Anterolateral Ligament of the Knee Shows Variable Anatomy in Pediatric Specimens

Abstract

This study expands our understanding of the anterolateral ligament and provides important anatomic information to surgeons considering anterolateral ligament reconstruction concomitantly with primary or revision ACL reconstruction in pediatric athletes.

An Overview of Anatomy and Imaging of the Anterolateral Structures of the Knee

“…Anatomic studies in pediatric specimens were able to isolate the ALL in the minority of the specimens; hence, it was suggested that the ALL might not be present at the beginning of development, appearing in the capsular region because of in situ mechanical forces. 24 , 25 After this assumption, studies on fetal specimens were performed by Helito et al 26 and Toro-Ibarguen et al, 27 and clearly found the ALL in 100% of cases, despite some controversy caused by the study of Sabzevari et al 28 that failed to identify this structure.…”

Combined Anterolateral Ligament Reconstruction and Capsular Reinforcement in the Skeletally Immature Knee

“…With the knee in flexion, the lateral epicondyle is palpated through the proximal incision. Although the femoral attachment of the ALL is the subject of debate, especially in children, 11 , 17 , 18 , 19 , 20 , 21 the most commonly cited attachment point is just posterior and proximal to the lateral epicondyle. Accordingly, this point is identified within the proximal incision, and the overlying soft tissues are carefully dissected.…”

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.…”

“…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. 13 The function and biomechanical parameters of a modest "capsular thickening" are quite distinct from a substantial anatomic structure such as the medial collateral ligament, lateral collateral ligament, or ACL. Although MRI may be the gold standard by which we characterize ligament damage, evidence suggests that the anterolateral capsule may behave less like a traditional ligament but rather a sheet-like structure akin to the inferior glenohumeral ligament.…”