Anterolateral ligament of the knee: a step-by-step dissection

Abstract

Background The number of studies and clinical interest in the anterolateral ligament of the knee (ALL) has grown in recent years. A meticulous and accurate ALL dissection is vital in anatomic and biomechanical studies, and a standardized technique is not yet established. As such, the aim of this study was to describe a step-by-step ALL dissection technique that could help authors consistently identify the ALL. Methods Twenty knees from frozen adult cadavers, with no preference for sex or age, were included in the study. All the cadavers were dissected using the same technique to determine the incidence of the ALL. Results A transverse incision is performed in the iliotibial band (ITB), around 10 cm proximal to the topography of the lateral epicondyle of the femur. Next, the ITB undergoes anterograde blunt dissection until its insertion at Gerdy’s tubercle in the tibia. Maintaining biceps femoris insertion, a dissection is performed anteriorly to it, until the lateral collateral ligament (LCL) is found. Using the LCL, internal rotation and 30 to 60° flexion as references, the ALL can be located in the anterolateral topography of the knee, with its origin near the lateral epicondyle (proximal and posterior) and insertion between Gerdy’s tubercle and the fibula (4.0 mm to 7.0 mm below the tibial plateau), expanding to the lateral meniscus (between the body and anterior horn), exhibiting a mean length of 4.0 ± 0.4 cm and mean width of 5.5 ± 0.8 mm. Conclusions The present article describes an effective and reproducible ALL dissection technique that made it was possible to identify the ligament in 100% of the cases in the present study. Electronic supplementary material The online version of this article (10.1186/s12891-019-2517-0) contains supplementary material, which is available to authorized users.

Correlation Between the Thickness of Anterolateral Ligament and Lateral Collateral Ligament of the Knee

“…Various cadaveric studies have demonstrated the presence of ALL in 50-100% of specimens [7][8][9][16][17][18][19]. In our study, ALL was present in 79% of the specimens (Figure 1, Figure 2, Figure 3).…”

“…Lateral extra-articular reinforcement procedures have been used since the 1970s as a possible solution for persistent ALRI after primary ACL reconstruction [3,6]. There has been a renewed worldwide interest in defining the anterolateral corner of the knee following the publication of the precise anatomic details of the anterolateral ligament (ALL) [7][8][9]. Cadaveric as well as clinical studies have reported on the benefits of supplementing ALL reconstruction with ACL reconstruction in cases with concomitant injuries [10][11][12].…”

Avulsion Fractures around the Knee and their Importance

“…40,41,42 ALL was clearly demonstrated on 3.0T MRI and through step by step dissection method. 43,44 According to Claes et al origin of ALL is from the lateral femoral epicondyle, just anterior to the origin of lateral collateral ligament and passing caudally in close association with the body of the lateral meniscus to insert onto the proximal tibia between Gerdy tubercle and fibular head. 45 It is an anterolateral stabilizer of the knee.…”

Anatomical and Biomechanical Characteristics of the Anterolateral Ligament: A Descriptive Korean Cadaveric Study Using a Triaxial Accelerometer

“…All cadavers were dissected by a single surgeon (D.S.) using techniques described in the literature [ 2 , 26 , 27 , 28 ]. Care was taken to prevent unnecessary excision of tissue.…”