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INTRODUCTION
Injury to the anterior cruciate ligament (ACL)
is common, and affects a predominantly young
and active population. Isolated intra-articular
reconstruction, the accepted standard of
operative treatment, may fail to restore
rotational stability to the joint [1, 2]. Residual
rotational laxity, which may manifest as the
pivot shift, is associated with inferior subjective
outcomes [3, 4].
Recent interest in the anterolateral ligament
has refocused attention on the secondary
restraints to rotation, and the role these
structures may play in both the spectrum of
observed instability and residual laxity after
intra-articular reconstruction. In addition to the
ACL, the anterolateral ligament (ALL) [5],
iliotibial band (ITB) [6], the lateral meniscus
[7, 8] and medial meniscotibial ligament [9]
have all been shown to restrain internal rotation
at the knee.
THE ANTEROLATERAL
LIGAMENT
Anatomical and radiological studies over the
past 40 years have described structures
connecting the lateral femoral condyle, the
lateral meniscus, and the lateral tibial plateau
on the anterolateral aspect of the knee [10-17].
These structures have been described as
capsular thickenings, components of the ilio
tibial tract, or ligaments in their own right, and
have been variously referred to as the “middle
one third of the lateral capsular ligament” or
simply the “lateral capsular ligament” [10], the
“anterolateral femoro-tibial ligament” [12], the
“capsulo-osseous layer of the iliotibial tract”
[13], the “retrograde tract fibres” [18], the
“anterior oblique band” [15], and the “lateral
femorotibial ligament” [16]. This non-
standardized nomenclature, coupled with
vague anatomical descriptions, has contributed
to ongoing confusion regarding the anatomy of
the anterolateral knee.
In 2013, Claes and colleagues published their
description of the anterolateral ligament [19].
They described an extra-capsular structure,
originating just anterior to the lateral collateral
ligament (LCL), posterior and proximal to the
popliteus tendon insertion, and inserting onto
the proximal tibia midway between Gerdy’s
tubercle and the fibula head. The structure had
a strong connection to the body of the lateral
meniscus, but lacked attachments to the ITB,
and was identified in 40 of 41 specimens.
Since this time, a number of authors have
furthered our understanding of this structure,
SECONDARY RESTRAINTS TO
INTERNAL ROTATION: THE ROLE
OF THE ANTEROLATERAL
LIGAMENT, ILIOTIBIAL BAND
AND LATERAL MENISCUS
T. LORDING, A. GETGOOD, T.P. BRANCH