Study of the Anterolateral Ligament of the Knee in Formalin-Embedded Cadavers

Fardin, P; Lizardo, Juliana Hott de Fúcio; Baptista, Josemberg da Silva

doi:10.1590/1413-785220172502162204

Cited by 15 publications

(10 citation statements)

References 24 publications

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“…Fardin et al [23] described a dissection technique starting with a section of the ITB 5 cm proximal to the lateral epicondyle of the femur, followed by detachment up to Gerdy’s tubercle in order to identify the articular capsule, the LCL and the tendon of the popliteus muscle. However, in contrast to literature data and evidence of the presence of the ALL is most knees, in none of the 15 specimens studied was the ALL identified properly.…”

Section: Discussionmentioning

confidence: 99%

“…Understanding its function in knee kinematics is currently being investigated [4, 5]. However, a few studies still report a low ALL visualization rate in dissections [9, 23, 25–27]. Those that did not find the ALL were usually performed with techniques that might interfere with proper ALL isolation and on embalmed cadavers [9, 23, 26], which may hinder dissection, regardless of the technique used.…”

Section: Discussionmentioning

confidence: 99%

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

Lima

Helito

Daggett

et al. 2019

BMC Musculoskelet Disord

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Lima

Helito

Daggett

et al. 2019

BMC Musculoskelet Disord

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“…48 Previous studies have reported variable prevalence or identification of the ALL in cadaveric dissections, ranging from 0% to 100%. 8,12,38,45,50,51 Several studies have noted a thickening within the ALC but no distinct anatomic structure in anatomic dissections and MRI studies. 11,21,30 In the current study, a distinct or nondistinct ALL was determined by the presence or absence of a ligamentous structure in the appropriate anatomic location.…”

Section: Discussionmentioning

confidence: 99%

“…34 Anatomic studies of the ALL have shown conflicting results, with a reported prevalence between 0% and 100%. 8,12,38,45,50,51 Histological examination of the ALL has shown ligamentous and capsular organization. 5,11,15 There is a complex relationship among the other anterolateral knee structures, such as the iliotibial band, Kaplan fibers, and anterolateral capsule (ALC), but the structure-function relationship is unknown.…”

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confidence: 99%

Microstructural and Mechanical Properties of the Anterolateral Ligament of the Knee

et al. 2020

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Background: The variable anatomy and controversy of the anterolateral ligament (ALL) reflect the complex relationship among the anterolateral knee structures. Purpose/Hypothesis: The purpose was to quantify the microstructural and mechanical properties of the ALL as compared with the anterolateral capsule (ALC) and lateral collateral ligament (LCL). The primary hypotheses were that (1) there is no difference in these properties between the ALL and ALC and (2) the LCL has significantly different properties from the ALL and ALC. Study Design: Descriptive laboratory study. Methods: The LCL, ALL, and ALC were harvested from 25 cadaveric knees. Mechanical testing and microstructural analyses were performed using quantitative polarized light imaging. The average degree of linear polarization (AVG DoLP; mean strength of collagen alignment) and standard deviation of the angle of polarization (STD AoP; degree of variation in collagen angle orientation) were calculated. Results: Linear region moduli were not different between the ALC and ALL (3.75 vs 3.66 MPa, respectively; P > .99). AVG DoLP values were not different between the ALC and ALL in the linear region (0.10 vs 0.10; P > .99). Similarly, STD AoP values were not different between the ALC and ALL (24.2 vs 21.7; P > .99). The LCL had larger modulus, larger AVG DoLP, and smaller STD AoP values than the ALL and ALC. Of 25 knee specimens, 3 were observed to have a distinct ALL, which exhibited larger modulus, larger AVG DoLP, and smaller STD AoP values as compared with nondistinct ALL samples. Conclusion: There were no differences in the mechanical and microstructural properties between the ALL and ALC. The ALC and ALL exhibited comparably weak and disperse collagen alignment. However, when a distinct ALL was present, the properties were suggestive of a ligamentous structure. Clinical Relevance: The properties of the ALL are similar to those of a ligament only when a distinct ALL is present, but otherwise, for the majority of specimens, ALL properties are closer to those of the capsule. Variability in the ligamentous structure of the ALL suggests that it may be more important in some patients than others and reconstruction may be considered in selective patients. Further study is needed to better understand its selective role and optimal indications for reconstruction.

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“…Perceptions of anatomy, function, current imaging capabilities, and optimal ways to restore ALL have changed over time and continue to do so today. There is still no consensus among scientists on the anatomy of the ALL, and even its existence is questioned by several anatomical studies [4].…”

mentioning

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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Study of the Anterolateral Ligament of the Knee in Formalin-Embedded Cadavers

Cited by 15 publications

References 24 publications

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

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

Microstructural and Mechanical Properties of the Anterolateral Ligament of the Knee

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

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