title: Macroscopic anatomical, histological and magnetic resonance imaging correlation of the lateral capsule of the knee.
abstract: OBJECTIVE
  The objective of the present study was to correlate macroscopic and microscopic anatomy of the lateral capsule of the knee joint with high-quality magnetic resonance imaging (MRI), with a hypothesis that a distinct lateral capsular ligament would be inconsistently observed via surgical dissection and that high-quality MRI imaging would correlate to findings from dissection.
  
  
  METHODS
  Ten fresh-frozen human cadaveric knee specimens were utilized for this study. MRI of each knee was obtained pre- and post-dissection. The lateral knee was dissected and analysed for the presence or absence of a discrete capsular thickening or an independent ligamentous structure. A musculoskeletal radiologist analysed the pre- and post-dissection MRI. Subsequently, two specimens with positive lateral capsular thickening were prepared for histology.
  
  
  RESULTS
  On macroscopic dissection, none of the ten specimens were found to have a discrete lateral capsular ligament. A palpable macroscopic thickening of the lateral capsule was identified in 4/10 specimens. MRI analysis revealed a 2-4 mm thickening of the central third of the lateral capsule in 3/10 specimens. On histological analysis, the lateral capsular thickening demonstrated properties similar to both capsule and ligament.
  
  
  CONCLUSIONS
  In fresh-frozen cadaveric specimens, macroscopic and MRI evaluation of the lateral capsule of the knee revealed variations in morphology without consistent capsuloligamentous anatomy and specifically no discrete lateral capsular ligament. Further investigation in the form of clinical and mechanical relevance of the lateral capsular structures is of paramount importance before limited anatomical data can be utilized to drive clinical decision-making and patient care.
authors: Department of Orthopaedic Surgery, University of Pittsburgh, 3200 South Water Street, Pittsburgh, PA, USA.
authors: Malcolm E
authors: ME
authors: Dombrowski
authors: Department of Radiology, University of Pittsburgh, Pittsburgh, PA, USA.
authors: Joanna M
authors: JM
authors: Costello
authors: Department of Orthopaedic Surgery, University of Pittsburgh, 3200 South Water Street, Pittsburgh, PA, USA.
authors: Bruno
authors: B
authors: Ohashi
authors: Department of Orthopaedic Surgery, University of Pittsburgh, 3200 South Water Street, Pittsburgh, PA, USA.
authors: Christopher D
authors: CD
authors: Murawski
authors: Department of Orthopaedic Surgery, University of Pittsburgh, 3200 South Water Street, Pittsburgh, PA, USA.
authors: Benjamin B
authors: BB
authors: Rothrauff
authors: Department of Orthopaedic Surgery, University of Pittsburgh, 3200 South Water Street, Pittsburgh, PA, USA.
authors: Fabio V
authors: FV
authors: Arilla
authors: Department of Orthopaedic Surgery, University of Pittsburgh, 3200 South Water Street, Pittsburgh, PA, USA. frielna@upmc.edu.
authors: Nicole A
authors: NA
authors: Friel
authors: Department of Orthopaedic Surgery, University of Pittsburgh, 3200 South Water Street, Pittsburgh, PA, USA.
authors: Freddie H
authors: FH
authors: Fu
authors: Department of Orthopaedic Surgery, University of Pittsburgh, 3200 South Water Street, Pittsburgh, PA, USA.|Department of Bioengineering, University of Pittsburgh, UPMC Center for Sports Medicine, 3200 South Water Street, Pittsburgh, PA, USA.
authors: Richard E
authors: RE
authors: Debski
authors: Department of Orthopaedic Surgery, University of Pittsburgh, 3200 South Water Street, Pittsburgh, PA, USA.|Department of Bioengineering, University of Pittsburgh, UPMC Center for Sports Medicine, 3200 South Water Street, Pittsburgh, PA, USA.
authors: Volker
authors: V
authors: Musahl
mesh_terms: D000368:Aged; D002102:Cadaver; D017885:Collateral Ligaments; D004210:Dissection; D006652:Histological Techniques; D006801:Humans; D007719:Knee Joint / Q000033:anatomy & histology*; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D055815:Young Adult
keywords: Anatomy; Anterolateral ligament; Knee; Lateral capsule
references: Anderson AF, Snyder RB, Lipscomb AB Jr (2001) Anterior cruciate ligament reconstruction. A prospective randomized study of three surgical methods. Am J Sports Med 29(3):272–279
references: 11394593
references: Bignozzi S, Zaffagnini S, Lopomo N, Martelli S, Iacono F, Marcacci M (2009) Does a lateral plasty control coupled translation during antero-posterior stress in single-bundle ACL reconstruction? An in vivo study. Knee Surg Sports Traumatol Arthrosc 17(1):65–70
references: 18982310
references: Caterine S, Litchfield R, Johnson M, Chronik B, Getgood A (2014) A cadaveric study of the anterolateral ligament: re-introducing the lateral capsular ligament. Knee Surg Sports Traumatol Arthrosc. doi: 10.1007/s00167-014-3117-z
references: Claes S, Luyckx T, Vereecke E, Bellemans J (2014) The segond fracture: a bony injury of the anterolateral ligament of the knee. Arthroscopy 30(11):1475–1482
references: 25124480
references: Claes S, Vereecke E, Maes M, Victor J, Verdonk P, Bellemans J (2013) Anatomy of the anterolateral ligament of the knee. J Anat 223(4):321–328
references: 23906341
references: Dietz GW, Wilcox DM, Montgomery JB (1986) Segond tibial condyle fracture: lateral capsular ligament avulsion. Radiology 159(2):467–469
references: 3961179
references: Dodds AL, Halewood C, Gupte CM, Williams A, Amis AA (2014) The anterolateral ligament: anatomy, length changes and association with the segond fracture. Bone Jt J 96(3):325–331
references: Goldman AB, Pavlov H, Rubenstein D (1988) The segond fracture of the proximal tibia: a small avulsion that reflects major ligamentous damage. AJR Am J Roentgenol 151(6):1163–1167
references: 3263770
references: Hughston JC, Andrews JR, Cross MJ, Moschi A (1976) Classification of knee ligament instabilities. Part I. The medial compartment and cruciate ligaments. J Bone Jt Surg Am 58(2):159–172
references: Hughston JC, Andrews JR, Cross MJ, Moschi A (1976) Classification of knee ligament instabilities. Part II. The lateral compartment. J Bone Jt Surg Am 58(2):173–179
references: Johnson LL (1979) Lateral capsular ligament complex: anatomical and surgical considerations. Am J Sports Med 7(3):156–160
references: 464170
references: Kennedy JC, Stewart R, Walker DM (1978) Anterolateral rotatory instability of the knee joint. An early analysis of the Ellison procedure. J Bone Jt Surg Am 60(8):1031–1039
references: LaPrade RF (1997) Arthroscopic evaluation of the lateral compartment of knees with grade 3 posterolateral knee complex injuries. Am J Sports Med 25(5):596–602
references: 9302462
references: LaPrade RF, Gilbert TJ, Bollom TS, Wentorf F, Chaljub G (2000) The magnetic resonance imaging appearance of individual structures of the posterolateral knee. A prospective study of normal knees and knees with surgically verified grade III injuries. Am J Sports Med 28(2):191–199
references: 10750995
references: LaPrade RF, Terry GC (1997) Injuries to the posterolateral aspect of the knee. Association of anatomic injury patterns with clinical instability. Am J Sports Med 25(4):433–438
references: 9240974
references: Last JR (1948) Some anatomical details of the knee joint. J Bone Jt Surg Br 30:683–688
references: Pernin J, Verdonk P, Si Selmi TA, Massin P, Neyret P (2010) Long-term follow-up of 24.5 years after intra-articular anterior cruciate ligament reconstruction with lateral extra-articular augmentation. Am J Sports Med 38(6):1094–1102
references: 20305053
references: Pomajzl R, Maerz T, Shams C, Guettler J, Bicos J (2014) A review of the anterolateral ligament of the knee: current knowledge regarding its incidence, anatomy, biomechanics, and surgical dissection. Arthroscopy. doi: 10.1016/j.arthro.2014.09.010
references: 25447415
references: Segond P (1879) Recherches cliniques et expérimentales sur les épanchements sanguins du genou par entorse. Progrès Med 7:297–341
references: Stijak L, Bumbasirevic M, Radonjic V, Kadija M, Puskas L, Milovanovic D, Filipovic B (2014) Anatomic description of the anterolateral ligament of the knee. Knee Surg Sports Traumatol Arthrosc. doi: 10.1007/s00167-014-3422-6
references: Terry GC, LaPrade RF (1996) The posterolateral aspect of the knee. Anatomy and surgical approach. Am J Sports Med 24(6):732–739
references: 8947393
references: Vieira EL, Vieira EA, da Silva RT, Berlfein PA, Abdalla RJ, Cohen M (2007) An anatomic study of the iliotibial tract. Arthroscopy 23(3):269–274
references: 17349469
references: Vincent JP, Magnussen RA, Gezmez F, Uguen A, Jacobi M, Weppe F, Al-Saati MF, Lustig S, Demey G, Servien E, Neyret P (2012) The anterolateral ligament of the human knee: an anatomic and histologic study. Knee Surg Sports Traumatol Arthrosc 20(1):147–152
references: 21717216
references: Warren RF, Marshall JL (1978) Injuries of the anterior cruciate and medial collateral ligaments of the knee. A long-term follow-up of 86 cases–part II. Clin Orthop Relat Res 136:198–211
references: 729286