title: Anatomy of the anterolateral ligament of the knee.
abstract: In 1879, the French surgeon Segond described the existence of a 'pearly, resistant, fibrous band' at the anterolateral aspect of the human knee, attached to the eponymous Segond fracture. To date, the enigma surrounding this anatomical structure is reflected in confusing names such as '(mid-third) lateral capsular ligament', 'capsulo-osseous layer of the iliotibial band' or 'anterolateral ligament', and no clear anatomical description has yet been provided. In this study, the presence and characteristics of Segond's 'pearly band', hereafter termed anterolateral ligament (ALL), was investigated in 41 unpaired, human cadaveric knees. The femoral and tibial attachment of the ALL, its course and its relationship with nearby anatomical structures were studied both qualitatively and quantitatively. In all but one of 41 cadaveric knees (97%), the ALL was found as a well-defined ligamentous structure, clearly distinguishable from the anterolateral joint capsule. The origin of the ALL was situated at the prominence of the lateral femoral epicondyle, slightly anterior to the origin of the lateral collateral ligament, although connecting fibers between the two structures were observed. The ALL showed an 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. Its insertion on the anterolateral tibia was grossly located midway between Gerdy's tubercle and the tip of the fibular head, definitely separate from the iliotibial band (ITB). The ALL was found to be a distinct ligamentous structure at the anterolateral aspect of the human knee with consistent origin and insertion site features. By providing a detailed anatomical characterization of the ALL, this study clarifies the long-standing enigma surrounding the existence of a ligamentous structure connecting the femur with the anterolateral tibia. Given its structure and anatomic location, the ALL is hypothesized to control internal tibial rotation and thus to affect the pivot shift phenomenon, although further studies are needed to investigate its biomechanical function.
authors.affiliation: Department of Orthopedic Surgery & Traumatology, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Steven
authors.initials: S
authors.lastname: Claes
authors.forename: Evie
authors.initials: E
authors.lastname: Vereecke
authors.forename: Michael
authors.initials: M
authors.lastname: Maes
authors.forename: Jan
authors.initials: J
authors.lastname: Victor
authors.forename: Peter
authors.initials: P
authors.lastname: Verdonk
authors.forename: Johan
authors.initials: J
authors.lastname: Bellemans
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002102:Cadaver; D004210:Dissection; D005260:Female; D005269:Femur / Q000033:anatomy & histology; D006801:Humans; D007719:Knee Joint / Q000033:anatomy & histology*; D008023:Ligaments, Articular / Q000033:anatomy & histology*; D008297:Male; D008592:Menisci, Tibial / Q000033:anatomy & histology; D008875:Middle Aged; D013977:Tibia / Q000033:anatomy & histology
keywords: Segond fracture; anatomy; anterior cruciate ligament; anterolateral ligament; pivot-shift
references.citation: Am J Sports Med. 1996 Nov-Dec;24(6):732-9
references.pmid: 8947393
references.citation: J Bone Joint Surg Br. 2004 Jul;86(5):674-81
references.pmid: 15274262
references.citation: Clin Orthop Relat Res. 2005 Jul;(436):229-36
references.pmid: 15995446
references.citation: J Bone Joint Surg Am. 1976 Mar;58(2):159-72
references.pmid: 1254619
references.citation: J Bone Joint Surg Am. 1958 Jul;40-A(4):817-32
references.pmid: 13549519
references.citation: Clin Orthop Relat Res. 1994 Jun;(303):193-7
references.pmid: 8194233
references.citation: AJR Am J Roentgenol. 1988 Dec;151(6):1163-7
references.pmid: 3263770
references.citation: J Bone Joint Surg Br. 1987 Aug;69(4):613-4
references.pmid: 3611168
references.citation: Am J Sports Med. 1979 May-Jun;7(3):156-60
references.pmid: 464170
references.citation: Knee Surg Sports Traumatol Arthrosc. 2012 Jan;20(1):147-52
references.pmid: 21717216
references.citation: Am J Sports Med. 1979 Jan-Feb;7(1):27-33
references.pmid: 420385
references.citation: J Anat. 2006 Mar;208(3):309-16
references.pmid: 16533314
references.citation: J Bone Joint Surg Am. 1979 Jul;61(5):704-9
references.pmid: 582318
references.citation: Am J Sports Med. 1993 Jan-Feb;21(1):55-60
references.pmid: 8427369
references.citation: Radiology. 2001 May;219(2):381-6
references.pmid: 11323461
references.citation: J Bone Joint Surg Am. 1976 Mar;58(2):173-9
references.pmid: 1254620
references.citation: J Knee Surg. 2005 Apr;18(2):137-45
references.pmid: 15915835
references.citation: J Am Acad Orthop Surg. 2008 Dec;16(12):679-88
references.pmid: 19056917
references.citation: Am J Sports Med. 1997 Sep-Oct;25(5):596-602
references.pmid: 9302462
references.citation: J Bone Joint Surg Am. 2007 Sep;89(9):2000-10
references.pmid: 17768198
references.citation: J Bone Joint Surg Am. 1982 Apr;64(4):536-41
references.pmid: 7068696
references.citation: Arthroscopy. 2007 Mar;23(3):269-74
references.pmid: 17349469
references.citation: AJR Am J Roentgenol. 2003 Mar;180(3):647-53
references.pmid: 12591668