Anatomical and Biomechanical Characteristics of the Anterolateral Ligament: A Descriptive Korean Cadaveric Study Using a Triaxial Accelerometer

Abstract

Background and Objectives: The anterolateral ligament (ALL) could be the potential anatomical structure responsible for rotational instability after anterior cruciate ligament (ACL) reconstruction. The purpose of this study was to investigate the anatomical and biomechanical characteristics of the ALL in Korean cadaveric knee joints. Materials and Methods: Twenty fresh-frozen cadaveric knees were dissected and tested. Femoral and tibial footprints of the ALL were recorded. Pivot shift and Lachman tests were measured with KiRA. Results: The prevalence of ALL was 100%. The average distance of the tibial footprint to the tip of the fibular head was 19.85 ± 3.41 mm; from the tibial footprint to Gerdy’s tubercle (GT) was 18.3 ± 4.19 mm; from the femoral footprint to the lateral femoral epicondyle was 10.25 ± 2.97 mm. ALL’s footprint distance was the longest at 30° of flexion (47.83 ± 8.05 mm, p < 0.01) in a knee with intact ALL–ACL and neutral rotation. During internal rotation, the footprint distance was the longest at 30° of flexion (50.05 ± 8.88 mm, p < 0.01). Internal rotation produced a significant increase at all three angles after ACL–ALL were transected (p = 0.022), where the footprint distance was the longest at 30° of flexion (52.05 ± 7.60 mm). No significant difference was observed in KiRA measurements between intact ALL–ACL and ALL-transected knees for pivot shift and Lachman tests. However, ACL–ALL-transected knees showed significant differences compared to the intact ALL–ACL and ALL-transected knees (p < 0.01). Conclusions: The ALL was identified as a distinct ligament structure with a 100% prevalence in this cadaveric study. The ALL plays a protective role in internal rotational stability. An isolated ALL transection did not significantly affect the ALL footprint distances or functional stability tests. Therefore, the ALL is thought to act as a secondary supportive stabilizer for rotational stability of the knee joint in conjunction with the ACL.

Progress in research on and classification of surgical methods of arthroscopic reconstruction of the ACL and ALL using a shared tendon graft through the femoral tunnel

“…Among them, the triaxial accelerometer is a small, non-invasive system that is easy to apply in clinical practice. It evaluates the phenomenon of pivot shift by measuring tibial acceleration, which more accurately quantifies the axial displacement experiment, making the diagnostic axial displacement test more standardized (35). In terms of imaging diagnosis, the reference value for ALL injury in x-ray films is limited, and only Segond fracture can indirectly determine ALL fracture.…”

Incidence of Convergence Between Distally and Anteriorly Oriented ALL Femoral Tunnels and ACL Femoral Tunnels in Combined ACL and ALL Reconstruction: 3-Dimensional Computed Tomography Analysis of 227 Patients

“…The anterolateral ligament (ALL) is a distinct ligament at the anterolateral aspect of the knee, with its femoral attachment located posterior and proximal to the lateral epicondyle. 21,23 Within the last decade, there have been multiple studies published on the anatomic and biome-chanical characteristics of the ALL. 2,7,13,16,23,26 ALL reconstruction in conjunction with anterior cruciate ligament (ACL) reconstruction has been shown to improve stability and lower failure rates compared with isolated ACL reconstruction.…”

“…21,23 Within the last decade, there have been multiple studies published on the anatomic and biome-chanical characteristics of the ALL. 2,7,13,16,23,26 ALL reconstruction in conjunction with anterior cruciate ligament (ACL) reconstruction has been shown to improve stability and lower failure rates compared with isolated ACL reconstruction. 1,5,6,22 Even though ALL reconstruction has been previously limited to patients undergoing revision ACL surgery after failed ACL reconstruction, indications are now being extended to patients at a high risk of ACL rerupture.…”