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The Anterolateral ligament

The anterolateral ligament is the newest anatomical find in the orthopedic world of medicine to date. Dr. Steven Claes and Dr. Johan Bellemans are two orthopedic surgeons from the University Hospital of Leuven who spent four years researching pivot shifts in the knee and why they still seem to occur even after the anterior cruciate ligament (ACL) had been successfully operated on.

The knee as a whole is an extremely complex and delicate anatomical instrument that is usually subject to wear and tear especially among athletes.  Extensive research and new surgical techniques are continuously being tried out in order to keep the knee as healthy and as functional as possible for as long as is realistically allowed.

Knee joint - anterior (left) & posterior (right) views

Knee joint - anterior (left) & posterior (right) views

As it happens, the theory that an extra ligament could exist on knee has been around since 1879 when a french surgeon named Paul Segond documented his findings. This hypothesis was further examined by the Belgian surgeons from Leuven, in order to solve the mystery as to the continuing complaint of joint pivot shifts, who managed to positively confirm the theory.

Recommended video: Bones and ligaments of lower leg
Bones, ligaments and joints of the knee and the lower leg.

The Anatomy of the Anterolateral Ligament (ALL)

Since 2013, the anterolateral ligament has been confirmed to originate from the lateral epicondyle of the femur and insert into the anterolateral aspect of the proximal tibia.

Anterolateral ligament - lateral view

Anterolateral ligament - lateral view

It has been debated since if the origin is indeed where it has been previously stated or whether it comes from the lateral femoral condyle, which remains to be seen.

This anatomical structure is thought to be present in up to 79% of the world’s current human population and functions to stabilize the knee during medial rotation. Therefore, when a patient presents with a pivot shift and an anterior cruciate ligament (ACL) injury, it is now known that this occurrence is more than likely due to an anterolateral ligament (ALL) injury.

Clincical note

Segond fracture

A Segond fracture, first described by french surgeon Paul Ferdinand Segond (1851-1912), is a type of avulsion fracture involving the lateral condyle of the tibia. 

This type of fracture is traditionally associated with tears of the anterior cruciate ligament of the knee (ACL), but increasingly also with the anterolateral ligament described above. 

This type of fracture is most often caused by 'bowing'/varus stress to the knee joint, combined with medial rotation of the tibia. 

Segond fractures are characterised by the presence of isolated bony material, known as an avulsion, from the lateral tibial condyle. 

The bony fragment itself is often best visualised by CT (computed tomography), however MRI (magnetic resonance imaging) may also be useful by means of characterisation of ligamentous/meniscal injury, as well as bone marrow oedema of the underlying fractured bone.

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Show references

References:

  • Gretchen Reynolds. Doctors a new knee ligament. The New York Times. November 13, 2013.
  • Caleb Garling. The anterolateral ligament: A life and (slight) death of wrong information on the Internet. SF Gate. November 8, 2013.
  • Anna Hodgekiss, Emma Innes. Scientists discover a new body part in the knee - and it could explain why so many injured joints give way during exercise. Mail Online. November 6, 2013.
  • Orthopaedic surgeon says anterolateral ligament not "new" but promising for ACL injuries. Medical Xpress. November 11, 2013.
  • Shaikh H., The Segond Fracture Is an Avulsion of the Anterolateral Complex. Am J Sports Med. August 2017

Author:

  • Dr. Alexandra Sieroslawska

Illustrators:

  • Anterolateral ligament - lateral view - Yousun Koh 
  • Knee joint - anterior & posterior views - Yousun Koh
© Unless stated otherwise, all content, including illustrations are exclusive property of Kenhub GmbH, and are protected by German and international copyright laws. All rights reserved.

Related Atlas Images

Tibia and fibula

Tibial condyles level (section 18/23)

Knee Joint

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