubercle

Background. The morphology and function of anterolateral ligament (ALL) of the knee are not clearly understood even today with all the sophisticated techniques available. There have been differing descriptions of the ALL of the knee in literature, and not all of them have been named or described clearly.Aim. The present study was undertaken to provide a clear structure/relationship description on ALL.Materials and Methods. We used 24 formalin-fixed cadaveric limbs. Knee regions of the all the limbs were neatly dissected and the ALL was exposed. Its proximal and distal attachments were traced carefully. Middle portion of ALL was removed and processed for histological analysis.Results. ALL was found in one right knee (4.16%). It extended distally from the lateral femoral condyle to the lateral tibial plateau margin. Its attachment on the tibial plateau was located between head of the fibula and Gerdy’s tubercle. A strong connection was identified between the ALL and the periphery of the middle third of the lateral meniscus. Histological analysis of ALL confirmed the presence of true ligamentous structure in it with dense connective tissue and plenty of fibroblasts.Conclusion. The prevalence of ALL in different populations along with its clinical significance has been discussed in detail in this paper.

scholarly journals Anterolateral ligament as a main stabilizing structure оf rotational stability оf the knee joint

2019 ◽  
Vol 10 (1) ◽  
pp. 72-80
Author(s):  
Alena A. Epshtein ◽  
A. P. Prizov ◽  
F. L. Lazko ◽  
N. V. Zagorodniy ◽  
A. A. Akhpashev
Keyword(s):  
Knee Joint ◽  
Cruciate Ligament ◽  
Anterolateral Ligament ◽  
Rotational Stability ◽  
Histological Structure ◽  
Surgical Methods ◽  
Ligamentous Structure ◽  
Anterior Cruciate ◽  
Anterolateral Instability

Currently, anterior cruciate ligament grafting is one of the most popular operations on the knee joint, but despite the fact that the technique has been used for years, there is a high percentage of unsatisfactory long-term postoperative results, reaching 25%, according to various authors. The concern over this problem has led to an increase in the number of studies aimed at the understanding of the causes of these failures. Most researchers have concluded that the unsatisfactory results are associated with instability in the knee joint, which is caused by the damage of a ligamentous structure found in many dissections, namely, anterolateral ligament (ALL). In this literature review, we have analyzed the articles dedicated to the ALL, its anatomical and histological structure, its biomechanics, as well as its role in the anterolateral stability of the joint. Also in this review we consider the existing surgical methods for the correction of anterolateral instability associated with the ALL damage.

Current Concepts of the Anterolateral Ligament of the Knee: Anatomy, Biomechanics, and Reconstruction

2017 ◽  
Vol 46 (5) ◽  
pp. 1235-1242 ◽  
Author(s):  
Matthew J. Kraeutler ◽  
K. Linnea Welton ◽  
Jorge Chahla ◽  
Robert F. LaPrade ◽  
Eric C. McCarty
Keyword(s):  
Clinical Outcomes ◽  
Internal Rotation ◽  
Proximal Tibia ◽  
Case Series ◽  
Anterolateral Ligament ◽  
Tibial Rotation ◽  
Ligamentous Structure ◽  
Gerdy’S Tubercle ◽  
Tibial Translation ◽  
Tendon Autograft

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 resisting anterior tibial translation and internal tibial rotation. These biomechanical studies indicate that concurrent reconstruction of the ACL and ALL results in significantly reduced internal rotation and axial plane tibial translation compared with isolated ACL reconstruction (ACLR) in the presence of ALL deficiency. Clinically, a variety of techniques are available for ALL reconstruction (ALLR). Current graft options include the iliotibial (IT) band, gracilis tendon autograft or allograft, and semitendinosus tendon autograft or allograft. Fixation angle also varies between studies from full knee extension to 60° to 90° of flexion. To date, only 1 modern study has described the clinical outcomes of concomitant ALLR and ACLR: a case series of 92 patients with a minimum 2-year follow-up. Further studies are necessary to define the ideal graft type, location of fixation, and fixation angle for ALLR. Future studies also must be designed in a prospective comparative manner to compare the clinical outcomes of patients undergoing ACLR with ALL reconstruction versus without ALL reconstruction. By discovering the true effect of the ALL, investigators can elucidate the importance of ALLR in the setting of an ACL tear.

The anterolateral ligament is a distinct ligamentous structure: A histological explanation

The Knee ◽  
2018 ◽  
Vol 25 (3) ◽  
pp. 360-366 ◽  
Author(s):  
Thomas Neri ◽  
Pierre Dalcol ◽  
Fabien Palpacuer ◽  
Florian Bergandi ◽  
Jean Michel Prades ◽  
...  
Keyword(s):  
Anterolateral Ligament ◽  
Ligamentous Structure

Influence of Knee Ligament Structure Viscoelasticity on Dynamic Tests

2014 ◽  
Author(s):  
Dumitru I. Caruntu ◽  
Eduardo Granados ◽  
Ricardo Gomez
Keyword(s):  
Viscoelastic Properties ◽  
Dynamic Testing ◽  
Viscoelastic Model ◽  
Vertical Position ◽  
Dynamic Tests ◽  
Dimensional Model ◽  
Harmonic Force ◽  
Knee Ligament ◽  
Human Knee ◽  
Ligamentous Structure

This paper deals with nonlinear dynamics of viscoelastic ligament model human knee. A two dimensional model of the human knee to include tibia and femur, and the ligamentous structure between the two bones is used to investigate the influence of ligamentous viscoelastic properties on dynamic testing of human knee. An exercise in which the femur is pinned at the hip in a sitting position, and tibia in a vertical position is actuated by a vertical harmonic force at various frequencies is proposed. The viscoelastic model of ligaments shows for the knee dynamic testing a resonance in the range of 15 Hz to 20 Hz.

Microstructural and Mechanical Properties of the Anterolateral Ligament of the Knee

2020 ◽  
Vol 49 (1) ◽  
pp. 172-182
Author(s):  
Ronak M. Patel ◽  
Ryan M. Castile ◽  
Matthew J. Jenkins ◽  
Spencer P. Lake ◽  
Robert H. Brophy
Keyword(s):  
Mechanical Properties ◽  
Polarized Light ◽  
Lateral Collateral Ligament ◽  
Anterolateral Ligament ◽  
Linear Region ◽  
Anterolateral Capsule ◽  
Ligamentous Structure ◽  
Mechanical And Microstructural Properties ◽  
Collagen Alignment ◽  
Angle Orientation

Background: The variable anatomy and controversy of the anterolateral ligament (ALL) reflect the complex relationship among the anterolateral knee structures. Purpose/Hypothesis: The purpose was to quantify the microstructural and mechanical properties of the ALL as compared with the anterolateral capsule (ALC) and lateral collateral ligament (LCL). The primary hypotheses were that (1) there is no difference in these properties between the ALL and ALC and (2) the LCL has significantly different properties from the ALL and ALC. Study Design: Descriptive laboratory study. Methods: The LCL, ALL, and ALC were harvested from 25 cadaveric knees. Mechanical testing and microstructural analyses were performed using quantitative polarized light imaging. The average degree of linear polarization (AVG DoLP; mean strength of collagen alignment) and standard deviation of the angle of polarization (STD AoP; degree of variation in collagen angle orientation) were calculated. Results: Linear region moduli were not different between the ALC and ALL (3.75 vs 3.66 MPa, respectively; P > .99). AVG DoLP values were not different between the ALC and ALL in the linear region (0.10 vs 0.10; P > .99). Similarly, STD AoP values were not different between the ALC and ALL (24.2 vs 21.7; P > .99). The LCL had larger modulus, larger AVG DoLP, and smaller STD AoP values than the ALL and ALC. Of 25 knee specimens, 3 were observed to have a distinct ALL, which exhibited larger modulus, larger AVG DoLP, and smaller STD AoP values as compared with nondistinct ALL samples. Conclusion: There were no differences in the mechanical and microstructural properties between the ALL and ALC. The ALC and ALL exhibited comparably weak and disperse collagen alignment. However, when a distinct ALL was present, the properties were suggestive of a ligamentous structure. Clinical Relevance: The properties of the ALL are similar to those of a ligament only when a distinct ALL is present, but otherwise, for the majority of specimens, ALL properties are closer to those of the capsule. Variability in the ligamentous structure of the ALL suggests that it may be more important in some patients than others and reconstruction may be considered in selective patients. Further study is needed to better understand its selective role and optimal indications for reconstruction.

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