A Review of Current Concepts of the Anterolateral Complex of the Knee

Abstract

The anterolateral complex (ALC) of the knee has gained increased interest over the last decades due to the high revision rates of anterior cruciate ligament reconstruction (ACLR). Furthermore, in patients with an ACL tear, the injury of at least one of the ALC’s anatomic structures has been shown to be significantly higher, thus affecting its secondary stabilizing role at the knee joint. As such, ACLR augmentation techniques, that embrace the ALC, have been proposed recently, and indications for these procedures are still evolving. This review aims to present and discuss the most current anatomical, biomechanical, and imaging data, current reconstruction techniques, and the clinical results of ALC reconstruction.

Postoperative Return to Play and the Role of Imaging

“…An additional consideration in athletes is the status of the anterolateral complex, which is vulnerable in the setting of an ACL injury and includes the superficial iliotibial band, the deep iliotibial band, the anterolateral ligament (ALL), and the joint capsule. 19 In particular, the ALL plays a key role in controlling internal tibial rotation and was shown to be injured in 11 to 79% of ACL tears on preoperative MRI. 19 20…”

“…19 In particular, the ALL plays a key role in controlling internal tibial rotation and was shown to be injured in 11 to 79% of ACL tears on preoperative MRI. 19 20…”

“…10 An additional consideration in athletes is the status of the anterolateral complex, which is vulnerable in the setting of an ACL injury and includes the superficial iliotibial band, the deep iliotibial band, the anterolateral ligament (ALL), and the joint capsule. 19 In particular, the ALL plays a key role in controlling internal tibial rotation and was shown to be injured in 11 to 79% of ACL tears on preoperative MRI. 19,20 The ALL has a variable morphology and is best seen on coronal and axial MR sequences, with attachments posterior and proximal to the lateral femoral epicondyle proximally, and between the anterior border of the fibular head and posterior border of Gerdy's tubercle distally (►Fig.…”

“…19 In particular, the ALL plays a key role in controlling internal tibial rotation and was shown to be injured in 11 to 79% of ACL tears on preoperative MRI. 19,20 The ALL has a variable morphology and is best seen on coronal and axial MR sequences, with attachments posterior and proximal to the lateral femoral epicondyle proximally, and between the anterior border of the fibular head and posterior border of Gerdy's tubercle distally (►Fig. 1).…”

“…19,21 Because persistent anterolateral rotary instability is associated with graft failure and an indication for ACL reconstruction revision, reinforcement of the anterolateral complex with lateral extra-articular tenodesis may be considered in athletes. 19,22 As with ACL reconstruction, lateral extra-articular tenodesis has varied graft options to provide lateral reinforcement; however, portions of the iliotibial band are frequently used. 22 When the iliotibial band is used as a graft site, a slip is attached to the lateral femoral epicondyle and the distal insertion is left in situ, and an iliotibial band gap at the graft harvest site is a normal postoperative appearance.…”