The anterolateral ligament of the knee joint: a review of the anatomy, biomechanics, and anterolateral ligament surgery

Abstract

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.

Keywords: ALL reconstruction; Anterior cruciate ligament; Anterolateral ligament; Anterolateral tenodesis; Knee instability.

Fig. 1

Photograph of dissected specimen. ALL anterolateral ligament, LCL lateral collateral ligament, FH fibular head, GT Gerdy’s tubercle, ITB iliotibial band, BF biceps femoris, LFE lateral femoral epicondyle

Fig. 2

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)