the anterolateral ligament (all) of the knee mimics the course of which structure?

The Anterolateral Ligament of the Knee (ALL) is described as a distinct ligamentous structure at the anterolateral aspect of the knee in 2013 Attachments[edit| edit source] Origin[edit| edit source] The prominence of the lateral femoral epicondyle, slightly anterior to the origin of the lateral collateral ligament.

Full Answer

Is the anterolateral ligament of the knee identified?

Abstract. The femoral attachment of the anterolateral ligament (ALL) of the knee is still under debate, but the tibial attachment is consistently between Gerdy's tubercle and the fibular head. The structure is less identifiable and more variable in younger patients. The ALL likely plays a role in rotational stability, but its impact on anterior ...

Is the anterolateral ligament a stabilizer?

The ALL had its greatest extend at 60° of knee flexion and maximal internal rotation. Conclusion: The ALL is a firm ligamentous structure in the anterolateral part of the knee present in 45.5% of the cases. Given the course and characteristics of this structure, a function in providing rotational stability by preventing internal rotation of ...

Is the extra-articular anterolateral structure important for rotational knee stability?

The anterolateral ligament of the knee mimics the course of which structure? IT Band According to the Surgical Technique Guide, the tibial 2.4 mm guide pin should be placed _____ posterior to Gerdy's tubercle and ______ distal to the joint line

What is the all ligament?

The Anterolateral Ligament of the Knee (ALL) ... Oblique course to the anterolateral aspect of the proximal tibia, with firm attachments to the lateral meniscus, thus enveloping the inferior lateral geniculate artery and vein. ... Given its structure and anatomic location, the ALL is hypothesized to control internal tibial rotation and thus to ...

What is the role of the All in the knee?

Clinical relevance: The ALL might be an important stabilizer in the knee and may play a significant role in preventing excessive internal tibial rotation and subluxation of the knee joint.

What is the ALL in the knee?

Conclusion: The ALL is a firm ligamentous structure in the anterolateral part of the knee present in 45.5% of the cases. Given the course and characteristics of this structure, a function in providing rotational stability by preventing internal rotation of the knee is likely.

What is the ALL in cadaveric knees?

Methods: Forty-four human cadaveric knees were dissected to reveal the ALL and other significant structures in the anterolateral compartment of the knee joint. The ALL was defined as a firm structure running in an oblique direction from the lateral femoral epicondyle to a bony insertion at the anterolateral tibia.

Where is the 6 division of clinical and functional anatomy?

6 Division of Clinical and Functional Anatomy, Medical University of Innsbruck (MUI), Innsbruck, Austria. Electronic address: Karl-Heinz.Kuenzel@i-med.ac.at.

Is the anterolateral ligament an anatomical structure?

Background: Recent studies have described the presence of the anterolateral ligament (ALL). However, there is still no consensus regarding the anatomy of this structure with the topic controversially discussed. The aim of this study was to provide an anatomical description of the ligamentous structures on the anterolateral side of the knee with special emphasis on the ALL.

Where is the anterolateral ligament visualized?

The anterolateral ligament (ALL) is best visualized on the PD-weighted fat saturation sequence on the coronal plane

What is the name of the ligament that shows tension during forced internal rotation?

The anterolateral ligament (ALL) of the knee was described by Segond in 1897 as “a pearly, resistant fibrous band which shows tension during forced internal rotation” [1].  Previously, it was unclear whether the ALL is part of the iliotibial band or a separate ligament entity, as evidenced by various names it was called, including “short lateral ligament,” “capsule-osseous layers of iliotibial band,” “mid third lateral capsular ligament,” and “lateral capsular ligament” [2-5].

What is the most commonly identified structure in a PD FS scan?

Out of the three components, the femoral part is the most commonly identified structure (n=27, 75%), followed by the meniscus part (n=25,69.4%) and the tibial part (n=21, 58.3%). ALLs are best visualized on PD FS coronal view, with the lateral inferior genicular artery acting as a guide to locate the bifurcation of the meniscal and tibial components (Figure ​(Figure1).1). Delineation of ALLs from other surrounding structures, such as lateral collateral ligaments, iliotibial band, and popliteus tendon, is done in both coronal and axial views.

What is the role of the all in avulsion fracture?

characterize the anatomy of the ALL, which was inserted to the exact location described in the Segond fracture [1-6].  Although not fully understood, the ALL was hypothesized to be a lateral stabilizer, as evidenced by its role in controlling tibial rotation that affects the pivot shift phenomenon [6].  Injury of the ALL has been attributed to up to 10% of patients who have persistent rotational instability and pivot shift after a successful ACL reconstruction [13,17,24].

What are the components of the ALL?

All components of the ALL (femoral, meniscal, and tibial ) are assessed and are labeled as either visualized or not visualized. When all three components of the ALL are seen, it is classified as a fully visualized ALL. Next, the ALLs are assessed for any abnormality, as evidenced by any obvious discontinuity in the fibers, irregular contours associated with periligamentous edema, or proximal or distal avulsion, with or without associated bone fragment [22-23].  Other intra-articular structures of the knee, including ACL, posterior cruciate ligament (PCL), medial meniscus (MM), and lateral meniscus (LM), as well as the medial and lateral collateral ligaments (MCL and LCL), are assessed for any injury.

What is the ALL in knee?

After detailed anatomi cal delineation of the anterolateral ligament (ALL) of the knee, there is a surge in research on this anatomical structure. Owing to the anatomical variation and lack of experience in the identification of this structure, magnetic resonance (MR) evaluation of the ALL produces mixed results. It was aimed to evaluate the ALL using the routinely performed MR imaging of the knee and to determine any associated factors with ALL injuries.

How many knees have ACL injuries?

Out of the 36 knee MR images included in this study, 11 (30.6%) have ALL injuries. There are also 19 knees (52.8%) with evidence of ACL injuries. This is followed by injuries of the medial meniscus (n=18, 50%), lateral meniscus (n=16, 44.4%), PCL (n=3, 8.3%), and lateral collateral ligament (n=1, 2.8%). There is no medial collateral ligament injury identified among all the knee MR images in this series. Among the 19 knees with evidence of ACL injuries, nine of them have concomitant ALL injuries. The association of ALL injuries with injuries of other ligamentous structure are highlighted in Table ​Table3.3. ACL injuries are found to be associated with ALL injuries (p=0.031). There is no association detected between ALL injuries and injuries of other structures such as medial meniscus (p=0.471), lateral meniscus (p=0.483), PCL (p=0.216), and lateral collateral ligament (p=1.0).

Where is the ALL located in the knee?

However, several anatomical studies did not show 100% prevalence of the ALL. Runer et al. defined the ALL as a ligamentous structure at the anterolateral side of the knee, with a bony origin at the lateral epicondylar region and an oblique course to a bony insertion at the anterolateral proximal tibia [ 16 ]. After removing the superficial, deep and capsular-osseous layer of the ITB, the ALL could be clearly identified only in 45.5% ( n = 20) of the dissected knees according to their definition. Recently, Roessler et al. suggested that the ALL could be identified as an independent ligamentous structure in front of the anterolateral joint capsule in only 60% ( n = 12) of the dissected knee joints [ 15 ].

Which ligament is used for modified Lemaire Tenodesis?

Modified Lemaire tenodesis passed superficial ( a) and deep ( b) to the lateral collateral ligament using the iliotibial band in a cadaveric knee, and anatomical anterolateral ligament (ALL) reconstruction using the gracilis tendon ( c)

How to reduce residual internal rotation after ACL reconstruction?

Several studies have suggested that anterolateral augmentation with the ITB could be an effective surgical method to reduce residual internal rotation and a positive pivot shift after ACL reconstruction [ 3, 11, 39 ]. To biomechanically compare various extra-articular anterolateral surgeries, Inderhaug et al. performed ACL reconstruction alone and in combination with the following: modified MacIntosh tenodesis, modified Lemaire tenodesis passed both superficial and deep to the lateral collateral ligament, and anatomical ALL reconstruction with 20 N and 40 N of graft tension [ 11 ]. In this study, the modified MacIntosh tenodesis was performed using a central strip of the ITB. The graft was routed deep to the LCL and fixed into the bone tunnel positioned 70 mm proximal to the femoral epicondyle. In the modified Lemaire tenodesis, the central strip of the ITB was routed deep to the LCL and fixed into a bone tunnel positioned proximal and slightly posterior to the lateral epicondyle. In the combined ACL plus anterolateral-injured knee, ACL reconstruction alone failed to restore intact knee kinematics when an anterior drawer force and internal torque was applied. The deep Lemaire and MacIntosh procedures restored rotational kinematics to the intact state, while the anatomical ALL reconstruction underconstrained internal rotation and the superficial Lemaire overconstrained internal rotation [ 11 ].

What are the problems with ACL reconstruction?

Residual knee instability and low rates of return to previous sport are major concerns after anterior cruciate ligament (ACL) reconstruction. To improve outcomes, surgical methods, such as the anatomical single-bundle technique or the double-bundle technique, were developed. However, these reconstruction techniques failed to adequately overcome these problems, and, therefore, new potential answers continue to be of great interest. Based on recent anatomical and biomechanical studies emphasizing the role of the anterolateral ligament (ALL) in rotational stability, novel surgical methods including ALL reconstruction and anterolateral tenodesis have been introduced with the possibility of resolving residual instability after ACL reconstruction. However, there is still little consensus on many aspects of the ALL, including: several anatomical issues, appropriate indications for ALL surgery, and the optimal surgical method and graft choice for reconstruction surgery. Therefore, further studies are necessary to advance our knowledge of the ALL and its contribution to knee stability.

How to identify ALL injury?

Magnetic resonance imaging (MRI) has been reported as a useful modality to identify the ALL injury in recent studies. It is suggested that MRI on injured knees provides better visualization of the ALL than on intact knees. Soft-tissue inflammation and joint effusion may provide signal intensification, leading to this observation [ 22, 28 ]. The assessment of the ALL injury varied between using 1.5-T and 3.0-T MRIs. The recent MRI study suggested that 3.0-T MRI may provide increased visualization [ 29 ]. The insertion of the ALL into the proximal tibia just distal to the lateral joint line was well identified in most studies [ 22, 25, 28, 29, 30, 31, 32, 33 ]. The origin on the distal femur was difficult to visualize because of the close proximity of other lateral structures such as the LCL, popliteus tendon and ITB [ 22 ]. The variability in identifying the ALL through the dissections in previous anatomical studies may also explain the various results in the identification of the ALL injury in MRI studies. Monaco et al. reported that MRI is highly sensitive, specific, and accurate for the detection of abnormalities of the ALL and anterolateral capsule and shows a high percentage of agreement with surgical findings [ 30 ]. They proved that the percentage agreement between MRI and surgical findings was 88% for ALL and anterolateral capsule injuries through the surgical exploration in acute ACL-injured knees. In a recent systemic review, the ALL appeared on the MRI findings in 51–100% of all assessed 2427 knees in a total of 24 studies [ 28 ]. This study suggested that high variability was found in the identification of normal and injured ALL in MRI, and the entire portion of the ligament was often not seen.

Which ligament controls the acceleration of the tibia during the pivot shift?

Hardy A, Casabianca L, Hardy E, Grimaud O, Meyer A (2017) Combined reconstruction of the anterior cruciate ligament associated with anterolateral tenodesis effectively controls the acceleration of the tibia during the pivot shift. Knee Surg Sports Traumatol Arthrosc 25 (4):1117–1124

Is ACL reconstruction good?

Anterior cruciate ligament (ACL) reconstruction has improved significantly over the last several decades due to better understanding of anatomy and technical advancements in surgical techniques, resulting in satisfactory results in the majority of cases. Despite these advancements, some patients continue to experience unsatisfactory outcomes with residual knee instability after conventional ACL reconstruction [ 1 ]. To address this issue, there has been recent focus on adding additional extra-articular augmentation to ACL reconstruction, specifically with augmentation or reconstruction of the anterolateral ligament (ALL) [ 2, 3, 4, 5, 6 ]. The ALL is a ligament on the lateral aspect of the knee, anterior to the fibular collateral ligament. Recent anatomical and biomechanical studies have reported on the role of this extra-articular anterolateral structure, demonstrating its synergistic relationship with the ACL with respect to rotational knee stability [ 2, 3, 4 ]. Despite some arguments against the efficacy of extra-articular ALL reconstruction [ 7, 8, 9, 10 ], several biomechanical studies have reported that the addition of extra-articular ALL reconstruction showed superior outcomes compared to intra-articular ACL reconstruction alone, especially with regards to objective postoperative knee stability [ 11, 12, 13, 14 ]. However, there is no consensus on several anatomical issues, including the bony origin and insertion of the ALL, and the change in ALL length with knee flexion [ 4, 5, 6, 15, 16, 17, 18, 19 ]. Due to this, the optimal surgical technique is still debated, with outstanding issues of ideal graft choice [ 20, 21 ], location of fixation, and fixation angle [ 11, 22, 23, 24] still unresolved. In the aspect of the surgical indications, the additional ALL surgery is usually recommended for the revision surgery or the ACL-deficient knee with a high-grade pivot-shift test [ 22, 23 ]. Recently, its surgical indications have been extended to chronic ACL rupture, concomitant meniscal repair, or pivoting activities [ 25 ]. But there is still no consensus for the appropriate surgical indication. The purpose of this review is to highlight the findings of the current literature on the anatomy of the ALL, the function and biomechanics of the ALL, the techniques for ALL surgery, and its clinical outcomes.

Where is the anterolateral ligament located?

It is located toward the outside of the knee and a little toward the front.

What is the new ligament in the knee?

The new ligament is called the anterolateral ligament (ALL), and the researchers were able to identify the ligament in 40 of 41 cadaver knees they dissected. It is located toward the outside of the knee and a little toward the front. This is significant because, based on its location, ALL deficiencies may be present with ACL injuries or with iliotibial band syndrome. The Belgian surgeon behind the research says they have been repairing ALL along with ACL repairs, but it is too soon to determine if this has a significant impact in the rehab process or in decreasing the risk for re-rupture of the ACL.2

What is the capsule around the knee?

Well the knee joint is completely covered by a fibrous capsule that holds fluid in so that the knee can move smoothly. The ligaments around the knee, specifically the MCL and LCL, are adjacent to the capsule and sometimes difficult to distinguish as a separate band of fibers.