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INTRODUCTION
The rotational stability of the knee is pro
vided by a complex ligamento-muscular
system, whose the understanding improves
progressively. One of its elements is the
anterolateral ligament (ALL), which aroused
much interest recently. The lateral extra-
articular procedures allow a therapeutic option
for patients with persistent rotatory instability
following anterior cruciate ligament (ACL)
reconstruction. These surgical techniques are
numerous and evolved in parallel with
anatomic and biomechanics advances. We are
providing an overview of the ALL history and
current surgical techniques.
HISTORY
The avulsion fracture of Segond is the first
observation of anterolateral structure’s damage.
It is localized just posterior to the Gerdy’s
tubercle, at the tibial insertion of a structure
described as “a resistant, pearly, fibrous band,
which, in a exaggeration of internal rotational
movement, is always subjected to an extreme
degree of tension” [1]. This fracture reflected
the forced internal rotation at the knee. Since
1968 and the description of the rotatory
instability by Slocum [2], then by Hughston in
1976 [3], the understanding of the anatomy
and the biomechanics of ALL has made
considerable progress.
ANATOMYAND
BIOMECHANICS
The lateral capsuloligamentous tissues are
composed of several elements, whose the
relationships and the mechanical properties
during knee motion are not completely
understood. The capsulo-osseous portion of the
iliotibial tract is considered as the “anterolateral
ligament” of the knee [4]. It is almost
universally present. According to authors, it
gets some different names: “short lateral
ligament”, “capsule-osseous layers” of the
iliotibial band (ITB), “midthird lateral capsular
ligament”. During some years its anatomy was
unclear. Several studies have described it as an
independent structure, others as a part of the
ITB, with various insertion sites. Vincent have
precisely described this ALL [5]. It is inserted
on the lateral femoral condyle, “just anterior to
the popliteus tendon insertion, blending with
its fibers”. Its distal attachment is on the
proximal anterolateral tibia, 5mm below the
joint line, posterior to the Gerdy’s tubercle
(fig. 1). This ligament is a distinct fibrous
structure, closely associated with the lateral
meniscus near the junction of its anterior and
middle thirds, without cleavage plane.
ANTEROLATERAL LIGAMENT
HISTORY AND SURGICAL
TECHNIQUES
C. BATAILLER, S. LUSTIG, D. WASCHER,
E. SERVIEN, P. NEYRET