Anterolateral Ligament of the Knee: a Step-by-step Dissection

Overview

Journal BMC Musculoskelet Disord

Publisher Biomed Central

Specialties Orthopedics
Physiology

Date 2019 Apr 6

PMID 30947710

Citations 8

Authors

Diego Ariel de Lima

Camilo Partezani Helito

Matthew Daggett

Francisco Magalhaes Monteiro Neto

Lana Lacerda de Lima

Jose Alberto Dias Leite

Maria Luzete Costa Cavalcante

Affiliations

Soon will be listed here.

Abstract

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.

Citing Articles

The Top 100 Most Cited Articles on Anterolateral Ligament: A Bibliometric Analysis and Review.

Helito C, Araujo V, Canuto S, Jorge P, Padua V, Ariel de Lima D Rev Bras Ortop (Sao Paulo). 2025; 60(1):1-14.

PMID: 40041747 PMC: 11879490. DOI: 10.1055/s-0044-1800939.

Anterolateral corner of knee: Current concepts.

Meena A, Attri M, Farinelli L, Campos V, Rajpal K, DAmbrosi R J Exp Orthop. 2025; 12(1):e70172.

PMID: 39931146 PMC: 11808268. DOI: 10.1002/jeo2.70172.

Morphological Description of the Embryonic to Fetal Development of the Menisco- Tibio-Popliteus-Fibular Complex and the Anterolateral Ligament.

Morales-Avalos R, Lopez-Serna N, Erosa-Villarreal R, Padilla-Medina J, Cortes-Alvarez C, Torres-Gonzalez V Orthop J Sports Med. 2024; 12(12):23259671241302770.

PMID: 39697604 PMC: 11653441. DOI: 10.1177/23259671241302770.

Combined Reconstruction of the Anterior Cruciate Ligament and Anterolateral Ligament: Triple-Strand Braided Hamstring Graft for the Anterior Cruciate Ligament and Gracilis Strand for the Anterolateral Ligament With a Single Femoral Tunnel.

Ariel de Lima D, Helito C, Canuto S Arthrosc Tech. 2024; 13(8):103023.

PMID: 39233804 PMC: 11369946. DOI: 10.1016/j.eats.2024.103023.

Anatomical and Biomechanical Characteristics of the Anterolateral Ligament: A Descriptive Korean Cadaveric Study Using a Triaxial Accelerometer.

Suh D, Cho I, Noh S, Yoon D, Jang K Medicina (Kaunas). 2023; 59(2).

PMID: 36837620 PMC: 9964873. DOI: 10.3390/medicina59020419.

References

Vincent J, Magnussen R, Gezmez F, Uguen A, Jacobi M, Weppe F . The anterolateral ligament of the human knee: an anatomic and histologic study. Knee Surg Sports Traumatol Arthrosc. 2011; 20(1):147-52. DOI: 10.1007/s00167-011-1580-3. View

Claes S, Vereecke E, Maes M, Victor J, Verdonk P, Bellemans J . Anatomy of the anterolateral ligament of the knee. J Anat. 2013; 223(4):321-8. PMC: 3791125. DOI: 10.1111/joa.12087. View

Dodds A, Halewood C, Gupte C, Williams A, Amis A . The anterolateral ligament: Anatomy, length changes and association with the Segond fracture. Bone Joint J. 2014; 96-B(3):325-31. DOI: 10.1302/0301-620X.96B3.33033. View

Helito C, Demange M, Bonadio M, Passareli Tirico L, Gobbi R, Pecora J . Radiographic landmarks for locating the femoral origin and tibial insertion of the knee anterolateral ligament. Am J Sports Med. 2014; 42(10):2356-62. DOI: 10.1177/0363546514543770. View

Claes S, Luyckx T, Vereecke E, Bellemans J . The Segond fracture: a bony injury of the anterolateral ligament of the knee. Arthroscopy. 2014; 30(11):1475-82. DOI: 10.1016/j.arthro.2014.05.039. View

Pomajzl R, Maerz T, Shams C, Guettler J, Bicos J . A review of the anterolateral ligament of the knee: current knowledge regarding its incidence, anatomy, biomechanics, and surgical dissection. Arthroscopy. 2014; 31(3):583-91. DOI: 10.1016/j.arthro.2014.09.010. View

Sonnery-Cottet B, Thaunat M, Freychet B, Pupim B, Murphy C, Claes S . Outcome of a Combined Anterior Cruciate Ligament and Anterolateral Ligament Reconstruction Technique With a Minimum 2-Year Follow-up. Am J Sports Med. 2015; 43(7):1598-605. DOI: 10.1177/0363546515571571. View

van der Watt L, Khan M, Rothrauff B, Ayeni O, Musahl V, Getgood A . The structure and function of the anterolateral ligament of the knee: a systematic review. Arthroscopy. 2015; 31(3):569-82.e3. DOI: 10.1016/j.arthro.2014.12.015. View

Helito C, Bonadio M, Soares T, da Mota E Albuquerque R, Natalino R, Pecora J . The meniscal insertion of the knee anterolateral ligament. Surg Radiol Anat. 2015; 38(2):223-8. DOI: 10.1007/s00276-015-1533-5. View

10.

Helito C, Demange M, Bonadio M, Tirico L, Gobbi R, Pecora J . Anatomy and Histology of the Knee Anterolateral Ligament. Orthop J Sports Med. 2015; 1(7):2325967113513546. PMC: 4555517. DOI: 10.1177/2325967113513546. View

11.

Helito C, Partezani Helito P, Bonadio M, Pecora J, Bordalo-Rodrigues M, Camanho G . Correlation of Magnetic Resonance Imaging With Knee Anterolateral Ligament Anatomy: A Cadaveric Study. Orthop J Sports Med. 2016; 3(12):2325967115621024. PMC: 4710116. DOI: 10.1177/2325967115621024. View

12.

Kosy J, Soni A, Venkatesh R, Mandalia V . The anterolateral ligament of the knee: unwrapping the enigma. Anatomical study and comparison to previous reports. J Orthop Traumatol. 2016; 17(4):303-308. PMC: 5071230. DOI: 10.1007/s10195-016-0392-0. View

13.

Sonnery-Cottet B, Lutz C, Daggett M, Dalmay F, Freychet B, Niglis L . The Involvement of the Anterolateral Ligament in Rotational Control of the Knee. Am J Sports Med. 2016; 44(5):1209-14. DOI: 10.1177/0363546515625282. View

14.

Daggett M, Busch K, Sonnery-Cottet B . Surgical Dissection of the Anterolateral Ligament. Arthrosc Tech. 2016; 5(1):e185-8. PMC: 4886040. DOI: 10.1016/j.eats.2015.10.019. View

15.

Shea K, Polousky J, Jacobs Jr J, Yen Y, Ganley T . The Anterolateral Ligament of the Knee: An Inconsistent Finding in Pediatric Cadaveric Specimens. J Pediatr Orthop. 2016; 36(5):e51-4. DOI: 10.1097/BPO.0000000000000616. View

16.

Watanabe J, Suzuki D, Mizoguchi S, Yoshida S, Fujimiya M . The anterolateral ligament in a Japanese population: Study on prevalence and morphology. J Orthop Sci. 2016; 21(5):647-51. DOI: 10.1016/j.jos.2016.06.004. View

17.

Potu B, Salem A, Abu-Hijleh M . Morphology of Anterolateral Ligament of the Knee: A Cadaveric Observation with Clinical Insight. Adv Med. 2016; 2016:9182863. PMC: 5099490. DOI: 10.1155/2016/9182863. View

18.

Parker M, Smith H . Anatomical variation in the anterolateral ligament of the knee and a new dissection technique for embalmed cadaveric specimens. Anat Sci Int. 2016; 93(2):177-187. DOI: 10.1007/s12565-016-0386-2. View

19.

Roessler P, Schuttler K, Stein T, Gravius S, Heyse T, Prescher A . Anatomic dissection of the anterolateral ligament (ALL) in paired fresh-frozen cadaveric knee joints. Arch Orthop Trauma Surg. 2016; 137(2):249-255. DOI: 10.1007/s00402-016-2617-3. View

20.

Helito C, do Amaral Jr C, Nakamichi Y, Gobbi R, Bonadio M, Natalino R . Why Do Authors Differ With Regard to the Femoral and Meniscal Anatomic Parameters of the Knee Anterolateral Ligament?: Dissection by Layers and a Description of Its Superficial and Deep Layers. Orthop J Sports Med. 2017; 4(12):2325967116675604. PMC: 5298406. DOI: 10.1177/2325967116675604. View