IJAR.2018.194

Type of Article:  Original Research

Volume 6; Issue 2.3 (June 2018)

Page No.: 5316-5319

DOI: https://dx.doi.org/10.16965/ijar.2018.194

THE ANTEROLATERAL LIGAMENT OF THE KNEE: EMERGING INTEREST FOR RECONSTRUCTIVE SURGERY

Anita Rahul Gune *1, Dhanaji T Wagh 2, Vasudha R Nikam 3.

*1 Associate Professor, Dept. of Anatomy, D.Y.Patil Medical College, Kolhapur, Maharashtra, India.

2 Tutor, Dept. of Anatomy, D.Y.Patil Medical College, Kolhapur, Maharashtra, India.

3 Associate Dean, Professor and HOD, Dept. of Anatomy, D. Y. Patil Medical College, Kolhapur, Maharashtra, India.

Address for correspondence: Dr. Anita Rahul Gune, MS Anatomy, D.G.O (CPS), Associate Professor, Dept. of Anatomy,  Dr. D.Y.Patil Medical College, Kolhapur 416006.Maharashtra, India. Phone 0231 2658770, 9922108770 E-Mail: anitargune@gmail.com

ABSTRACT:

Background: The anterolateral ligament (ALL) originates from the lateral epicondyle of the femur and inserts on the tibia in between Gerdy’s tubercle (GT) and fibula head (FH). The ALL exists as a ligamentous structure that becomes taut if tibia is rotated 30° medially. It has been suggested that the ALL of the knee has importance in limiting rotational instability, and reconstruction of the same along with anterior cruciate ligament (ACL) may prevent a continued pivot-shift following surgery.  We describe our experience of cadaveric dissection with reference to other published.

Materials and Methods: This study was conducted in Department of Anatomy, D.Y.Patil Medical College, Kolhapur from 2016 to 2018. The ALL was identified in 14 Females and 16 Males cadavers, total 60 knee joints. The ALL tissue was identified with internal rotation of the tibia. Measurements were made using a digital calliper and details of the origin and insertion were recorded.

Results: The ALL was identified had mean dimensions were: length 38.06 ±3 mm on Right side and 37.94 ± 3 mm on Left side, width 4.38 ± 0.25 mm on Right side and 4.37 ± 0.25 mm on Left side, thickness 0.9 ± 0.02 mm on Right side and 0.9 ± 0.02 mm on Left side. The femoral origin Posterior and Proximal (PP) in 23, Anterior and Distal (AD) in 29 and Femoral Lateral Epicondyle in 8 knee joint. The tibial insertion was a mean 1.79 ± 0.3 mm on Right side and 1.82 ± 0.3 mm on Left side from Gerdy’s tubercle (GT) and 1.28 ± 0.03mm on Right side and 1.25 ± 0.03 mm on Left side from the fibula head (FH).

Conclusions: Our results go along the studies describing that the ALL is a capsular thickening and has meniscal attachment. The findings will help surgeon to perform reconstructive surgery and also help them to select the appropriate graft.  Further, we feel this ligament should be added in all gross anatomy book so that medical undergraduates are also aware of ALL.

Key words: Anterolateral Ligament (ALL), Anterior Cruciate Ligament (ACL), Reconstructive surgery.

REFERENCES

  1. Caterine S, Litchfield R, Johnson M, Chronik B, Getgood A. A cadaveric study of the anterolateral ligament: re-introducing the lateral capsular ligament. Knee Surgery, Sports Traumatology, Arthroscopy. 2015 Nov 1;23(11):3186-95.
  2. Vincent JP, Magnussen RA, Gezmez F, Uguen A, Jacobi M, Weppe F, Al-Saati MF, Lustig S, Demey G, Servien E, Neyret P. The anterolateral ligament of the human knee: an anatomic and histologic study. Knee Surg Sports Traumatol Arthrosc 2012;20:147–152.doi: 10.1007/s00167-011-1580-3
  3. Monaco E, Ferretti A, Labianca L, Maestri B, Speranza A, Kelly MJ, D’Arrigo C. Navigated knee kinematics after cutting of the ACL and its secondary restraint. Knee Surg Sports Trau matol Arthrosc. 2012;20:870–877. doi:10.1007/s00167-011-1640-8
  4. Colombet P. Knee laxity control in revision anterior cruciate ligament reconstruction versus anterior cruciate ligament reconstruction and lateral tenodesis: clinical assessment using computer-assisted navigation. Am J Sports Med 2012;39:1248–1254. doi:10.1177/0363546510395462
  5. Helito CP, Demange MK, Bonadio MB, Tırico LEP, Gobbi RG, Pecora JR, Camanho GL. Anatomy and histology of the knee anterolateral ligament. Orthop J Sports Med 2013;1:1–5. doi: 10. 1177/2325967113513546
  6. Trojani C, Beaufils P, Burdin G, Bussie`re C, Chassaing V, Djian P, Dubrana F, Ehkirch FP, Franceschi JP, Hulet C, Jouve F, Potel JF, Sbihi A, Neyret P, Colombet P. Revision ACL reconstruction: influence of a lateral tenodesis. Knee Surg Sports Traumatol Arthrosc 2012; 20:1565–1570. doi:10.1007/s00167-011-1765-9.
  7. Vadala AP, Iorio R, De Carli A, Bonifazi A, Iorio C, Gatti A, Rossi C, Ferretti A. An extra-articular procedure improves the clinical outcome in anterior cruciate ligament reconstruction with hamstrings in female athletes. Int Orthop 2013;37:187–192. doi:10.1007/s00264-012-1571-0
  8. Edwards DJ, Brown JN, Roberts SN, Paterson RS. Long-term results of anterior cruciate ligament reconstruction using ilio-tibial tract and semitendinosus tendon. Knee 2000;7:87–93.
  9. Marcacci M, Zaffagnini S, Giordano G, Iacono F, Presti ML. Anterior cruciate ligament reconstruction associated with extra-articular tenodesis: a prospective clinical and radiographic evaluation with 10- to 13-year follow-up. Am J Sports Med 2009;37:707–714. doi: 10.1177/0363546508328114.
  10. Pernin J, Verdonk P, Si Selmi TA, Massin P, Neyret P. Long-term follow-up of 24.5 years after intra-articular anterior cruciate ligament reconstruction with lateral extra-articular augmentation. Am J Sports Med 2010;38:1094–1102. doi:10.1177/ 0363546509361018 308
  11. LaPrade RF, Gilbert TJ, Bollom TS, Wentorf F, Chaljub G. The magnetic resonance imaging appearance of individual structures of the posterolateral knee. A prospective study of normal knees and knees with surgically verified grade III injuries. Am J Sports Med 2000;28:191–199.
  12. Campos JC, Chung CB, Lektrakul N, Pedowitz R, Trudell D, Yu J, Resnick D. Pathogenesis of the Segond fracture: anatomic and MR imaging evidence of the iliotibial tract or anterior oblique band avulsion. Radiology 2001;219:381–386.
  13. Dodds AL, Halewood C, Gupte CM, Williams A, Amis AA. The anterolateral ligament: anatomy, length changes and association with the Segond fracture. Bone Joint J 2014;96:325–331. doi:10.1302/0301-620X.96B3.33033
  14. Vieira EL, Vieira EA, da Silva RT, Berlfein PA, Abdalla RJ, Cohen M. An anatomic study of the iliotibial tract. Arthroscopy 2007;23:269–274. doi:10.1016/j.arthro.2006.11.019
  15. Claes S, Bartholomeeusen S, Bellemans J. High prevalence of anterolateral ligament abnormalities in magnetic resonance images of anterior cruciate ligament-injured knees. Acta Orthop Belg 2014;80:45–49.
  16. Helito CP, Helito PV, Costa HP, Bordalo-Rodrigues M, Pecora JR, Camanho GL, Demange MK. MRI evaluation of the anterolateral ligament of the knee: assessment in routine 1.5-T scans. Skeletal Radiol 2014;43:1421–1427. doi: 10.1007/s00256-014-1966-7.
  17. Helito CP, Demange MK, Bonadio MB, Tirico LE, Gobbi RG, Pecora JR, Camanho GL. Radiological markers for locating the femoral origin and tibial insertion of the knee anterolateral ligament. Am J Sports Med 2014;42:2356–2362. doi: 10.1177/ 0363546514543770.
  18. Rezansoff AJ, Caterine S, Spencer L, Tran MN, Litchfield RB, Getgood AM. Radiographic landmarks for surgical reconstruction of the anterolateral ligament of the knee. Knee Surgery, Sports Traumatology, Arthroscopy. 2015 Nov 1;23(11):3196-201.
  19. Claes S, Luyckx T, Vereecke E, Bellemans J. The Segond fracture: a bony injury of the anterolateral ligament of the knee. Arthroscopy. 2014 Nov 1;30(11):1475-82.
  20. Hughston JC, Andrews JR, Cross MJ, Moschi A. Classification of knee ligament instabilities. Part II. The lateral compartment Bone Joint Surg Am 1976;58:173–179.
  21. Caterine S, Litchfield R, Johnson M, Chronik B, Getgood A. A cadaveric study of the anterolateral ligament: re-introducing the lateral capsular ligament. Knee Surgery, Sports Traumatology, Arthroscopy. 2015 Nov 1;23(11):3186-95.
  22. laes S, Vereecke E, Maes M, Victor J, Verdonk P, Bellemans J. Anatomy of the anterolateral ligament of the knee. Journal of anatomy. 2013 Oct 1;223(4):321-8.
  23. Jonathan D. Kosy, Ashish Soni, Ramakrishnan Venkatesh, Vipul I. Mandalia. The anterolateral ligament of the knee: unwrapping the enigma. Anatomical study and comparison to previous reports. J Orthopaed Traumatol 2016;17:303–308 DOI 10.1007/s10195-016-0392-0
  24. Edwards DJ, Brown JN, Roberts SN, Paterson RS. Long term results of anterior cruciate ligament reconstruction using ilio-tibial tract and semitendinosus tendon. Knee 2000;7:87–93.

Cite this article: Anita Rahul Gune, Dhanaji T Wagh, Vasudha R Nikam. THE ANTEROLATERAL LIGAMENT OF THE KNEE: EMERGING INTEREST FOR RECONSTRUCTIVE SURGERY. Int J Anat Res 2018;6(2.3):5316-5319. DOI: 10.16965/ijar.2018.194