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The anterolateral ligament of the knee joint: anatomy, biomechanics and surgical procedures
Arthrosc Orthop Sports Med 2023;10:45-54
Published online November 1, 2023;  https://doi.org/10.14517/aosm23013
© 2023 Korean Arthroscopy Society and Korean Orthopedic Society for Sports Medicine.

Ki Tae Park, Dong Wook Son, Jun Yeop Lee, Jin Kwang Lee, Ji Hyun Ahn

Department of Orthopaedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
Correspondence to: Ji Hyun Ahn, https://orcid.org/0000-0001-9455-8504
Department of Orthopaedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul 03181, Korea. Tel: +82-2-2001-2168, Fax: +82-2-2001-2176, E-mail: drsky7171@gmail.com
Received August 30, 2023; Revised October 2, 2023; Accepted October 3, 2023.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
The anterolateral ligament (ALL), first described in 1879 by the French surgeon Paul Segond, is a ligament on the lateral aspect of the knee that originates from the lateral femoral epicondyle to midway between Gerdy’s tubercle and the head of the fibula. However, there is a lack of agreement regarding the anatomical aspects, such as its bony origin and biomechanical properties. Establishing the surgical procedure for ALL reconstruction or anterolateral tenodesis requires consideration of these two crucial factors. While initial biomechanical and clinical evaluations have raised doubts about the efficacy of ALL reconstruction, recent long-term follow-up studies and meta-analyses suggest more favorable surgical outcomes. Further anatomical and biomechanical investigations are needed to optimize surgical techniques. Moreover, comprehensive clinical studies with extended follow-up would be essential to assess clinical efficacy with surgical procedure of ALL.
Keywords : Anterolateral ligament; Anterior cruciate ligament
References
  1. Cavaignac E, Ancelin D, Chiron P, et al. Historical perspective on the “discovery” of the anterolateral ligament of the knee. Knee Surg Sports Traumatol Arthrosc 2017;25:991-6.
    Pubmed CrossRef
  2. Claes S, Vereecke E, Maes M, Victor J, Verdonk P, Bellemans J. Anatomy of the anterolateral ligament of the knee. J Anat 2013;223:321-8.
    Pubmed KoreaMed CrossRef
  3. Sepúlveda F, Sánchez L, Amy E, Micheo W. Anterior cruciate ligament injury: return to play, function and long-term considerations. Curr Sports Med Rep 2017;16:172-8.
    Pubmed CrossRef
  4. Sonnery-Cottet B, Lutz C, Daggett M, et al. The involvement of the anterolateral ligament in rotational control of the knee. Am J Sports Med 2016;44:1209-14.
    Pubmed CrossRef
  5. Slette EL, Mikula JD, Schon JM, et al. Biomechanical results of lateral extra-articular tenodesis procedures of the knee: a systematic review. Arthroscopy 2016;32:2592-611.
    Pubmed CrossRef
  6. Kennedy MI, Claes S, Fuso FA, et al. The anterolateral ligament: an anatomic, radiographic, and biomechanical analysis. Am J Sports Med 2015;43:1606-15.
    Pubmed CrossRef
  7. Dodds AL, Halewood C, Gupte CM, Williams A, Amis AA. The anterolateral ligament: anatomy, length changes and association with the Segond fracture. Bone Joint J 2014;96-B:325-31.
    Pubmed CrossRef
  8. Stentz-Olesen K, Nielsen ET, de Raedt S, et al. Reconstructing the anterolateral ligament does not decrease rotational knee laxity in ACL-reconstructed knees. Knee Surg Sports Traumatol Arthrosc 2017;25:1125-31.
    Pubmed CrossRef
  9. Noyes FR, Huser LE, Jurgensmeier D, Walsh J, Levy MS. Is an anterolateral ligament reconstruction required in ACL-reconstructed knees with associated injury to the anterolateral structures? A robotic analysis of rotational knee stability. Am J Sports Med 2017;45:1018-27.
    Pubmed CrossRef
  10. Drews BH, Kessler O, Franz W, Dürselen L, Freutel M. Function and strain of the anterolateral ligament part I: biomechanical analysis. Knee Surg Sports Traumatol Arthrosc 2017;25:1132-9.
    Pubmed CrossRef
  11. Schon JM, Moatshe G, Brady AW, et al. Anatomic anterolateral ligament reconstruction leads to overconstraint at any fixation angle: response. Am J Sports Med 2016;44:NP58-9.
    Pubmed CrossRef
  12. Inderhaug E, Stephen JM, Williams A, Amis AA. Biomechanical comparison of anterolateral procedures combined with anterior cruciate ligament reconstruction. Am J Sports Med 2017;45:347-54.
    Pubmed CrossRef
  13. Hardy A, Casabianca L, Hardy E, Grimaud O, Meyer A. Combined reconstruction of the anterior cruciate ligament associated with anterolateral tenodesis effectively controls the acceleration of the tibia during the pivot shift. Knee Surg Sports Traumatol Arthrosc 2017;25:1117-24.
    Pubmed CrossRef
  14. Bonanzinga T, Signorelli C, Grassi A, et al. Kinematics of ACL and anterolateral ligament. Part II: anterolateral and anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2017;25:1062-7. Erratum in: Knee Surg Sports Traumatol Arthrosc 2017;25:3991
    Pubmed CrossRef
  15. Nitri M, Rasmussen MT, Williams BT, et al. An in vitro robotic assessment of the anterolateral ligament, part 2: anterolateral liga ment reconstruction combined with anterior cruciate ligament reconstruction. Am J Sports Med 2016;44:593-601.
    Pubmed CrossRef
  16. Roessler PP, Schüttler KF, Stein T, et al. Anatomic dissection of the anterolateral ligament (ALL) in paired fresh-frozen cadaveric knee joints. Arch Orthop Trauma Surg 2017;137:249-55.
    Pubmed CrossRef
  17. Runer A, Birkmaier S, Pamminger M, et al. The anterolateral ligament of the knee: a dissection study. Knee 2016;23:8-12.
    Pubmed CrossRef
  18. Helito CP, do Amaral C Jr, Nakamichi YD, et al. Why do authors differ with regard to the femoral and meniscal anatomic parameters of the knee anterolateral ligament?: dissection by layers and a description of its superficial and deep layers. Orthop J Sports Med 2016;4:2325967116675604.
    Pubmed KoreaMed CrossRef
  19. Daggett M, Ockuly AC, Cullen M, et al. Femoral origin of the anterolateral ligament: an anatomic analysis. Arthroscopy 2016; 32:835-41.
    Pubmed CrossRef
  20. Zens M, Niemeyer P, Ruhhammer J, et al. Length changes of the anterolateral ligament during passive knee motion: a human cadaveric study. Am J Sports Med 2015;43:2545-52.
    Pubmed CrossRef
  21. Wytrykowski K, Swider P, Reina N, et al. Cadaveric study comparing the biomechanical properties of grafts used for knee anterolateral ligament reconstruction. Arthroscopy 2016;32:2288-94.
    Pubmed CrossRef
  22. Helito CP, Bonadio MB, Rozas JS, et al. Biomechanical study of strength and stiffness of the knee anterolateral ligament. BMC Musculoskelet Disord 2016;17:193.
    Pubmed KoreaMed CrossRef
  23. Patel RM, Brophy RH. Anterolateral ligament of the knee: anatomy, function, imaging, and treatment. Am J Sports Med 2018; 46:217-23.
    Pubmed CrossRef
  24. Kraeutler MJ, Welton KL, Chahla J, LaPrade RF, McCarty EC. Current concepts of the anterolateral ligament of the knee: anatomy, biomechanics, and reconstruction. Am J Sports Med 2018; 46:1235-42.
    Pubmed CrossRef
  25. Van de Velde SK, Kernkamp WA, Hosseini A, LaPrade RF, van Arkel ER, Li G. In vivo length changes of the anterolateral ligament and related extra-articular reconstructions. Am J Sports Med 2016;44:2557-62.
    Pubmed CrossRef
  26. Sonnery-Cottet B, Vieira TD, Ouanezar H. Anterolateral ligament of the knee: diagnosis, indications, technique, outcomes. Arthroscopy 2019;35:302-3.
    Pubmed CrossRef
  27. Helito CP, Helito PV, Bonadio MB, et al. Evaluation of the length and isometric pattern of the anterolateral ligament with serial computer tomography. Orthop J Sports Med 2014;2: 2325967114562205.
    Pubmed KoreaMed CrossRef
  28. Andrade R, Rebelo-Marques A, Bastos R, et al. Identification of normal and injured anterolateral ligaments of the knee: a systematic review of magnetic resonance imaging studies. Arthroscopy 2019;35:1594-613.e1.
    Pubmed CrossRef
  29. Marshall T, Oak SR, Subhas N, Polster J, Winalski C, Spindler KP. Can the anterolateral ligament be reliably identified in anterior cruciate ligament-intact and anterior cruciate ligament-injured knees on 3-T magnetic resonance imaging? Orthop J Sports Med 2018;6:2325967118796452.
    Pubmed KoreaMed CrossRef
  30. Monaco E, Helito CP, Redler A, et al. Correlation between magnetic resonance imaging and surgical exploration of the anterolateral structures of the acute anterior cruciate ligament-injured knee. Am J Sports Med 2019;47:1186-93.
    Pubmed CrossRef
  31. Miyaji N, Hoshino Y, Tanaka T, et al. MRI-determined anterolateral capsule injury did not affect the pivot-shift in anterior cruciate ligament-injured knees. Knee Surg Sports Traumatol Arthrosc 2019;27:3426-31.
    Pubmed CrossRef
  32. Khanna M, Gupte C, Dodds A, Williams A, Walker M. Magnetic resonance imaging appearances of the capsulo-osseous layer of the iliotibial band and femoral attachments of the iliotibial band in the normal and pivot-shift ACL injured knee. Skeletal Radiol 2019;48:729-40.
    Pubmed KoreaMed CrossRef
  33. Ferretti A, Monaco E, Redler A, et al. High prevalence of anterolateral ligament abnormalities on MRI in knees with acute anterior cruciate ligament injuries: a case-control series from the SANTI study group. Orthop J Sports Med 2019;7:2325967119852916.
    Pubmed KoreaMed CrossRef
  34. Kosy JD, Soni A, Venkatesh R, Mandalia VI. The anterolateral ligament of the knee: unwrapping the enigma. Anatomical study and comparison to previous reports. J Orthop Traumatol 2016; 17:303-8.
    Pubmed KoreaMed CrossRef
  35. Getgood A, Brown C, Lording T, et al. The anterolateral complex of the knee: results from the International ALC Consensus Group Meeting. Knee Surg Sports Traumatol Arthrosc 2019;27:166-76.
    Pubmed CrossRef
  36. Imbert P, Lutz C, Daggett M, et al. Isometric characteristics of the anterolateral ligament of the knee: a cadaveric navigation study. Arthroscopy 2016;32:2017-24.
    Pubmed CrossRef
  37. Thein R, Boorman-Padgett J, Stone K, Wickiewicz TL, Imhauser CW, Pearle AD. Biomechanical assessment of the anterolateral ligament of the knee: a secondary restraint in simulated tests of the pivot shift and of anterior stability. J Bone Joint Surg Am 2016;98:937-43.
    Pubmed CrossRef
  38. Tavlo M, Eljaja S, Jensen JT, Siersma VD, Krogsgaard MR. The role of the anterolateral ligament in ACL insufficient and reconstructed knees on rotatory stability: a biomechanical study on human cadavers. Scand J Med Sci Sports 2016;26:960-6.
    Pubmed CrossRef
  39. Rasmussen MT, Nitri M, Williams BT, et al. An in vitro robotic assessment of the anterolateral ligament, part 1: secondary role of the anterolateral ligament in the setting of an anterior cruciate ligament injury. Am J Sports Med 2016;44:585-92.
    Pubmed CrossRef
  40. Williams A, Ball S, Stephen J, White N, Jones M, Amis A. The scientific rationale for lateral tenodesis augmentation of intra-articular ACL reconstruction using a modified ‘Lemaire’ procedure. Knee Surg Sports Traumatol Arthrosc 2017;25:1339-44.
    Pubmed CrossRef
  41. Lee DH, Kim CH, Kim TH, Kim SG. Sectioning of the anterolateral ligaments in anterior cruciate ligament sectioned knees increases internal rotation of the knee joint: a systematic review and meta-analysis of cadaveric studies. Arthroscopy 2023;39:1692-701.
    Pubmed CrossRef
  42. Servant C. Editorial commentary: during anterior cruciate ligament reconstruction, lateral extra-articular procedures have risks and should be reserved for proper indications: do not let all revision anterior cruciate ligament reconstructions be the same. Arthroscopy 2023;39:320-3.
    Pubmed CrossRef
  43. Sonnery-Cottet B, Saithna A, Cavalier M, et al. Anterolateral ligament reconstruction is associated with significantly reduced ACL graft rupture rates at a minimum follow-up of 2 years: a prospective comparative study of 502 patients from the SANTI study group. Am J Sports Med 2017;45:1547-57.
    Pubmed CrossRef
  44. Jesani S, Getgood A. Modified lemaire lateral extra-articular tenodesis augmentation of anterior cruciate ligament reconstruction. JBJS Essent Surg Tech 2019;9:e41.1-7.
    Pubmed KoreaMed CrossRef
  45. Ibrahim SA, Shohdy EM, Marwan Y, et al. Anatomic reconstruction of the anterior cruciate ligament of the knee with or without reconstruction of the anterolateral ligament: a randomized clinical trial. Am J Sports Med 2017;45:1558-66.
    Pubmed CrossRef
  46. Zhang H, Qiu M, Zhou A, Zhang J, Jiang D. Anatomic anterolateral ligament reconstruction improves postoperative clinical outcomes combined with anatomic anterior cruciate ligament reconstruction. J Sports Sci Med 2016;15:688-96.
  47. Lee DW, Kim JG, Cho SI, Kim DH. Clinical outcomes of isolated revision anterior cruciate ligament reconstruction or in combination with anatomic anterolateral ligament reconstruction. Am J Sports Med 2019;47:324-33.
    Pubmed CrossRef
  48. Kunze KN, Manzi J, Richardson M, et al. Combined anterolateral and anterior cruciate ligament reconstruction improves pivot shift compared with isolated anterior cruciate ligament reconstruction: a systematic review and meta-analysis of randomized controlled trials. Arthroscopy 2021;37:2677-703.
    Pubmed CrossRef
  49. Park YB, Lee HJ, Cho HC, Pujol N, Kim SH. Combined lateral extra-articular tenodesis or combined anterolateral ligament reconstruction and anterior cruciate ligament reconstruction improves outcomes compared to isolated reconstruction for anterior cruciate ligament tear: a network meta-analysis of randomized controlled trials. Arthroscopy 2023;39:758-76.e10.
    Pubmed CrossRef
  50. Littlefield CP, Belk JW, Houck DA, et al. The anterolateral ligament of the knee: an updated systematic review of anatomy, biomechanics, and clinical outcomes. Arthroscopy 2021;37:1654-66.
    Pubmed CrossRef


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