Arthroscopic Identification of the Anterolateral Ligament of the Knee

Abstract

Intense interest has focused on the recent description of the anterolateral ligament of the knee. Advancing knowledge of its anatomy and function is leading to a realization of its importance in the rotatory control of the tibia in anterior cruciate ligament injuries. Reconstruction of this structure will increasingly become an important goal during anterior cruciate ligament reconstruction. However, preoperative assessment of this ligament is difficult. Clinical assessment of rotatory laxity has poor reproducibility, and it is difficult to define using current imaging techniques. This article is the first to describe a safe and reproducible arthroscopic technique to allow identification and examination of the anterolateral ligament of the knee. With the knee at 90 of flexion, the arthroscope is introduced through the anterolateral portal to allow clear visualization of the lateral gutter. Under direct vision, an accessory portal is made over the inferior limit of the lateral gutter. A shaver is then introduced through this portal and used to debride this synovial recess and define the anterolateral ligament. This allows the surgeon to examine the integrity of the anterolateral ligament, in particular its femoral insertion. If required, this additional information can facilitate the performance of a more accurate and effective extra-articular reconstruction.

The meniscal insertion of the knee anterolateral ligament

“…SonneryCottet et al [24] demonstrated an arthroscopic technique for ALL visualization; however, they only managed to visualize the most proximal portion of the ligament. According to the anatomical and resonance parameters In this image, it is possible to observe the spreading of ligament fibers immediately before the meniscal insertion Surg Radiol Anat described, the ALL insertion in the meniscus region should correspond to the location with narrower meniscal width, as it could serve as a guide in a possible attempt at arthroscopic location of this structure [7,10].…”

A Review of the Anterolateral Ligament of the Knee: Current Knowledge Regarding Its Incidence, Anatomy, Biomechanics, and Surgical Dissection

“…One of these articles was a recent technical note describing the arthroscopic identification of the ALL in a single patient, 13 which was not found to be adequate for data extraction and systematic review. Another article was a letter to the editor describing the identification of the ALL on magnetic resonance imaging (MRI), 14 which had an inadequate description of methods and, thus, was excluded.…”

An anatomical and MRI assessment of the of anterolateral ligament

“…We did observe a connection between the ALL and lateral meniscus, which was also seen by many other investigators. Under arthroscopy, Sonnery-Cottet [15] observed the ALL to connect with the lateral meniscus as it passed though the lateral meniscus. Our anatomical findings of the ALL are consistent with descriptions provided from previous research on the ALL.…”