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INTRODUCTION
The 2013 publication by Steven Claes [1] in
the
Journal of Anatomy
about the knee’s
anterolateral ligament (ALL) generated
significant media attention related to the
discovery of a “new knee ligament”. Since
then, more than 85 anatomical and
biomechanical studies on this anatomical
structure have been published. These described
the ALL’s anatomy in detail and more
importantly, established its role in knee
kinematics.
Despite this large research effort, there is still a
great deal of controversy surrounding the ALL.
Some authors feel this anatomical structure
does not exist [2] nor contribute to knee
stability [3]. But other studies have identified
the ALL in all dissected knees [4-6]. It was
described as having ligament-like properties
[7, 8], and being involved in rotational control
of the knee [9, 10].
The main questions for surgeons in 2016 are
whether the ALL is truly a ligament structure,
if it actually has a role in controlling knee
rotation and above all, if it needs to be repaired
during anterior cruciate ligament (ACL)
reconstruction.
HISTORY
This structure was first described in 1879 by a
French surgeon, Paul Segond [11]. While
dissecting cadaver knees, he noted the presence
of a “pearly, resistant, fibrous band over the
anterolateral aspect of the joint. This band
invariably was under extreme tension during
forced internal rotation of the knee. Gerdy’s
tubercle never fails, only a bone segment
immediately behind it”. The Segond fracture
was named based on these observations and its
location has recently been confirmed [12].
This structure was then in large part forgotten,
until Jack Hughston published several articles
on various types of knee rotational instability
in 1976 [13, 14]. He referred to a “mid-third
lateral capsular ligament” that inserted on the
lateral meniscus and was divided in menisco
ANTEROLATERAL LIGAMENT
OF THE KNEE
B. SONNERY-COTTET, R. ZAYNI