Macroscopic anatomical, histological and magnetic resonance imaging correlation of the lateral capsule of the knee

Dombrowski, Malcolm E.; Costello, Joanna; Ohashi, Bruno; Murawski, Christopher D.; Rothrauff, Benjamin B.; Arilla, Fabio V.; Friel, Nicole A.; Fu, Freddie H.; Debski, Richard E.; Musahl, Volker

doi:10.1007/s00167-015-3517-8

Cited by 64 publications

(52 citation statements)

References 24 publications

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“…These findings suggest that a proposed ligamentous structure in the anterolateral capsule does not have tensile properties like ligaments. This is in accordance with a histological study, which compared the anterolateral capsule to the ACL . The collagen pattern of the thickenings in the anterolateral capsule were organized into individual bundles, indicating that the anterolateral capsule includes a combination of multiple thickenings and not a homogenous entity such as the ACL.…”

Section: Discussionsupporting

confidence: 89%

Non‐uniform strain distribution in anterolateral capsule of knee: Implications for surgical repair

Guenther

Sexton

Bell

et al. 2019

Journal Orthopaedic Research

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The existence of a ligamentous structure within the anterolateral capsule, which can be injured in combination with the anterior cruciate ligament, has been debated. Therefore, the purpose of this study was to determine the magnitude and direction of the strain in the anterolateral capsule in response to external loads applied to the knee. The anterolateral capsule was hypothesized to not function like a traditional ligament. A 6-degree-of-freedom robotic testing system was used to apply ten external loads to human cadaveric knees (n ¼ 7) in the intact and anterior cruciate ligament (ACL) deficient states. The position of strain markers was recorded on the midsubstance of the anterolateral capsule during the resulting joint kinematics to determine the magnitude and direction of the maximum principal strain. The peak maximum principal strain ranged from 22% to 52% depending on the loading condition. When histograms of strain magnitude values were analyzed to determine strain uniformity, the mean kurtosis was 1.296 AE 0.955, lower than a typical ligament, and the mean variance was 0.015 AE 0.008, higher than a typical ligament. The mean angles of the strain direction vectors compared to the proposed ligament ranged between 38˚and 130˚(p < 0.05). The magnitude of the maximum principal strain in the anterolateral capsule is much larger than a typical ligament and does not demonstrate a uniform strain distribution. The direction of strain is also not aligned with the proposed ligament. Clinical Significance: Reconstruction methods using tendons will not produce normal joint function due to replacement of a multi-axial structure with a uni-axial structure. ß

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Section: Discussionsupporting

confidence: 89%

Non‐uniform strain distribution in anterolateral capsule of knee: Implications for surgical repair

Guenther

Sexton

Bell

et al. 2019

Journal Orthopaedic Research

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“…4–7,19,31,37 Moreover, it is possible that the mid-third capsular thickening located at the confluence of capsular layers is more noticeable in some individuals than others, further contributing to the widely ranging prevalence of reported ALL and/or mid-third capsular ligament in published literature. 4–8,13,19,31,37,45,47 …”

Section: Discussionmentioning

confidence: 99%

The Anterolateral Complex of the Knee

Herbst

Albers

Burnham

et al. 2017

Orthopaedic Journal of Sports Medicine

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Background:Significant controversy exists regarding the anterolateral structures of the knee.Purpose:To determine the layer-by-layer anatomic structure of the anterolateral complex of the knee.Study Design:Descriptive laboratory study.Methods:Twenty fresh-frozen cadaveric knees (age range, 38-56 years) underwent a layer-by-layer dissection to systematically expose and identify the various structures of the anterolateral complex. Quantitative measurements were performed, and each layer was documented with high-resolution digital imaging.Results:The anterolateral complex of the knee consisted of different distinct layers, with the superficial and deep iliotibial band (ITB) representing layer 1. The superficial ITB had a distinct connection to the distal femoral metaphysis and femoral condyle (Kaplan fibers), and the deep layers of the ITB were identified originating at the level of the Kaplan fibers proximally. This functional unit, consisting of the superficial and deep ITB, was reinforced by the capsulo-osseous layer of the ITB, which was continuous with the fascia of the lateral gastrocnemius and biceps femoris muscles. These 3 components of the ITB became confluent distally, and the insertion spanned from the Gerdy tubercle anteriorly to the lateral tibia posteriorly on a small tubercle (lateral tibial tuberosity). Layer 3 consisted of the anterolateral capsule, in which 35% (7/20) of specimens had a discreet mid-third capsular ligament.Conclusion:The anterolateral complex consists of the superficial and deep ITB, the capsulo-osseous layer of the ITB, and the anterolateral capsule. The anterolateral complex is defined by the part of the ITB between the Kaplan fibers proximally and its tibial insertion, which forms a functional unit. A discrete anterolateral ligament was not observed; however, the anterolateral ligament described in recent studies likely refers to the capsulo-osseous layer or the mid-third capsular ligament.Clinical Relevance:The anterolateral knee structures form a complex functional unit. Surgeons should use caution when attempting to restore this intricate structure with extra-articular procedures designed to re-create a single discreet ligament.

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“…Three different patterns have been reported in relation to the landmark represented by the FCL: (1) The ALL is always anterior and distal to the FCL (Vincent et al, ; Claes et al, ; Helito et al, ; Dombrowski et al, ; Stijak et al, ); (2) The ALL is always proximal and posterior to the FCL (Dodds et al, ; Cavaignac et al, ); or (3) The ALL and the FCL share a common attachment (Kosy and Mandalia, ; Runer et al, ). Another group of authors observed a variant set of three patterns (Kosy and Mandalia, ; Caterine et al, ; Daggett et al, ; Rezansoff et al, ; Helito et al, 2016a, 2016b; Runer et al, ; Kosy et al, ; Macchi et al, ; Shea et al, ; Watanabe et al, ).…”

Section: Discussionmentioning

confidence: 99%

“…, 2014Helito et al, 2013;Dodds et al, 2014;Bonasia et al, 2015;Caterine et al, 2015;Daggett et al, 2015;Guenther et al, 2015;Kosy and Mandalia, 2015;Pomajzl et al, 2015;Roessler et al, 2015;Taneja et al, 2015;Van der Watt et al, 2015;Cavaignac et al, 2016;Helito et al, 2016aHelito et al, , 2016bMacchi et al, 2016;Musahl et al, 2016;Parker and Smith, 2016;Runer et al, 2016, Stijak et al, 2016Roessler et al, 2017), but there are controversies regarding the attachment in relation to the FCL and the popliteus muscle tendon. Three different patterns have been reported in relation to the landmark represented by the FCL: (1) The ALL is always anterior and distal to the FCL (Vincent et al, 2012;Claes et al, 2013;Helito et al, 2013Helito et al, , 2014Dombrowski et al, 2016;Stijak et al, 2016);…”

Section: Does the Femoral Attachment Have A Constant Relationship Tomentioning

confidence: 99%

The anterolateral ligament: A cadaveric study in fetuses

et al. 2017

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The aim of this study was to determine the presence and morphology of the anterolateral ligament (ALL) of the knee in a sample of fetuses. We hypothesized that the ALL is present in sample fetuses and its origin is not related to repetitive stresses throughout life. Forty fresh-frozen knees from cadaveric fetuses were dissected using a standard technique. The ALL and other structures in the anterolateral compartment of the knee were identified. The details of the femoral and tibial attachments, course and relationships with anatomical structures of the ALL were identified, recorded, and quantitatively characterized. The ALL was identified in 100% of the dissected knees. We found three anatomical patterns regarding the femoral attachment: (1) Proximal and posterior to the fibular collateral ligament (55%); (2) Together with the fibular collateral ligament (25%); and (3). Anterior and distal to it (20%). The ALL was extracapsular with an oblique course attaching into the anterolateral aspect of the tibia, midway between the midpoint of Gerdy's tubercle and the fibular head. The ALL has a strong attachment to the lateral meniscus, creating two fascicles: proximal or meniscofemoral and distal or meniscotibial. The ALL is a constant, extracapsular anatomical structure in the anterolateral compartment of the knee, present from the later prenatal period of life. Its morphology shows three different patterns of femoral attachment in relation to the fibular collateral ligament position, a strong attachment in the lateral meniscus, and a constant tibial attachment. Clin. Anat. 30:625-634, 2017. © 2017 Wiley Periodicals, Inc.

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Macroscopic anatomical, histological and magnetic resonance imaging correlation of the lateral capsule of the knee

Cited by 64 publications

References 24 publications

Non‐uniform strain distribution in anterolateral capsule of knee: Implications for surgical repair

Non‐uniform strain distribution in anterolateral capsule of knee: Implications for surgical repair

The Anterolateral Complex of the Knee

The anterolateral ligament: A cadaveric study in fetuses

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