The anterolateral ligament (ALL) and its relationship to the other lateral structures (lateral collateral ligament and popliteus tendon)
The re-discovered ligament
Despite earlier decriptions in the literature, this structure was not widely recognised by knee surgeons until 2013 when evidence for its anatomy and importance was presented in a PhD dissertation.
Since then many knee surgeons have felt that it is the 'missing link' in understanding anterolateral rotational instability.
Peer-reviewed paperQuote from peer-reviewed paper:
"....Numerous studies....establish its potential role as a stabilizer for anterolateral rotational instability....ALL reconstruction can be a solution for residual rotational instability after anterior cruciate ligament reconstruction...."
Citation: Park JG, Han SB, Rhim HC, Jeon OH, Jang KM. Anatomy of the anterolateral ligament of the knee joint. World J Clin Cases. 2022 Jul 26;10(21):7215-7223. doi: 10.12998/wjcc.v10.i21.7215. PMID: 36158026; PMCID: PMC9353924.
What is anterolateral rotational instability?
Anterolateral rotational instability is the kind of knee instability that gives a very positive result when the surgeon performs the pivot shift test while assessing the anterior cruciate ligament.
Damage to the anterolateral ligament - by avulsion of the ligament from the bone during the initial ACL incident - is thought to explain why some patients still have rotational instability even after anterior cruciate ligament reconstruction.
Peer-reviewed paperQuote from peer-reviewed paper:
"....It is now clear that the anterolateral complex (ALC) of the knee possesses a fundamental role, in association with the ACL, in controlling internal rotation....."
Citation: Sabatini L, Capella M, Vezza D, Barberis L, Camazzola D, Risitano S, Drocco L, Massè A. Anterolateral complex of the knee: State of the art. World J Orthop. 2022 Aug 18;13(8):679-692. doi: 10.5312/wjo.v13.i8.679. PMID: 36159618; PMCID: PMC9453282.
Surgical repair of the anterolateral ligament
The procedure to repair the ligament is called a tenodesis, where a strip of ITB (iliotibial band) or gracilis tendon is used to reinforce the anterolateral corner.
Peer-reviewed paperQuote from peer-reviewed paper:
"....the combination of a lateral extra-articular tenodesis technique has proven to be a safe, easily reproducible, and effective practice in reducing tibial internal rotation, improving ACL graft survival, reducing the overall reintervention rate, and improving the rate of return to previous athletic activity......"
Citation: Sabatini L, Capella M, Vezza D, Barberis L, Camazzola D, Risitano S, Drocco L, Massè A. Anterolateral complex of the knee: State of the art. World J Orthop. 2022 Aug 18;13(8):679-692. doi: 10.5312/wjo.v13.i8.679. PMID: 36159618; PMCID: PMC9453282.