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2013 ; 1
(7
): 2325967113513546
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Anatomy and Histology of the Knee Anterolateral Ligament
#MMPMID26535259
Helito CP
; Demange MK
; Bonadio MB
; Tírico LE
; Gobbi RG
; Pécora JR
; Camanho GL
Orthop J Sports Med
2013[Dec]; 1
(7
): 2325967113513546
PMID26535259
show ga
BACKGROUND: Reconstruction of the anterior cruciate ligament (ACL) is one of the
most common procedures in orthopaedic surgery. However, even with advances in
surgical techniques and implants, some patients still have residual anterolateral
rotatory laxity after reconstruction. A thorough study of the anatomy of the
anterolateral region of the knee is needed. PURPOSE: To study the anterolateral
region and determine the measurements and points of attachments of the
anterolateral ligament (ALL). STUDY DESIGN: Descriptive laboratory study.
METHODS: Dissections of the anterolateral structures of the knee were performed
in 20 human cadavers. After isolating the ALL, its length, thickness, width, and
points of attachments were determined. The femoral attachment of the ALL was
based on the anterior-posterior and proximal-distal distances from the attachment
of the lateral collateral ligament (LCL). The tibial attachment point was based
on the distance from the Gerdy tubercle to the fibular head and the distance from
the lateral tibial plateau. The ligaments from the first 10 dissections were sent
for histological analysis. RESULTS: The ALL was found in all 20 knees. The
femoral attachment of the ALL at the lateral epicondyle averaged 3.5 mm distal
and 2.2 mm anterior to the attachment of the LCL. Two distal attachments were
observed: one inserts into the lateral meniscus, the other between the Gerdy
tubercle and the fibular head, approximately 4.4 mm distal to the tibial
articular cartilage. The mean measurements for the ligament were 37.3 mm
(length), 7.4 mm (width), and 2.7 mm (thickness). The histological analysis of
the ligaments revealed dense connective tissue. CONCLUSION: The ALL is
consistently present in the anterolateral region of the knee. Its attachment to
the femur is anterior and distal to the attachment of the LCL. Moving distally,
it bifurcates at close to half of its length. The ALL features 2 distal
attachments, one at the lateral meniscus and the other between the Gerdy tubercle
and the fibular head. CLINICAL RELEVANCE: The ALL may be important in maintaining
normal rotatory limits of knee motion; ALL rupture could be responsible for
rotatory laxity after isolated intra-articular reconstruction of the ACL.
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