Anatomy of the anterolateral ligament of the knee joint

Abstract

Despite remarkable improvements in clinical outcomes after anterior cruciate ligament reconstruction, the residual rotational instability of knee joints remains a major concern. The anterolateral ligament (ALL) has recently gained attention as a distinct ligamentous structure on the anterolateral aspect of the knee joint. Numerous studies investigated the anatomy, function, and biomechanics of ALL to establish its potential role as a stabilizer for anterolateral rotational instability. However, controversies regarding its existence, prevalence, and femoral and tibial insertions need to be addressed. According to a recent consensus, ALL exists as a distinct ligamentous structure on the anterolateral aspect of the knee joint, with some anatomic variations. The aim of this article was to review the updated anatomy of ALL and present the most accepted findings among the existing controversies. Generally, ALL originates slightly proximal and posterior to the lateral epicondyle of the distal femur and has an anteroinferior course toward the tibial insertion between the tip of the fibular head and Gerdy’s tubercle below the lateral tibial plateau.

Keywords: Knee joint; Anatomy; Anterolateral ligament; Anterior cruciate ligament; Anterolateral rotational instability; Anterolateral ligament reconstruction

Core Tip: Although there are some anatomical variations in the anterolateral ligament (ALL), the most recent studies agree that it exists as a distinct ligamentous structure on the anterolateral aspect of the knee joint. ALL reconstruction can be a solution for residual rotational instability after anterior cruciate ligament reconstruction. Further investigations are necessary to resolve the controversies regarding ALL anatomy and to establish appropriate ALL reconstruction techniques.