Abstract:Background. The morphology and function of anterolateral ligament (ALL) of the knee are not clearly understood even today with all the sophisticated techniques available. There have been differing descriptions of the ALL of the knee in literature, and not all of them have been named or described clearly. Aim. The present study was undertaken to provide a clear structure/relationship description on ALL. Materials and Methods. We used 24 formalin-fixed cadaveric limbs. Knee regions of the all the limbs were neat… Show more
“…However, the main difference is that they only recommend searching for the ALL after total isolation of the LCL. Similarly, using the LCL as reference, Potu et al [9] dissected cadavers fixed in formalin and found the ALL in only 4.6% of the cases. Due to the anterolateral path overlapping the proximal LCL fibers, if the LCL is completed isolated, the most proximal fibers of the ALL will need to be removed, what could affect is proper isolation and interfere in the dissection results.…”
Section: Discussionmentioning
confidence: 99%
“…It measures between 34 and 59 mm long, 4.0 mm and 7.0 mm high and around 2 mm thick in men and 1 mm in women. It originates near the lateral epicondyle of the femur and is inserted between Gerdy’s tubercle and the fibular head, expanding to the lateral meniscus [1–3, 6–9]. Fig.…”
Background
The number of studies and clinical interest in the anterolateral ligament of the knee (ALL) has grown in recent years. A meticulous and accurate ALL dissection is vital in anatomic and biomechanical studies, and a standardized technique is not yet established. As such, the aim of this study was to describe a step-by-step ALL dissection technique that could help authors consistently identify the ALL.
Methods
Twenty knees from frozen adult cadavers, with no preference for sex or age, were included in the study. All the cadavers were dissected using the same technique to determine the incidence of the ALL.
Results
A transverse incision is performed in the iliotibial band (ITB), around 10 cm proximal to the topography of the lateral epicondyle of the femur. Next, the ITB undergoes anterograde blunt dissection until its insertion at Gerdy’s tubercle in the tibia. Maintaining biceps femoris insertion, a dissection is performed anteriorly to it, until the lateral collateral ligament (LCL) is found. Using the LCL, internal rotation and 30 to 60° flexion as references, the ALL can be located in the anterolateral topography of the knee, with its origin near the lateral epicondyle (proximal and posterior) and insertion between Gerdy’s tubercle and the fibula (4.0 mm to 7.0 mm below the tibial plateau), expanding to the lateral meniscus (between the body and anterior horn), exhibiting a mean length of 4.0 ± 0.4 cm and mean width of 5.5 ± 0.8 mm.
Conclusions
The present article describes an effective and reproducible ALL dissection technique that made it was possible to identify the ligament in 100% of the cases in the present study.
Electronic supplementary material
The online version of this article (10.1186/s12891-019-2517-0) contains supplementary material, which is available to authorized users.
“…However, the main difference is that they only recommend searching for the ALL after total isolation of the LCL. Similarly, using the LCL as reference, Potu et al [9] dissected cadavers fixed in formalin and found the ALL in only 4.6% of the cases. Due to the anterolateral path overlapping the proximal LCL fibers, if the LCL is completed isolated, the most proximal fibers of the ALL will need to be removed, what could affect is proper isolation and interfere in the dissection results.…”
Section: Discussionmentioning
confidence: 99%
“…It measures between 34 and 59 mm long, 4.0 mm and 7.0 mm high and around 2 mm thick in men and 1 mm in women. It originates near the lateral epicondyle of the femur and is inserted between Gerdy’s tubercle and the fibular head, expanding to the lateral meniscus [1–3, 6–9]. Fig.…”
Background
The number of studies and clinical interest in the anterolateral ligament of the knee (ALL) has grown in recent years. A meticulous and accurate ALL dissection is vital in anatomic and biomechanical studies, and a standardized technique is not yet established. As such, the aim of this study was to describe a step-by-step ALL dissection technique that could help authors consistently identify the ALL.
Methods
Twenty knees from frozen adult cadavers, with no preference for sex or age, were included in the study. All the cadavers were dissected using the same technique to determine the incidence of the ALL.
Results
A transverse incision is performed in the iliotibial band (ITB), around 10 cm proximal to the topography of the lateral epicondyle of the femur. Next, the ITB undergoes anterograde blunt dissection until its insertion at Gerdy’s tubercle in the tibia. Maintaining biceps femoris insertion, a dissection is performed anteriorly to it, until the lateral collateral ligament (LCL) is found. Using the LCL, internal rotation and 30 to 60° flexion as references, the ALL can be located in the anterolateral topography of the knee, with its origin near the lateral epicondyle (proximal and posterior) and insertion between Gerdy’s tubercle and the fibula (4.0 mm to 7.0 mm below the tibial plateau), expanding to the lateral meniscus (between the body and anterior horn), exhibiting a mean length of 4.0 ± 0.4 cm and mean width of 5.5 ± 0.8 mm.
Conclusions
The present article describes an effective and reproducible ALL dissection technique that made it was possible to identify the ligament in 100% of the cases in the present study.
Electronic supplementary material
The online version of this article (10.1186/s12891-019-2517-0) contains supplementary material, which is available to authorized users.
“…This recalls the morphology of the posterior part of the tibial collateral ligament. However, some authors have described a bifurcation of the ALL distally into two different attachments: the suprameniscal fibers that run into the lateral meniscus, and the inframeniscal fibers that extend from the meniscus to the anterolateral aspect of the tibia (Helito et al, , 2016a, ; Kosy et al, ; Parker and Smith, , Potu et al, ; Van Dyck et al, ; Corbo et al, ; Roessler et al, ).…”
“…поэтому алс не восстанавливали при хирургических вмешательствах по поводу разрыва передней крестообразной связки (пкс) до 2013 г. значимость данной структуры для реконструктивной хирургии возросла после того, как последующие исследования доказали участие алс в ротационной стабильности коленного сустава [12][13][14][15][16]. однако результаты топографо-анатомических исследований антеролатеральной связки коленного сустава во многом противоречивы и явно недостаточны [17], что требует ее дальнейшего изучения. anterolateral ligament (all) is known since it was found in 1879 by paul Segond.…”
Background: anterolateral ligament (ALL) is known since it was found in 1879 by Paul Segond. During more than 130 years this anatomical structure was not popular, later it became especially relevant, when its involvement in knee joint rotational stability was demonstrated by different studies. However, data about anterolateral ligament in the knee joint is controversial and limited so further research is necessary.Purpose of the study: to investigate frequency of occurrence, severity and features of topography of anterolateral ligament of the knee joint in the context of stabilizing procedures on the knee joint.Materials and methods: the study included 60 samples of lower limbs obtained from 30 unfixed corpses of people who died at the age from 69 to 99 years. Topography-anatomical study was performed with knee bent at 90° with internal rotation of lower leg using basic surgical instruments set and precision preparation instruments set. When the ligament was identified, relationship with the lateral meniscus body was evaluated, relationship with peroneal collateral ligament (mainly by connective fibers) and the presence of lateral lower knee vessels (artery and veins) were evaluated. Also, the place of ligament attachment on lateral epicondyle of femur and lateral condyle of tibia were measured.Results: the incidence of ALL in studied age group is 56.6 percent. ALL was observed in both knee joints in 100% of cases. In women ALL was observed in 66.7% (24 joints out of 36), in men — 41.6% (10 joint out of 24). The average length of the ALL was 38.5±4.4 mm. The average width at the level of joint gap — 4.45±0.85 mm.The location of the attachment to the lateral epicondyle of the femur was represented in three anatomical variants: posterior and proximal to the lateral collateral ligament — 64.7%, anterior to the lateral collateral ligament — 23.5%, in the place of attachment of popliteal muscle tendon or next to it — 11.8%. The place of attachment on lateral condyle of the tibia is typical — approximately in the middle of the line from fibula head to Gerdy tubercle.Conclusion. Based on the authors’ findings and findings of foreign studies the optimal area for proximal channel formation is the posterior position and proximal to place of lateral collateral ligament beginning. Also, the anatomical regularity of lateral lower knee vessels is obtained, that allows to preserve one of the main blood supply sources of anterolateral area of the knee joint.
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