Anatomical Consideration of the Anterolateral Ligament of the Knee

Cho, Ho-Jung; Kwak, Dai-Soon

doi:10.1155/2019/5740473

Cited by 17 publications

(18 citation statements)

References 30 publications

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“…Актуальним є питання -чи можемо ми порівнювати АЛЗ на ушкодженому колінному суглобі та здоровому контрлатеральному та очікувати, що вони в нормі мають виглядати однаково на МРТ та ультрасонографії, якщо навіть в анатомічних препаратах частота виявлення АЛЗ у правому та лівому колінному суглобах відрізняється [13]. Це має значення для порівняння антеролатеральної зв'язки у травмованому колінному суглобі у віддалений період після травми, коли ця зв'язка могла вже зростись нормально чи з подовженням, або не зростись, або виявитись відсутньою взагалі, з контрлатеральним здоровим суглобом.…”

Section: результати та їх обговоренняunclassified

“…(2015) -кілька видів прикріплення до латерального меніска, але за винятком меніскофеморального [8]. З іншого боку, на свіжозаморожених трупах частина дослідників виявляє АЛЗ у 100% випадків анатомічних розтинів чи наближаються до 100% [9][10][11][12], деякі виявляють АЛЗ лише у 42,5% пацієнтів [13]. Водночас група вчених на чолі з P.B.A.…”

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“…Fardin (2017) не змогла виділити антеролатеральну зв'язку як окрему структуру в жодному випадку (щоправда, колінні суглоби були не свіжозаморожені, а витримані у 4% розчині формаліну) [4]. Немає єдності й у тому, чи є АЛЗ потовщенням капсули [10,13], чи екстракапсулярною структурою [14]. S. Claes та ін.…”

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Methodology of Ultrasonographic Examination of the Anterolateral Ligament of the Knee Joint

Kostrub¹,

Котюк²,

Osadcha³

et al. 2020

VOTP

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Summary. Injury of the anterolateral ligament (ALL) accompanies more than half of the anterior cruciate ligament ruptures. However, the uncertainty in the anatomy of ALL raises many questions regarding its visualization on ultrasound. There are also very few ultrasonographic studies of the ALL in the scientific literature in the era of MRI and CT. Objective: to determine the optimal methods and techniques for identifying and improving the visualization of the ALL with ultrasonography. Materials and Methods. ALL ultrasonography was performed in 30 healthy volunteers without pathology of the knee joint on both knee joints using a linear high-frequency sensor (ACUSON NX2 Elite, 10 MHz) at different angles of bending and rotation. Results. Ultrasonography was able to visualize the ALL in all 30 patients as a fibrillar anisotropic structure. The distinctiveness of the ALL was significantly different between patients. It was easiest to find and visualize it well with an extended knee joint, and to assess the integrity and tension when bending the knee joint at an angle of 60° and in the maximum internal rotation of the lower leg. A clearly visible tubercle was revealed by ultrasonography at the site of attachment of the ALL to the tibia in 100% of patients, which has not been described previously and greatly facilitates its finding. There was a history of a violation of the integrity of the cortical layer at the site of attachment of the ALL to the tibia in 26.67% of patients without pathology of the knee joint and injuries. Ultrasonographic identification of the two-layer structure of the ALL failed. The femoral part of the ALL is usually woven into the initial part of the fibular collateral ligament and cannot be separated ultrasonographically from it. In all 30 patients with relatively healthy knee joints without traumatic pathology, the ALL in the contralateral joints looked similar, without statistically significant deviations in their morphometric parameters. Conclusions. Ultrasonography visualizes the tibial and femoral parts of the ALL particularly but not exclusively during movements; however, it almost does not show meniscus bundles separately. For a better visualization of the ALL and assessment of its integrity, we recommend starting its research with an extended knee joint, and then performing functional tests by alternating internal and external rotation of the lower leg at different angles of flexion of the knee joint. The starting point of the ALL is the origin of the fibular collateral ligament from the lateral condyle of the femur, and the reference point of attachment is the tubercle on the anterolateral surface of the tibia posterior to Gerdy tubercle uncovered by us with ultrasonography in all the patients, which is an important reference point that allows faster, easier, and more confident localization of the ALL tibial portion insertion site. On a healthy contralateral joint, the ALL can serve as a reference for comparison if its rupture is suspected.

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Methodology of Ultrasonographic Examination of the Anterolateral Ligament of the Knee Joint

Kostrub¹,

Котюк²,

Osadcha³

et al. 2020

VOTP

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“…Since then, investigation of the ALL grew and clinical interest into this structure developed. At present, many researchers advocate for this ligament's existence and have conducted morphometric studies [2,5,10,12,13,16,17,36,38]. However, some researchers have doubted the existence of the ALL, and corresponding studies have been unable to nd a distinct ligamentous structure that stands out in the anterolateral part of the knee [3,14,22].…”

Section: Introductionmentioning

confidence: 99%

Surgical Treatment for Avulsion Fractures of the Anterolateral Ligament Associated with Periarticular Fractures of the Knee

Wei

Wang

et al. 2020

Preprint

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Background: To confirm the existence of the ALL and evaluate the clinical outcomes of surgical management for avulsion fractures involving its insertion when associated with periarticular knee fractures.Methods: Twenty-three patients (16 males and 7 females) with avulsion fractures of the ALL associated with periarticular knee fractures were fixed with a spider plate, cannulated screw, or suture anchor. Eight patients were diagnosed with distal femoral fracture, 10 with tibial plateau fracture, and 5 with tibial eminence avulsion fracture. All patients underwent X-rays at follow-up. Clinical and functional outcomes were assessed with the pivot-shift test, objective and subjective International Knee Documentation Committee (IKDC) score, Lysholm score, and Tegner activity scale.Results: The ALL was found and identified as a distinct ligamentous structure in all patients. Pre-Segond repair, patients had significantly more instability as determined by pivot-shift test than seen postoperatively (P < .0001). At final follow-up, the mean subjective IKDC score was 83.2±10.3. Fourteen patients were graded A, 6 were graded B, and 3 was graded C on the IKDC objective score. The mean Lysholm score was 85.4 ± 12.2. The mean Tegner score was 7.5 ± 1.2.Conclusion: This study confirmed that the ALL is a distinct structure in the anterolateral portion of the knee. The fixation for the avulsion fracture of the ALL associated with periarticular knee fractures can be an effective procedure without specific complications. Longer term and comparative follow-up studies are necessary to confirm the effects.

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“…On the one hand, numerous anatomical studies [5][6][7][8][9], MRI [3], and ultrasonography studies [10] identified ALL in all or most knee joints. On the other hand, some scientists verify ALL only in the form of thickening of the joint capsule [7,11]. Some researchers do not identify it during anatomical dissections at all [4], or describe it only in the form of a multilayer structure consisted of aponeuroses of neighboring anatomical structures [12], or only as capsulo-osseous layer or the mid-third capsular ligament complex, which are the components of the anterolateral complex (the superficial and deep ITB, the capsulo-osseous layer of the ITB, and the anterolateral capsule) [13].…”

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confidence: 99%

Variability of anterolateral ligament on MRI images – lack of survey standardization or anatomical variants?

Коструб¹,

Котюк²,

Поляченко³

et al. 2021

Vescì Nac. akad. navuk Belarusì, Ser. med. navuk

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The anterolateral ligament is a rotational stabilizer of the knee joint. It is not always clear what we actually see on MRI in the area of anterolateral ligament (ALL).The aim of the study was to evaluate the ALL variants on MRI images to summarize their common features and differences, and to try to find an explanation for the phenomenon of the ALL variability.200 series of MRI images of knee joints were analyzed. The presence of the ALL, the number of its layers, the relation to the joint capsule, and other anatomical features were assessed.The ALL was visualized on MRI at least partially in 88 % of cases. At least partially two-layer structure was detected in 68 % of all 200 MRI series. The wavy appearance of the certain portions of the anterolateral ligament was observed in some normal knee joints without a history of injuries.Determined that the ALL is a separate anatomical element of the knee joint that has a variable, but in most cases two-layered, anatomical structure and can be detected on MRI in at least 88 % of cases. Axial sections help to identify ALL in complex cases and allow analyzing its anatomy, but adding little in the diagnosis of ALL injury.

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Anatomical Consideration of the Anterolateral Ligament of the Knee

Cited by 17 publications

References 30 publications

Methodology of Ultrasonographic Examination of the Anterolateral Ligament of the Knee Joint

Methodology of Ultrasonographic Examination of the Anterolateral Ligament of the Knee Joint

Surgical Treatment for Avulsion Fractures of the Anterolateral Ligament Associated with Periarticular Fractures of the Knee

Variability of anterolateral ligament on MRI images – lack of survey standardization or anatomical variants?

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