Diego Ariel de Lima1, Camilo Partezani Helito2, Lana Lacerda de Lima3, Daniel de Castro Silva4, Maria Luzete Costa Cavalcante4, José Alberto Dias Leite4. 1. Universidade Federal Rural do Semi-Árido, Mossoró, Brazil. Electronic address: arieldelima.diego@gmail.com. 2. Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil; Hospital Sírio Libanês, São Paulo, Brazil. 3. Universidade do Estado do Rio Grande do Norte, Mossoró, Brazil. 4. Departamento de Cirurgia da Universidade Federal do Ceará, Fortaleza, Brazil.
Abstract
PURPOSE: To conduct a systematic literature review to search for studies on the anatomy of the anterolateral ligament (ALL) of the knee, presenting the most accepted findings, as well as the evolution of anatomic information on this structure. METHODS: We reviewed the PubMed, MEDLINE, and ClinicalKey databases for anatomic studies on the ALL, involving cadaveric, histologic, and biochemical dissection and/or anatomic imaging. The primary data researched were the presence of the ligament; measures of length, width, and thickness; ligament path; insertions; number of bands; histologic assessment; and innervation. RESULTS: We identified 53 studies. The ALL was found in 82.87% of adult dissections (more easily visualized in fresh cadavers), 74.07% of fetal dissections, and 84.80% of magnetic resonance imaging (MRI) studies. In 29 articles, the ALL was found in 100% of cases. There are 3 ALL insertion points: femoral, tibial, and meniscal. Histologic sections showed dense, well-organized collagen fibers, with an average of 121 fibroblasts/mm2 in adults, in addition to the presence of vascular and nervous tissue. MRI was shown to be a good examination tool to visualize the ALL, primarily in the coronal plane and with T2-weighted images. CONCLUSIONS: The ALL is a distinct structure in the anterolateral portion of the knee. It exhibits typical ligament characteristics and can be visualized on imaging examinations, especially MRI. It has a femoral attachment near the lateral epicondyle, with a trend in recent years showing it to be located posterior and proximal to it, following an anteroinferior trajectory, with an insertion into the lateral meniscus and proximal tibia at the midpoint between the fibular head and Gerdy tubercle. Among the studies, the length of the ALL varied from 30.41 to 59.0 mm, the width ranged between 4.0 and 7.0 mm, and the thickness ranged between 1.0 and 2.0 mm. CLINICAL RELEVANCE: During the past few years, much controversy has been raised about the correct anatomy of the ALL. The main clinical relevance of this study is not only to end the discussion about the ALL's existence but also to clarify and synthesize the main evidence on the ALL's anatomy, mainly the currently most accepted attachments according to the recent literature, to enable more precise development of biomechanical settings and surgical techniques.
PURPOSE: To conduct a systematic literature review to search for studies on the anatomy of the anterolateral ligament (ALL) of the knee, presenting the most accepted findings, as well as the evolution of anatomic information on this structure. METHODS: We reviewed the PubMed, MEDLINE, and ClinicalKey databases for anatomic studies on the ALL, involving cadaveric, histologic, and biochemical dissection and/or anatomic imaging. The primary data researched were the presence of the ligament; measures of length, width, and thickness; ligament path; insertions; number of bands; histologic assessment; and innervation. RESULTS: We identified 53 studies. The ALL was found in 82.87% of adult dissections (more easily visualized in fresh cadavers), 74.07% of fetal dissections, and 84.80% of magnetic resonance imaging (MRI) studies. In 29 articles, the ALL was found in 100% of cases. There are 3 ALL insertion points: femoral, tibial, and meniscal. Histologic sections showed dense, well-organized collagen fibers, with an average of 121 fibroblasts/mm2 in adults, in addition to the presence of vascular and nervous tissue. MRI was shown to be a good examination tool to visualize the ALL, primarily in the coronal plane and with T2-weighted images. CONCLUSIONS: The ALL is a distinct structure in the anterolateral portion of the knee. It exhibits typical ligament characteristics and can be visualized on imaging examinations, especially MRI. It has a femoral attachment near the lateral epicondyle, with a trend in recent years showing it to be located posterior and proximal to it, following an anteroinferior trajectory, with an insertion into the lateral meniscus and proximal tibia at the midpoint between the fibular head and Gerdy tubercle. Among the studies, the length of the ALL varied from 30.41 to 59.0 mm, the width ranged between 4.0 and 7.0 mm, and the thickness ranged between 1.0 and 2.0 mm. CLINICAL RELEVANCE: During the past few years, much controversy has been raised about the correct anatomy of the ALL. The main clinical relevance of this study is not only to end the discussion about the ALL's existence but also to clarify and synthesize the main evidence on the ALL's anatomy, mainly the currently most accepted attachments according to the recent literature, to enable more precise development of biomechanical settings and surgical techniques.
Authors: Eoghan T Hurley; David A Bloom; Alexander Hoberman; Utkarsh Anil; Guillem Gonzalez-Lomas; Eric J Strauss; Michael J Alaia Journal: Knee Surg Sports Traumatol Arthrosc Date: 2021-01-23 Impact factor: 4.342
Authors: William Mullins; Gavin E Jarvis; Daniel Oluboyede; Linda Skingle; Ken Poole; Tom Turmezei; Cecilia Brassett Journal: J Anat Date: 2020-08-08 Impact factor: 2.610