Background:Reconstruction of the anterior cruciate ligament (ACL) is one of the most common procedures in orthopaedic surgery. However, even with advances in surgical techniques and implants, some patients still have residual anterolateral rotatory laxity after reconstruction. A thorough study of the anatomy of the anterolateral region of the knee is needed.Purpose:To study the anterolateral region and determine the measurements and points of attachments of the anterolateral ligament (ALL).Study Design:Descriptive laboratory study.Methods:Dissections of the anterolateral structures of the knee were performed in 20 human cadavers. After isolating the ALL, its length, thickness, width, and points of attachments were determined. The femoral attachment of the ALL was based on the anterior-posterior and proximal-distal distances from the attachment of the lateral collateral ligament (LCL). The tibial attachment point was based on the distance from the Gerdy tubercle to the fibular head and the distance from the lateral tibial plateau. The ligaments from the first 10 dissections were sent for histological analysis.Results:The ALL was found in all 20 knees. The femoral attachment of the ALL at the lateral epicondyle averaged 3.5 mm distal and 2.2 mm anterior to the attachment of the LCL. Two distal attachments were observed: one inserts into the lateral meniscus, the other between the Gerdy tubercle and the fibular head, approximately 4.4 mm distal to the tibial articular cartilage. The mean measurements for the ligament were 37.3 mm (length), 7.4 mm (width), and 2.7 mm (thickness). The histological analysis of the ligaments revealed dense connective tissue.Conclusion:The ALL is consistently present in the anterolateral region of the knee. Its attachment to the femur is anterior and distal to the attachment of the LCL. Moving distally, it bifurcates at close to half of its length. The ALL features 2 distal attachments, one at the lateral meniscus and the other between the Gerdy tubercle and the fibular head.Clinical Relevance:The ALL may be important in maintaining normal rotatory limits of knee motion; ALL rupture could be responsible for rotatory laxity after isolated intra-articular reconstruction of the ACL.

Objective. Refractory, disabling pain associated with knee osteoarthritis (OA) is usually treated with total knee replacement. However, pain in these patients might be associated with central nervous sensitization rather than peripheral inflammation and injury. We evaluated the presence of hyperalgesia in patients scheduled for a total knee replacement due to knee osteoarthritis with refractory pain, and we assessed the impact of pressure pain threshold measurements (PPT) on pain, disability, and quality of life of these patients. Methods. Sixty-two female patients were compared with 22 age-matched healthy controls without reported pain for the last year. PPT was measured at the lower extremities subcutaneous dermatomes, over the vastus medialis, adductor longus, rectus femoris, vastus lateralis, tibialis anterior, peroneus longus, iliacus, quadratus lumborum and popliteus muscles and at the supraspinous ligaments from L1-L5, over the L5-S1 and S1-S2 sacral areas and at the pes anserinus bursae and patellar tendon. Results. Patients with knee OA had significantly lower PPT over all evaluated structures versus healthy control subjects (P < 0.001). Lower PPT values were correlated with higher pain intensity, higher disability scores, and with poorer quality of life, except for the role-emotional and general health status. Combined PPT values over the patellar tendon, at the S2 subcutaneous dermatome and at the adductor longus muscle were the best predictors for visual analog scale and Western Ontario and McMaster Universities Osteoarthritis Index pain scores. Conclusion. Patients with pain due to osteoarthritis who were scheduled for total knee replacement showed hyperalgesia of nervous system origin that negatively impacted pain, knee functional capacity, and most aspects of quality of life.

The ALL can be visualized in routine 1.5-T MRI scans. Although some of the ligament could be depicted in nearly all of the scans (97.4%), it could only be observed in its entirety in about 71.7% of the tests.

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Greve J, Alonso A, Bordini ACPG, Camanho, GL. Correlation between body mass index and postural balance. Clinics. 2007;62(6):717-20. OBJECTIVE:To evaluate the correlation between body mass index (BMI) and postural balance in unipodal support. METHOD: 40 males, age 26 ± 5 yrs, body mass 72.3 ± 11 kg, height 176 ± 6 cm and BMI 23.3 ± 3.2 kg/m 2 , were submitted to functional stability tests using the Biodex ® Balance System (stability evaluation protocol level 2, which allows an inclination of up to 20° in the horizontal plane in all directions) to compare stability with BMI. RESULTS: The general stability index showed a correlation between BMI and postural balance -measured as imbalance (R= 0.723-dominant side and R=0.705-non-dominant side). The anteroposterior stability index -measured as instability -showed correlations on the dominant (R= 0.708) and non-dominant side (R=0.656). Lateral instability showed a correlation on the dominant side (R=0.721) and non-dominant side (R=0.728). The comparison of the balance indexes for dominant and non-dominant sides showed no statistically significant differences. CONCLUSION: High BMI demands more displacements to maintain postural balance.

Level III.

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Knowledge of the anatomic landmarks of the ALL on radiography will permit minimally invasive surgical reconstruction with lower morbidity.