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Researchers confirm existence of anterolateral ligament in the knee
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Researchers from Belgium have identified and detailed the anatomical characteristics of a ‘pearly, fibrous band’ in the knee that was first described in the 1800s. Now termed the anterolateral ligament, the structure connects the femur with the anterolateral tibia and researchers hypothesize it may play a role in the pivot shift phenomenon witnessed in ACL injuries.
The findings appeared in Journal of Anatomy.
“This study is the first to provide a detailed anatomical description of the anterolateral ligament (ALL) of the human knee. The ALL is found to be a distinct ligamentous structure showing consistent origin and insertion site features in 97% of the dissected specimens,” Steven Claes, MD, PhD, from University Hospitals Leuven/AZ Herentals Hospital, and colleagues wrote in their study. “Given its suggested role in common knee instability patterns such as the pivot shift, the precise anatomical knowledge of this enigmatic structure delivered by this study could be highly relevant for clinical practice. However, further research is needed to establish the function of the ALL and to determine its role in clinical knee injuries.”
According to the study abstract, French surgeon Paul Ferdinand Segond described a fibrous band situated at the anterolateral aspect of the knee and noted his finding in 1879. However, subsequent research on the knee by various authors rarely mentioned this structure or used various terms and unclear descriptions of such findings.
To confirm and describe the anatomy of this ligament, Claes and colleagues used macroscopic dissection techniques to investigate 41 cadaveric knees.
All but one knee contained the ALL, which was “situated at the prominence of the lateral femoral epicondyle, slightly anterior to the origin of the lateral collateral ligament,” according to the study abstract.
“Its insertion on the anterolateral tibia was grossly located midway between Gerdy’s tubercle and the tip of the fibular hear, definitely separate from the iliotibial band,” the authors noted. – Toni DiBona
- Reference:
- Claes S. J Anat. 2013;doi:10.1111/joa.12087.
- For more information:
- Steven Claes, MD, PhD, can be reached at Department of Orthopedic Surgery & Traumatology, University Hospitals Leuven, Weligerveld 1 B-3212 Pellenberg, Leuven, Belgium; email: steven.claes@uzleuven.be.
Disclosures: The authors have no relevant financial disclosures.
Perspective
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Freddie H. Fu, MD DSc(Hon) DPs(Hon)
Anatomy is the basis of orthopaedic surgery and treatment must be based on principle. In terms of treating knee ligament injuries, we as orthopaedic surgeons must either let an injury heal or repair what is torn. With respect to the anterolateral ligament (ALL) that was the focus of this study, this similar structure has been described previously by the likes of Hughston and colleagues (1976), Moorman and LaPrade (2005) and more recently, Neyret and colleagues (2012). Nevertheless, it is always valuable to re-visit anatomy.
This study was performed with embalmed specimens and should be repeated by independent researchers using fresh-frozen specimens from various age groups, including the fetus. The anatomy and basic science of the ALL should be further delineated biomechanically, kinematically, histologically and radiologically (eg, MRI). As clinicians, we need to define the frequency, injury pattern and clinical outcomes before a treatment plan is formulated (healing vs. repair). Ultimately, it is patient care that is the most important thing.
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