Radiographic Landmarks for Identifying the Anterolateral Ligament of the Knee

Heckmann, Nathanael; Sivasundaram, Lakshmanan; Villacis, Diego; Kleiner, Matthew T.; Yi, Anthony; White, Eric A.; Hatch, George F. Rick

doi:10.1016/j.arthro.2015.11.022

Cited by 21 publications

(20 citation statements)

References 19 publications

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“…Reliable identification of the ALL has also been complicated by a lack of consensus in the literature regarding its anatomy 22,23,24,25 with some authors reporting a proximal and posterior 23,25,26,27,28 origin in relation to the lateral epicondyle and others anterior and distal. 21,22,29,30 This variability in femoral origin was also demonstrated in the current study, but simultaneous visualisation of both types was also seen in 37.5% of patients. To the authors knowledge this has not previously been described in any imaging study.…”

Section: "Injured Knee" Groupsupporting

confidence: 86%

Three-dimensional Magnetic Resonance Imaging of the Anterolateral Ligament of the Knee: An Evaluation of Intact and Anterior Cruciate Ligament–Deficient Knees From the Scientific Anterior Cruciate Ligament Network International (SANTI) Study Group

Muramatsu¹,

Saithna

Watanabe³

et al. 2018

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Section: "Injured Knee" Groupsupporting

confidence: 86%

Three-dimensional Magnetic Resonance Imaging of the Anterolateral Ligament of the Knee: An Evaluation of Intact and Anterior Cruciate Ligament–Deficient Knees From the Scientific Anterior Cruciate Ligament Network International (SANTI) Study Group

Muramatsu¹,

Saithna

Watanabe³

et al. 2018

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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“…The performance of the dissection in a proximal to distal direction may damage some of the ALL fibers, as was observed in the study by Helito et al, 10 who aimed to expose the lateral epicondyle to identify the ALL, therefore visualizing only deeper structures. In a study focused on identifying radiographic landmarks for ALL reconstruction, Heckmann et al 6 discussed that the femoral point they found was more posterior than the point found by Helito et al 9 in a similar study. They explain these differences may be due to anatomic variability or methodological difference in the way the ALL the origin was identified.…”

Section: Discussionmentioning

confidence: 92%

“…A critical analysis of the dissections reported in published studies allows these studies to be divided into 2 groups: one in which the femoral origin is posterior and proximal to the lateral epicondyle and tends to increase in length on knee extension 4 , 13 and the other in which the femoral origin is distal to or in the epicondyle center and tends to increase in length on knee flexion. 2 , 6 , 7 Many studies described mixed ALL characteristics and included parameters that could accommodate the 2 types of descriptions.…”

mentioning

confidence: 99%

Why Do Authors Differ With Regard to the Femoral and Meniscal Anatomic Parameters of the Knee Anterolateral Ligament?

Helito

Amaral

Nakamichi

et al. 2016

Orthopaedic Journal of Sports Medicine

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Background:No consensus exists regarding the anatomic characteristics of the knee anterolateral ligament (ALL). A critical analysis of the dissections described in previous studies allows the division of the ALL into 2 groups with similar characteristics. The presence of considerable variability suggests that the authors may not be referring to the same structure.Purpose/Hypothesis:To perform a lateral anatomic dissection, by layers, seeking to characterize the 2 variants described for the ALL on the same knee. We hypothesized that we would identify the 2 variants described for the ALL and that these variants would have distinct characteristics.Study Design:Descriptive laboratory study.Methods:Thirteen unpaired cadaveric knees were used in this study. The dissection protocol followed the parameters described in previous studies. Immediately below the iliotibial tract, we isolated a structure designated as the superficial ALL, whereas between this structure and the articular capsule, we isolated a structure designated as the deep ALL. The 2 structures were measured for length at full extension and at 90° of flexion and for distance from the tibial insertion relative to the Gerdy tubercle. Potential contact with the lateral meniscus was also evaluated. After measurements were obtained, the 2 dissected structures underwent histologic analysis.Results:The superficial ALL presented a posterior and proximal origin to the center of the lateral epicondyle, its length increased on knee extension, and it exhibited no contact with the lateral meniscus. The deep ALL was located in the center of the lateral epicondyle, its length increased on knee flexion, and it presented a meniscal insertion. Both structures had a similar tibial insertion site; however, the insertion site of the deep ALL was located more posteriorly. The analysis of the histological sections for both structures indicated the presence of dense and well-organized collagen fibers.Conclusion:This anatomic study clearly identified 2 structures, described as the superficial and deep ALL, which were consistent with previous but conflicting descriptions of the ALL.Clinical Relevance:This study clarifies numerous controversies encountered in anatomic studies of the ALL. Knowledge regarding the existence of 2 distinct structures in the anterolateral knee will allow more accurate evaluation of their functions and characteristics.

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“…4 Possible explanations for the aforementioned differences in length change patterns might be the variability of the femoral attachment of the ALL used for ALL measurement in the cadaveric studies. The femoral insertion of the ALL has been described either together with the fibular collateral ligament (FCL), 5, 6 anterior-distal to the FCL 7-9 , posterior 10 or more posterior-proximal to the FCL. 2, 11, 12 Minor shifts in position around the rotational axis of the femur would result in contrary ligament kinematic patterns.…”

Section: Introductionmentioning

confidence: 99%

In Vivo Anterolateral Ligament Length Change in the Healthy Knee During Functional Activities—A Combined Magnetic Resonance and Dual Fluoroscopic Imaging Analysis

Kernkamp

Velde

Hosseini

et al. 2017

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Purpose To measure the in vivo anterolateral ligament (ALL) length change in healthy knees during step-up and sit-to-stand motions. Methods Eighteen healthy knees were imaged using magnetic resonance (MR) and dual fluoroscopic imaging techniques during a step-up and sit-to-stand motion. The ALL length change was measured, using the shortest 3-D wrapping path, with its femoral attachment located slightly anterior-distal (ALLClaes) or posterior-proximal (ALL-Kennedy) to the fibular collateral ligament (FCL) attachment. The ALL length measured from the extended knee position of the non-weight-bearing MR-scan, was used as a reference to normalize the length change. Results During the step-up motion (~55° flexion to full extension) both the ALL-Claes and ALL-Kennedy showed a significant decrease in length of 21.2% (95% confidence interval 18.0 to 24.4, P<0.001) and 24.3% (20.6 to 28.1, P<0.001) respectively. During the sit-to-stand motion (~90° flexion to full extension), both the ALL-Claes and ALL-Kennedy showed a consistent, significant decrease in length of 35.2% (28.8 to 42.2, P<0.001) and 39.2% (32.4 to 46.0, P<0.001) respectively. From ~90° to 70° of flexion, a decrease in length of approximately 6% was seen; 70° of flexion to full extension resulted in an approximate 30% decrease in length. Conclusion The ALL was found to be a non-isometric structure during the step-up and sit-to-stand motion. The length of the ALL was approximately 35% longer at ~90° of knee flexion when compared to full extension and showed decreasing length at lower flexion angles. Similar ALL length change patterns were found with its femoral attachment located slightly anterior-distal or posterior-proximal to the FCL attachment. Clinical Relevance These data suggest that, if performing anatomic ALL reconstruction, graft fixation may be performed beyond 70° flexion to reduce the chance of lateral compartment overconstraint. Anatomic ALL reconstruction may affect the knee kinematics more in high flexion than at low flexion angles.

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Radiographic Landmarks for Identifying the Anterolateral Ligament of the Knee

Cited by 21 publications

References 19 publications

Three-dimensional Magnetic Resonance Imaging of the Anterolateral Ligament of the Knee: An Evaluation of Intact and Anterior Cruciate Ligament–Deficient Knees From the Scientific Anterior Cruciate Ligament Network International (SANTI) Study Group

Three-dimensional Magnetic Resonance Imaging of the Anterolateral Ligament of the Knee: An Evaluation of Intact and Anterior Cruciate Ligament–Deficient Knees From the Scientific Anterior Cruciate Ligament Network International (SANTI) Study Group

Why Do Authors Differ With Regard to the Femoral and Meniscal Anatomic Parameters of the Knee Anterolateral Ligament?

In Vivo Anterolateral Ligament Length Change in the Healthy Knee During Functional Activities—A Combined Magnetic Resonance and Dual Fluoroscopic Imaging Analysis

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