Anatomy of the Anterolateral Ligament of the Knee: A Systematic Review

Editorial Commentary: Extension of Knowledge—and the Knee! New Biomechanical Study Suggests the Clinical Practice of Anterolateral Ligament Fixation Near Extension

“…Apart from some remaining controversy, the ALL is currently accepted as a true ligament in the anterolateral portion of the knee with a femoral attachment posterior and proximal to the lateral epicondyle 36 and an antero-inferior path to the periphery of the lateral meniscus 37 and to the anterolateral tibia, 38 between Gerdy's tubercle and the fibular head. A recent systematic review by de Lima et al 39 and 2 consensus papers led by Getgood et al 40 (hosted by Al Getgood and Charlie Brown Jr. in London, 2017) and Sonnery-Cottet et al 41 (hosted by Bertrand Sonnery-Cottet and Steven Claes in Lyon, France, 2015) clearly pointed this out. Biomechanical studies still show some controversy, but it is now accepted that if there is a combined lesion of the ACL and the anterolateral structures, ACL reconstruction alone does not reestablish normal knee kinematics, as shown again by Inderhaug et al 42 and the Imperial College group and also by Geeslin et al 43 from LaPrade's group in Colorado.…”

Editorial Commentary: Anatomy of the Anterolateral Ligament of the Knee—The Science of Looking for Bigfoot

“…Within this context, de Lima et al 1 sought to review all histologic, radiographic, and cadaveric investigations of the ALL since 2012. Table 1 in their article serves as an excellent reference for persons interested in the 34 various cadaveric dissections the authors review.…”

“…[6][7][8][9] Their work would generally not support the concept that the ALL is a separate structure worthy of the term "ligament." Regrettably, much of their work on the subject was not reviewed because de Lima et al 1 limited their searches to "anterolateral ligament." They rightly acknowledged that their search could and indeed did miss studies calling the collagen in question the "lateral capsule ligament" or "anterolateral complex.…”

Editorial Commentary: Anterolateral Ligament—Anatomy, Evaluation, and Future Applications to Knee Stability

“…To the frustrationdand perhaps also the fascinationdof the community that has contributed to the literature in recent history, the nature and clinical relevance of the ALL remain elusive. Just as cadaveric dissections have differed on the presence [8][9][10][11] or absence [12][13][14][15] of the ALL, as well as its anatomic variation and parameters, [14][15][16] so too have biomechanical studies questioned the understanding of this area. 17,18 Studies have shown the ALL is absent in up to 88% of pediatric cadavers, 12 and when present, the femoral origin point has significant variability regarding the physeal scar and the lateral collateral ligament.…”