J Korean Orthop Assoc.  2020 Aug;55(4):281-293. 10.4055/jkoa.2020.55.4.281.

Anterolateral Ligament of the Knee: Anatomy, Biomechanics, Techniques, and Clinical Outcome

Affiliations
  • 1Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Korea
  • 2Chung-Ang University College of Medicine, Seoul, Korea

Abstract

An anterior cruciate ligament (ACL) reconstruction is one of the most frequent surgical procedures in the knee joint, but despite the betterunderstanding of anatomy and biomechanics, surgical reconstruction procedures still fail to restore rotational stability in 7%–16% ofpatients. Hence, many studies have attempted to identify the factors for rotational laxity, including the anterolateral ligament (ALL), butstill showed controversies. Descriptions of the ALL anatomy are also confused by overlapping nomenclature, but it is usually known as adistinctive fiber running in an anteroinferior and oblique direction from the lateral epicondyle of the femur to the proximal anterolateraltibia, between the fibular head and Gerdy’s tubercle. The importance of the ALL as a secondary restraint in the knee has been emphasizedfor successful ACL reconstructions that can restore rotational stability, but there is still some controversy. Some studies reported that theALL could be a restraint to the tibial rotation, but not to anterior tibial translation. On the other hand, some studies reported that the roleof ALL in rotational stability would be limited as a secondary structure because it bears loads only beyond normal biomechanical motion.The diagnosis of an ALL injury can be performed by a physical examination, radiology examination, and magnetic resonance imaging, but itshould be assessed using a multimodal approach. Recently, ALL was considered one of the anterolateral complex structures, as well as theKaplan fiber in the iliotibial band. Many studies have introduced many indications and treatment options, but there is still some debate. Thetreatment methods are introduced mainly as ALL reconstructions or lateral extra-articular tenodesis, which can achieve additional benefitto the knee stability. Further studies will be needed on the indications and proper surgical methods of ALL treatment.

Keyword

knee; anterior cruciate ligament; rotatory instability; anterolateral ligament
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