Assessment of the Anterolateral Ligament of the Knee by Magnetic Resonance Imaging
19 December 2017
08 September 2018
02 November 2018 (eFirst)
Purpose The purpose of this study was to describe the anatomy of the anterolateral ligament (ALL) of the knee by the use of 1.5 Tesla (T) magnetic resonance imaging (MRI) in a series of young patients without knee injuries.
Methods Subjects aged 18 years or older without an anterior cruciate ligament injury, as confirmed on MRI, were included. MRI examinations were all performed on 1.5 T scans. The ALL was defined as the low signal band originating from the region of the lateral epicondyle of the femur, crossing the proximal surface of the lateral collateral ligament, deep to the iliotibial band, and inserting onto the tibia between the Gerdy's tubercle and the fibular head.
Results Twenty-six patients met the eligibility criteria and were enrolled into the study. In one patient, it was not possible to visualize the ALL. In all the other subjects, the ligament originated anterior and distal to the lateral epicondyle and inserted on the proximal tibia approximately 5 mm below the joint line and just distal to the Gerdy's tubercle. It had an average length of 33 ± 1.2 mm, an average width of 5.5 ± 0.3 mm, and an average thickness of 2 mm.
Conclusion The ALL is a distinct structure of the anterolateral capsule that can be easily identified using 1.5 T MRI scans.
Level of Evidence This is a level IV, observational study.
- 1 Claes S, Vereecke E, Maes M, Victor J, Verdonk P, Bellemans J. Anatomy of the anterolateral ligament of the knee. J Anat 2013; 223 (04) 321-328
- 2 Hughston JC, Andrews JR, Cross MJ, Moschi A. Classification of knee ligament instabilities. Part II. The lateral compartment. J Bone Joint Surg Am 1976; 58 (02) 173-179
- 3 Johnson LL. Lateral capsular ligament complex: anatomical and surgical considerations. Am J Sports Med 1979; 7 (03) 156-160
- 4 Norwood Jr LA, Andrews JR, Meisterling RC, Glancy GL. Acute anterolateral rotatory instability of the knee. J Bone Joint Surg Am 1979; 61 (05) 704-709
- 5 Segond P. Recherches cliniques et experimentales sur les epanchements sanguins du genou par entorse. Progres Medical. Paris; 1879. Available at: http://www.patrimoine.edilivre.com . Accessed September 26, 2018
- 6 Tanaka M, Vyas D, Moloney G, Bedi A, Pearle AD, Musahl V. What does it take to have a high-grade pivot shift?. Knee Surg Sports Traumatol Arthrosc 2012; 20 (04) 737-742
- 7 Caterine S, Litchfield R, Johnson M, Chronik B, Getgood A. A cadaveric study of the anterolateral ligament: re-introducing the lateral capsular ligament. Knee Surg Sports Traumatol Arthrosc 2015; 23 (11) 3186-3195
- 8 Daggett M, Ockuly AC, Cullen M. , et al. Femoral origin of the anterolateral ligament: an anatomic analysis. Arthroscopy 2016; 32 (05) 835-841
- 9 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-B (03) 325-331
- 10 Helito CP, Demange MK, Bonadio MB. , et al. Radiographic landmarks for locating the femoral origin and tibial insertion of the knee anterolateral ligament. Am J Sports Med 2014; 42 (10) 2356-2362
- 11 Pomajzl R, Maerz T, Shams C, Guettler J, Bicos J. A review of the anterolateral ligament of the knee: current knowledge regarding its incidence, anatomy, biomechanics, and surgical dissection. Arthroscopy 2015; 31 (03) 583-591
- 12 Vincent JP, Magnussen RA, Gezmez F. , et al. The anterolateral ligament of the human knee: an anatomic and histologic study. Knee Surg Sports Traumatol Arthrosc 2012; 20 (01) 147-152
- 13 Kennedy MI, Claes S, Fuso FA. , et al. The anterolateral ligament: an anatomic, radiographic, and biomechanical analysis. Am J Sports Med 2015; 43 (07) 1606-1615
- 14 Woods GW, Stanley RF, Tullos HS. Lateral capsular sign: x-ray clue to a significant knee instability. Am J Sports Med 1979; 7 (01) 27-33
- 15 Ferretti A, Monaco E, Fabbri M, Maestri B, De Carli A. Prevalence and classification of injuries of anterolateral complex in acute anterior cruciate ligament tears. Arthroscopy 2017; 33 (01) 147-154
- 16 Parsons EM, Gee AO, Spiekerman C, Cavanagh PR. The biomechanical function of the anterolateral ligament of the knee. Am J Sports Med 2015; 43 (03) 669-674
- 17 Monaco E, Ferretti A, Labianca L. , et al. Navigated knee kinematics after cutting of the ACL and its secondary restraint. Knee Surg Sports Traumatol Arthrosc 2012; 20 (05) 870-877
- 18 Helito CP, Demange MK, Helito PVP. , et al. Evaluation of the anterolateral ligament of the knee by means of magnetic resonance examination. Rev Bras Ortop 2015; 50 (02) 214-219
- 19 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 (01) 45-49
- 20 Taneja AK, Miranda FC, Braga CAP. , et al. MRI features of the anterolateral ligament of the knee. Skeletal Radiol 2015; 44 (03) 403-410
- 21 Hartigan DE, Carroll KW, Kosarek FJ, Piasecki DP, Fleischli JF, D'Alessandro DF. Visibility of anterolateral ligament tears in anterior cruciate ligament-deficient knees with standard 1.5-Tesla magnetic resonance imaging. Arthroscopy 2016; 32 (10) 2061-2065
- 22 Porrino Jr J, Maloney E, Richardson M, Mulcahy H, Ha A, Chew FS. The anterolateral ligament of the knee: MRI appearance, association with the Segond fracture, and historical perspective. Am J Roentgenol 2015; 204 (02) 367-373
- 23 Cavaignac E, Wytrykowski K, Reina N. , et al. Ultrasonographic identification of the anterolateral ligament of the knee. Arthroscopy 2016; 32 (01) 120-126
- 24 Faruch Bilfeld M, Cavaignac E, Wytrykowski K. , et al. Anterolateral ligament injuries in knees with an anterior cruciate ligament tear: contribution of ultrasonography and MRI. Eur Radiol 2018; 28 (01) 58-65
- 25 Macchi V, Porzionato A, Morra A. , et al. The anterolateral ligament of the knee: a radiologic and histotopographic study. Surg Radiol Anat 2016; 38 (03) 341-348