The operative treatment of ruptured internal lateral ligament of the knee

Abstract

THE internal lateral ligament of the knee is a large complex structure which forms the inner aspect of the capsule of the knee-joint, of which it is in reality only a thickening. It is usually described as consisting of two definite and distinct portions, a long outer or superficial portion, and a short inner or deep portion ; but thew two apparently separate structures are only different parts of the same ligament.It consists of a large bundle of fibres which run from the femur almost vertically clown t o the tibia. The longer fibres are inserted a t the femoral end into a small dcpression on the inner aspect of the femur just below the addilctor tubercle, and a t the other end into a wider area on the inner aspect of the shaft of the tibia about one inch below the level of the knee-joint. The deeper short fibres are inserted, like the superficial, into both the femur and the tibia, close to the articular edges of the bones, and in addition have an attachment t o the flat inncr surface of the internal semilunar cartilage. This attachment of the internal lateral ligament t o the internal semilunar cartilage renders the ligament much more complicated in its structure and in its action than is the case with the external lateral ligament, which is only attached t o the femur and t o the head of the fibula, and has no attachment t o the external semilunar cartilage.I n order t o understand the action and injuries of the internal lateral ligament, it is necessary t o comprehend clearly its structure and points of attachment, especially of the deeper portion, because on this depends largely the occurrence of complications in injuries of the ligament. The deep portion is attached above to the lower end of the femur and below t o the upper end of the tibia, in each case close t o the articular surface and in combination with the capsule of the joint. I n its course it is attached, in association with the capsule, t o the inner flat aspect of the internal semilunar cartilage ; but the length of the ligament between its attachment t o the femur and the cartilage is not the same as t h a t between its attachment t o the tibia and the cartilage.The internal semilunar cartilage is closely bound down t o the head of the tibia by its anterior and posterior cornug, and attached round its outer border by the capsule and by the internal lateral ligament, so that in any movement of the knee-joint the cartilage moves in conjunction with the head of the tibia, and only the very slightest amount of movement is present between these two structures, except in the case of an internal derangement of t h r knee-joint. Between the cartilage and the femur, however, there is movement on any change of position of the joint, so that the portion of the ligament between the femur and the cartilage must necessarily be longer than would be necessary t o bridge the space between these two structures when the joint is at rest.When the knee-joint is fully extended, both parts of the internal lateral ligament are tense, so that no lateral mobility can ...

Review of Jones (1963) on ‘Reconstruction of the anterior cruciate ligament. A technique using the central one-third of the patellar ligament‘

“…Many operations have been described to reconstruct the ACL, bearing therefore witness to the fact that none is totally satisfactory in reproducing its morphological and biomechanical properties. In 1919, McMurray used the semitendinosus tendon to replace the medial ligament of the knee,17 and Helfet18 in 1948 modified this procedure by cutting a single groove in the femur in the line of the ACL, permitting the tendon to run freely in it.…”