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ANATOMY OF THE ANTEROLATERAL LIGAMENT
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L
ateral meniscus
Some authors [1, 2, 6] identified connections
between the ALL and lateral meniscus. For
Claes [2], this connection occurs at the
periphery of the middle third of the lateral
meniscal body and he suggests dividing the
ALL into a meniscofemoral and a meniscotibial
band. For Helito [5], this connection is located
at the peripheral portion of the transition
between the anterior horn and the meniscus
body, approximately 19,4mm anterior to the
popliteus tendon. For Dodds [4], this
connection is rather due to a capsular thickening
of fibers, deep to the ALL, that runs from the
insertion of the popliteus tendon to the
anterolateral rim of the lateral meniscus an
does not continue directly down to the tibia.
A
ntero
-
lateral
capsule
Connections between antero-capsule and the
ALL remain controversed. For Dodds [4] and
Vincent [12], ALL is superficial and distinct to
the capsule as does the description from Claes
[2] finding that the ALL “was easily
distinguishable from the thinner joint capsule
lying anterior to it”.
In our study [7], we found that the ALL was the
anterior part of a “triangular anterolateral
capsular complex”. The posterior, vertical, part
of this complex was made up of capsular fibers
that inserted onto the LCL, and the base, distal,
comprised the insertion of the capsule on the
tibia. In this triangle, during internal rotation,
not only was the ALL tensed, but all the
capsular fibers between the LCL and the ALL.
The existence of an anatomical region including
the LCL and the ALL was also proposed by
Claes [2] using the term “lateral collateral
ligament complex (LCLC)”.
CONCLUSION
A rigorous and precise dissection is a
fundamental stage for identifying the
anterolateral ligament. This dissection should
include dynamic movements, specifically
internal rotation, to precise origin, insertion
and direction from this ligament.
Even if controversies remain, the principal
anatomical characteristics of the ALL are:
- a femoral origin near the lateral femoral
epicondyle, mostly proximal and posterior,
an anterior and distal direction and a tibial
attachment midway between the Gerdy
tubercle and the fibular head, 5 to 10mm
distal to the joint line;
- a mean length of 40mm that increases during
flexion and internal rotation;
- a narrow and tubular structure at the femoral
origin (5mm) and wider on the tibia (>10mm);
- connections are established with the lateral
meniscus but discussed for ITB and antero-
lateral capsule.
An accurate knowledge of ALL anatomy is
essential to understand its function and propose
antero-lateral reconstructions.
LITERATURE
[1] CATERINE S, LITCHFIELD R, JOHNSON M,
CHRONIK B, GETGOOD A. A cadaveric study of the
anterolateral ligament: re-introducing the lateral capsular
ligament.
Knee Surg Sports Traumatol Arthrosc 2015; 23:
3186-95 doi 10.1007/s00167-014-3117-z.
[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(4): 321-8.
[3] DAGGETT M, OCKULYA, CULLEN M,
et al.
Femoral
origin of the anterolateral ligament: an anatomic analysis
[published online December 22, 2015].
Arthroscopy.
doi:10.1016/j.arthro.2015.10.006.
[4] DODDSAL, HALEWOOD C, GUPTE CM, WILLIAMS
A, AMIS AA. The anterolateral ligament: anatomy, length
changes and association with the Segond fracture.
Bone
Joint J 2014; 96B(3): 325-31.