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

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          Abstract

          Background

          Persistent anterolateral rotatory instability (ALRI) following the anterior cruciate ligament (ACL) reconstruction has led to a renewed interest in defining the role of anterolateral complex (ALC) of the knee.

          Methods

          We explored the anterolateral corner of 34 cadaveric knees to define the anterolateral ligament (ALL) in all its dimensions and measured the thickness of lateral collateral ligament (LCL) at the lateral meniscus level (tLCL) in ALL-intact and ALL-deficient knees.

          Results

          ALL was present in 27/34 (79%) of the knees. We found complete ALL in 13 cadavers bilaterally. ALL was absent bilaterally in three cadavers; it was present on one side and absent contralaterally in one cadaver. In ALL-intact knees, the average tLCL was 2.05 mm, whereas, in ALL-deficient knees, it was 2.57 mm. This difference in tLCL was statistically significant.

          Conclusions

          Our study adds new data to the recent voluminous research on ALL. We have examined the correlation between the thickness of ALL and LCL and documented alterations in the thickness of LCL in ALL-intact knees. These findings would help in designing reconstructive procedures for the combined ACL injury with ALRI.

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          Most cited references28

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          Anatomy of the anterolateral ligament of the knee.

          Steven Claes, Evie Vereecke, Michael Maes … (2013)
          In 1879, the French surgeon Segond described the existence of a 'pearly, resistant, fibrous band' at the anterolateral aspect of the human knee, attached to the eponymous Segond fracture. To date, the enigma surrounding this anatomical structure is reflected in confusing names such as '(mid-third) lateral capsular ligament', 'capsulo-osseous layer of the iliotibial band' or 'anterolateral ligament', and no clear anatomical description has yet been provided. In this study, the presence and characteristics of Segond's 'pearly band', hereafter termed anterolateral ligament (ALL), was investigated in 41 unpaired, human cadaveric knees. The femoral and tibial attachment of the ALL, its course and its relationship with nearby anatomical structures were studied both qualitatively and quantitatively. In all but one of 41 cadaveric knees (97%), the ALL was found as a well-defined ligamentous structure, clearly distinguishable from the anterolateral joint capsule. The origin of the ALL was situated at the prominence of the lateral femoral epicondyle, slightly anterior to the origin of the lateral collateral ligament, although connecting fibers between the two structures were observed. The ALL showed an oblique course to the anterolateral aspect of the proximal tibia, with firm attachments to the lateral meniscus, thus enveloping the inferior lateral geniculate artery and vein. Its insertion on the anterolateral tibia was grossly located midway between Gerdy's tubercle and the tip of the fibular head, definitely separate from the iliotibial band (ITB). The ALL was found to be a distinct ligamentous structure at the anterolateral aspect of the human knee with consistent origin and insertion site features. By providing a detailed anatomical characterization of the ALL, this study clarifies the long-standing enigma surrounding the existence of a ligamentous structure connecting the femur with the anterolateral tibia. Given its structure and anatomic location, the ALL is hypothesized to control internal tibial rotation and thus to affect the pivot shift phenomenon, although further studies are needed to investigate its biomechanical function.
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            The anterolateral complex of the knee: results from the International ALC Consensus Group Meeting

            Alan Getgood, Charles Brown, Timothy Lording … (2019)
            The structure and function of the anterolateral complex (ALC) of the knee has created much controversy since the 're-discovery' of the anterolateral ligament (ALL) and its proposed role in aiding control of anterolateral rotatory laxity in the anterior cruciate ligament (ACL) injured knee. A group of surgeons and researchers prominent in the field gathered to produce consensus as to the anatomy and biomechanical properties of the ALC. The evidence for and against utilisation of ALC reconstruction was also discussed, generating a number of consensus statements by following a modified Delphi process. Key points include that the ALC consists of the superficial and deep aspects of the iliotibial tract with its Kaplan fibre attachments on the distal femur, along with the ALL, a capsular structure within the anterolateral capsule. A number of structures attach to the area of the Segond fracture including the capsule-osseous layer of the iliotibial band, the ALL and the anterior arm of the short head of biceps, and hence it is not clear which is responsible for this lesion. The ALC functions to provide anterolateral rotatory stability as a secondary stabiliser to the ACL. Whilst biomechanical studies have shown that these structures play an important role in controlling stability at the time of ACL reconstruction, the optimal surgical procedure has not yet been defined clinically. Concern remains that these procedures may cause constraint of motion, yet no clinical studies have demonstrated an increased risk of osteoarthritis development. Furthermore, clinical evidence is currently lacking to support clear indications for lateral extra-articular procedures as an augmentation to ACL reconstruction. The resulting statements and scientific rationale aim to inform readers on the most current thinking and identify areas of needed basic science and clinical research to help improve patient outcomes following ACL injury and subsequent reconstruction.Level of evidence V.
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              The Role of the Anterolateral Structures and the ACL in Controlling Laxity of the Intact and ACL-Deficient Knee.

              Christoph Kittl, Hadi El-Daou, Kiron K Athwal … (2016)
              Anterolateral rotatory instability (ALRI) may result from combined anterior cruciate ligament (ACL) and lateral extra-articular lesions, but the roles of the anterolateral structures remain controversial.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Cureus
                Journal ID (iso-abbrev): Cureus
                Journal ID (issn): 2168-8184
                Title: Cureus
                Publisher: Cureus (Palo Alto (CA) )
                ISSN (Electronic): 2168-8184
                Publication date (Electronic, pub): 12 January 2021
                Publication date (Electronic, collection): January 2021
                Volume: 13
                Issue: 1
                Electronic Location Identifier: e12668
                Affiliations
                [1 ] Anatomy, All India Institute of Medical Sciences, Bhopal, IND
                [2 ] Orthopaedics, All India Institute of Medical Sciences, Bhopal, IND
                [3 ] Radiology, All India Institute of Medical Sciences, Bhopal, IND
                [4 ] Orthopaedics, Kasturba Hospital Bhel, Bhopal, IND
                Author notes
                Article
                DOI: 10.7759/cureus.12668
                PMC ID: 7878636
                SO-VID: 64425cdf-31e6-47e9-be4b-01e7ed03d8b7
                Copyright © Copyright © 2021, Chaware et al.
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date accepted : 8 January 2021
                Categories
                Subject: Physical Medicine & Rehabilitation
                Subject: Orthopedics
                Subject: Anatomy

                Keywords: anterolateral ligament,acl,anterolateral complex,lateral collateral ligament,anterolateral rotatory instability
                Data availability:
                Keywords: anterolateral ligament, acl, anterolateral complex, lateral collateral ligament, anterolateral rotatory instability

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