Anatomical study on anterolateral ligament in a Chinese population_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CAI Jiangyu , JIN Wenhe , SHENG Dandan ,  CHEN Shiyi

Department of Sports Medicine and Arthroscopic Surgery, Huashan Hospital, Fudan University, Shanghai, 200040, P.R.China;

Corresponding author：

CHEN Shiyi, Email: cshiyi@163.com

Keywords：

Knee joint; anterolateral ligament; lateral collateral ligament; anatomy

DOI：

10.7507/1002-1892.201707042

Video：

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Objective To make further exploration of the structure characteristics of anterolateral ligament (ALL) and provide clinical reference for diagnosis and treatment of ALL injury, especially for ALL reconstruction through anatomical study of ALL in a Chinese population. Methods Sixteen cadaveric knees, including 8 left knees and 8 right knees with sex ratio of 1∶1 and a mean age of 73.5 years (range, 57-84 years), were dissected to reveal the ALL through a standard approach. A qualitative and a quantitative characterizations of the ALL were performed. Results ALL was seen in 75.0% of the specimens, originating on the lateral femoral epicondyle, proximal and posterior to the lateral collateral ligament (LCL). It coursed on LCL or was parallel to LCL, anterodistally to its anterolateral tibial attachment approximately midway between the center of the Gerdy’s tubercle and the lateral margin of the fibular head. A strong connection was observed between the middle part of the ALL and the periphery of the meniscal body of the lateral meniscus. The distance between the center of the insertion and Gerdy’s tubercle was (23.9±3.3) mm; and the distance between the center of the insertion and the lateral margin of the fibular head was (23.8±4.0) mm. The ALL length at 0° and 60° flexion and neutral knee rotation were (44.8±5.1) mm and (47.8±5.5) mm respectively (t=14.071, P=0.000), and the ligament had its great extend at 60° of knee flexion and internal rotation. Furthermore, the ALL length at 0° and 60° flexion of males were both significantly higher than those of females (t=2.920, P=0.015; t=2.806, P=0.019), while other measurements differences were significant between males and females (P>0.05). Conclusion ALL is an independent and a non-isometric ligament located in the anterolateral area to the knee, of which the length is different between males and females. ALL plays a role in rotational stability of the knee, and should be put much emphasis in clinical practice.

Citation： CAI Jiangyu, JIN Wenhe, SHENG Dandan, CHEN Shiyi. Anatomical study on anterolateral ligament in a Chinese population. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(12): 1452-1455. doi: 10.7507/1002-1892.201707042 Copy

1.	Herbst E, Albers M, Burnham JM, et al. The anterolateral complex of the knee: a pictorial essay. Knee Surg Sports Traumatol Arthrosc, 2017, 25(4): 1009-1014.
2.	Irvine GB, Dias JJ, Finlay DB. Segond fractures of the lateral tibial condyle: brief report. J Bone Joint Surg (Br), 1987, 69(4): 613-614.
3.	LaPrade RF, Gilbert TJ, Bollom TS, et al. The magnetic resonance imaging appearance of individual structures of the posterolateral knee. A prospective study of normal knees and knees with surgically verified grade III injuries. Am J Sports Med, 2000, 28(2): 191-199.
4.	Terry GC, Norwood LA, Hughston JC, et al. How iliotibial tract injuries of the knee combine with acute anterior cruciate ligament tears to influence abnormal anterior tibial displacement. Am J Sports Med, 1993, 21(1): 55-60.
5.	Vieira EL, Vieira EA, da Silva RT, et al. An anatomic study of the iliotibial tract. Arthroscopy, 2007, 23(3):269-274.
6.	Claes S, Vereecke E, Maes M, et al. Anatomy of the anterolateral ligament of the knee. J Anat, 2013, 223(4): 321-328.
7.	Dodds AL, Halewood C, Gupte CM, et al. The anterolateral ligament: Anatomy, length changes and association with the Segond fracture. Bone Joint J, 2014, 96-B(3): 325-331.
8.	Watanabe J, Suzuki D, Mizoguchi S, et al. The anterolateral ligament in a Japanese population: Study on prevalence and morphology. J Orthop Sci, 2016, 21(5): 647-651.
9.	Musahl V, Rahnemai-Azar AA, van Eck CF, et al. Anterolateral ligament of the knee, fact or fiction? Knee Surg Sports Traumatol Arthrosc, 2016, 24(1): 2-3.
10.	Vundelinckx B, Herman B, Getgood A, et al. Surgical Indications and Technique for Anterior Cruciate Ligament Reconstruction Combined with Lateral Extra-articular Tenodesis or Anterolateral Ligament Reconstruction. Clin Sports Med, 2017, 36(1): 135-153.
11.	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(3): 585-592.
12.	Roessler PP, Schuttler KF, Heyse TJ, et al. The anterolateral ligament (ALL) and its role in rotational extra-articular stability of the knee joint: a review of anatomy and surgical concepts. Arch Orthop Trauma Surg, 2016, 136(3): 305-313.
13.	李明, 秦勇, 于洪波, 等. 膝关节前外侧韧带的解剖和磁共振成像研究. 中华实验外科杂志, 2016, 33(3): 591.
14.	Terry GC, Hughston JC, Norwood LA. The anatomy of the iliopatellar band and iliotibial tract. Am J Sports Med, 1986, 14(1): 39-45.
15.	Runer A, Birkmaier S, Pamminger M, et al. The anterolateral ligament of the knee: A dissection study. Knee, 2016, 23(1): 8-12.
16.	Helito CP, Demange MK, Bonadio MB, et al. Anatomy and Histology of the Knee Anterolateral Ligament. Orthop J Sports Med, 2013, 1(7): PMC4555517.
17.	Kennedy MI, Claes S, Fuso FA, et al. The Anterolateral Ligament: An Anatomic, Radiographic, and Biomechanical Analysis. Am J Sports Med, 2015, 43(7): 1606-1615.
18.	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(10):2545-2552.

1. Herbst E, Albers M, Burnham JM, et al. The anterolateral complex of the knee: a pictorial essay. Knee Surg Sports Traumatol Arthrosc, 2017, 25(4): 1009-1014.
2. Irvine GB, Dias JJ, Finlay DB. Segond fractures of the lateral tibial condyle: brief report. J Bone Joint Surg (Br), 1987, 69(4): 613-614.
3. LaPrade RF, Gilbert TJ, Bollom TS, et al. The magnetic resonance imaging appearance of individual structures of the posterolateral knee. A prospective study of normal knees and knees with surgically verified grade III injuries. Am J Sports Med, 2000, 28(2): 191-199.
4. Terry GC, Norwood LA, Hughston JC, et al. How iliotibial tract injuries of the knee combine with acute anterior cruciate ligament tears to influence abnormal anterior tibial displacement. Am J Sports Med, 1993, 21(1): 55-60.
5. Vieira EL, Vieira EA, da Silva RT, et al. An anatomic study of the iliotibial tract. Arthroscopy, 2007, 23(3):269-274.
6. Claes S, Vereecke E, Maes M, et al. Anatomy of the anterolateral ligament of the knee. J Anat, 2013, 223(4): 321-328.
7. Dodds AL, Halewood C, Gupte CM, et al. The anterolateral ligament: Anatomy, length changes and association with the Segond fracture. Bone Joint J, 2014, 96-B(3): 325-331.
8. Watanabe J, Suzuki D, Mizoguchi S, et al. The anterolateral ligament in a Japanese population: Study on prevalence and morphology. J Orthop Sci, 2016, 21(5): 647-651.
9. Musahl V, Rahnemai-Azar AA, van Eck CF, et al. Anterolateral ligament of the knee, fact or fiction? Knee Surg Sports Traumatol Arthrosc, 2016, 24(1): 2-3.
10. Vundelinckx B, Herman B, Getgood A, et al. Surgical Indications and Technique for Anterior Cruciate Ligament Reconstruction Combined with Lateral Extra-articular Tenodesis or Anterolateral Ligament Reconstruction. Clin Sports Med, 2017, 36(1): 135-153.
11. 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(3): 585-592.
12. Roessler PP, Schuttler KF, Heyse TJ, et al. The anterolateral ligament (ALL) and its role in rotational extra-articular stability of the knee joint: a review of anatomy and surgical concepts. Arch Orthop Trauma Surg, 2016, 136(3): 305-313.
13. 李明, 秦勇, 于洪波, 等. 膝关节前外侧韧带的解剖和磁共振成像研究. 中华实验外科杂志, 2016, 33(3): 591.
14. Terry GC, Hughston JC, Norwood LA. The anatomy of the iliopatellar band and iliotibial tract. Am J Sports Med, 1986, 14(1): 39-45.
15. Runer A, Birkmaier S, Pamminger M, et al. The anterolateral ligament of the knee: A dissection study. Knee, 2016, 23(1): 8-12.
16. Helito CP, Demange MK, Bonadio MB, et al. Anatomy and Histology of the Knee Anterolateral Ligament. Orthop J Sports Med, 2013, 1(7): PMC4555517.
17. Kennedy MI, Claes S, Fuso FA, et al. The Anterolateral Ligament: An Anatomic, Radiographic, and Biomechanical Analysis. Am J Sports Med, 2015, 43(7): 1606-1615.
18. 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(10):2545-2552.

Chinese Journal of Reparative and Reconstructive Surgery

Anatomical study on anterolateral ligament in a Chinese population

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