Radiographic Landmarks for Locating the Femoral Origin and Tibial Insertion of the Knee Anterolateral Ligament

2014 ◽  
Vol 42 (10) ◽  
pp. 2356-2362 ◽  
Author(s):  
Camilo Partezani Helito ◽  
Marco Kawamura Demange ◽  
Marcelo Batista Bonadio ◽  
Luis Eduardo Passareli Tirico ◽  
Riccardo Gomes Gobbi ◽  
...  
Keyword(s):  
Anterolateral Ligament ◽  
Tibial Insertion ◽  
Radiographic Landmarks

The Segond Fracture Is an Avulsion of the Anterolateral Complex

2017 ◽  
Vol 45 (10) ◽  
pp. 2247-2252 ◽  
Author(s):  
Humza Shaikh ◽  
Elmar Herbst ◽  
Ata Amir Rahnemai-Azar ◽  
Marcio Bottene Villa Albers ◽  
Jan-Hendrik Naendrup ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Tibial Plateau ◽  
Anterolateral Ligament ◽  
Fibular Head ◽  
Lateral Tibial Plateau ◽  
Segond Fracture ◽  
Posterior Aspect ◽  
Tibial Insertion ◽  
Anterolateral Capsule ◽  
The Mean

Background: The Segond fracture was classically described as an avulsion fracture of the anterolateral capsule of the knee. Recently, some authors have attributed its pathogenesis to the “anterolateral ligament” (ALL). Biomechanical studies that have attempted to reproduce this fracture in vitro have reported conflicting findings. Purpose: To determine the anatomic characteristics of the Segond fracture on plain radiographs and magnetic resonance imaging (MRI), to compare this location with the location of the ALL described in prior radiographic and anatomic publications, and to determine the fracture’s attachments to the soft tissue anterolateral structures of the knee. Study Design: Case series; Level of evidence, 4. Methods: A total of 36 anterior cruciate ligament–injured patients with Segond fractures (33 male, 3 female; mean age, 23.2 ± 8.4 years) were enrolled. MRI scans were reviewed to determine the anatomic characteristics of the Segond fracture, including the following: proximal-distal (PD) length, anterior-posterior (AP) width, medial-lateral (ML) width, PD distance to the lateral tibial plateau, AP distance to the Gerdy tubercle (GT), and AP distance from the GT to the posterior aspect of the fibular head. The attachment of the anterolateral structures to the Segond fragment was then categorized as the iliotibial band (ITB) or anterolateral capsule. Interrater reliability of the measurements was determined by calculating the Spearman rank correlation coefficient. MEDLINE, Web of Science, and the Cochrane Library were searched from inception to May 2016 for the following keywords: (1) “Segond fracture,” (2) “anterolateral ligament,” (3) “knee avulsion,” (4) “lateral tibia avulsion,” and (5) “tibial plateau avulsion.” All studies describing the anatomic location of the Segond fracture and the ALL were included in the systematic review. Results: On plain radiographs, the mean distance of the midpoint of the fracture to the lateral tibial plateau was 4.6 ± 2.2 mm. The avulsed fracture had a mean PD length of 9.2 ± 2.5 mm and a mean ML width of 2.4 ± 1.4 mm. On MRI, the mean distance of the proximal fracture to the tibial plateau was 3.4 ± 1.6 mm. The mean PD length was 8.7 ± 2.2 mm, while the mean AP width was 11.1 ± 2.2 mm. The mean distance between the GT and the center of the fracture was 26.9 ± 3.3 mm, while the mean distance between the GT and the posterior fibular head was 53.9 ± 4.4 mm. The mean distance of the midpoint of the fracture to the tibial plateau was 7.8 ± 2.7 mm, while the center of the fracture was 49.9% of the distance between the GT and the posterior aspect of the fibular head. Analysis of soft tissue structures attached to the fragment revealed that the ITB attached in 34 of 36 patients and the capsule attached in 34 of 36 patients. One patient had only the capsule attached, another had only the ITB attached, and the last showed neither clearly attached. A literature review of 20 included studies revealed no difference between the previously described Segond fracture location and the tibial insertion of the ALL. Conclusion: The results of this study confirmed that while the Segond fracture occurs at the location of the tibial insertion of the ALL, as reported in the literature, MRI was unable to identify any distinct ligamentous attachment. MRI analysis revealed that soft tissue attachments to the Segond fracture were the posterior fibers of the ITB and the lateral capsule in 94% of patients.

Radiographic Landmarks for Identifying the Anterolateral Ligament of the Knee

2016 ◽  
Vol 32 (5) ◽  
pp. 844-848 ◽  
Author(s):  
Nathanael Heckmann ◽  
Lakshmanan Sivasundaram ◽  
Diego Villacis ◽  
Matthew Kleiner ◽  
Anthony Yi ◽  
...  
Keyword(s):  
Anterolateral Ligament ◽  
Radiographic Landmarks

Radiographic landmarks for surgical reconstruction of the anterolateral ligament of the knee

2014 ◽  
Vol 23 (11) ◽  
pp. 3196-3201 ◽  
Author(s):  
Alex J. Rezansoff ◽  
Scott Caterine ◽  
Luke Spencer ◽  
Michael N. Tran ◽  
Robert B. Litchfield ◽  
...  
Keyword(s):  
Anterolateral Ligament ◽  
Surgical Reconstruction ◽  
Radiographic Landmarks

scholarly journals PEDIATRIC REFERENCE ANATOMY FOR ANTEROLATERAL LIGAMENT RECONSTRUCTION– A CADAVERIC STUDY

2020 ◽  
Vol 8 (4_suppl3) ◽  
pp. 2325967120S0027
Author(s):  
Sahej D Randhawa ◽  
Sunny Trivedi ◽  
Tyler J. Stavinoha ◽  
Theodore J. Ganley ◽  
Marc Tompkins ◽  
...  
Keyword(s):  
Lateral Collateral Ligament ◽  
Anterolateral Ligament ◽  
Joint Line ◽  
Cadaveric Study ◽  
Clear Understanding ◽  
Tibial Insertion ◽  
Quantitative Anatomy ◽  
Text Figure ◽  
Anterolateral Complex ◽  
Gerdy’S Tubercle

Background: The anatomy of the anterolateral ligament (ALL) has been controversial, with modern studies varying in their description of the precise origin and insertion, as well as relation to surrounding structures on the lateral femur and anterolateral tibia Regardless of such controversy, principles of reconstruction, even non-anatomic, require a clear understanding of the referenced anatomy and surrounding structures. Due to high rates of primary and recurrent ACL tears in pediatric/adolescent patients, the use of ALL reconstruction is increasing in these groups. No pediatric cadaveric study to date has clearly identified the locations of the known surrounding structures of the anterolateral ligamentous complex. Purpose: The purpose of this study was to quantitatively assess the anatomy of the pediatric lateral collateral ligament (LCL) origin, the popliteus origin, and in the tibial insertion of the iliotibioband (ITB). Methods: Nine pediatric cadaveric knee specimens were dissected to identify the ligamentous femoral origin of the LCL, popliteus, and tibial insertion of the ITB.. Marking pins were used to localize the central footprint of these structures, followed by CT Scans. Results: LCL & Popliteus: On the femur, the popliteus was consistently found deep to the LCL and inserted both distally and anteriorly to the LCL a mean distance of 4.6 mm (range 1.9 to 7.6 mm; std dev 2.0). The LCL measured a mean of 12.5 mm to the joint line while the popliteus measured a mean of 8.2 mm from the joint line. Both the LCL and popliteus were consistently distal to the physis. The LCL was a mean distance of 4.4 mm (range 1.0 - 9.5 ) and the popliteus was a mean distance of 8.2 (range 1.7 – 12.5), respectively. ITB insertion: The ITB insertion at Gerdy’s tubercle had an average footprint measuring 28.2 mm2 (range 10.3-58.4), and the ITB center was found proximal to the physis in 6 specimens and distal in 3 specimens. Mean distance from the footprint center to the physis was 1.6 mm proximal (range 7.1 mm proximal to 2.2 mm distal). Conclusion: This study provides quantitative anatomy to structures on the lateral femur and anterolateral tibia, commonly referenced in descriptions of the ALL and lateral extraarticular reconstruction techniques. Knowledge of these structures will define the anterolateral complex and guide extra-articular procedures that provide extraarticular anterolateral rotatory stabilization in the pediatric patients. [Figure: see text][Figure: see text]

scholarly journals Multiplanar reformation improves identification of the anterolateral ligament with MRI of the knee

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Andreas Hecker ◽  
Rainer J. Egli ◽  
Emanuel F. Liechti ◽  
Christiane S. Leibold ◽  
Frank M. Klenke
Keyword(s):  
Anterolateral Ligament ◽  
Joint Line ◽  
Coronal Plane ◽  
Rotational Stability ◽  
Current Debate ◽  
Fibular Head ◽  
Multiplanar Reformation ◽  
Tibial Insertion ◽  
Gerdy’S Tubercle ◽  
Mri Image

AbstractThe anterolateral ligament (ALL) is subject of the current debate concerning rotational stability in case of anterior cruciate ligament (ACL) injuries. Today, reliable anatomical and biomechanical evidence for its existence and course is available. Some radiologic studies claim to be able to identify the ALL on standard coronal plane MRI sections. In the experience of the authors, however, ALL identification on standard MRI sequences frequently fails and is prone to errors. The reason for this mainly lies in the fact, that the entire ALL often cannot be identified on a single MRI image. This study aimed to establish an MRI evaluation protocol improving the visualization of the ALL, using multiplanar reformation (MPR) with the goal to be able to evaluate the ALL on one MRI image. A total of 47 knee MRIs performed due to atraumatic knee pain between 2018 and 2019 without any pathology were analyzed. Identification of the ALL was performed twice by an orthopedic surgeon and a radiologist on standard coronal plane and after MPR. For the latter axial and coronal alignment was obtained with the femoral condyles as a reference. Then the coronal plane was adjusted to the course of the ALL with the lateral epicondyle as proximal reference. Visualization of the ALL was rated as “complete” (continuous ligamentous structure with a tibial and femoral insertion visible on one coronal image), “partial” (only parts of the ALL like the tibial insertion were visible) and “not visible”. The distances of its tibial insertion to the bony joint line, Gerdy’s tubercle and the tip of the fibular head were measured. On standard coronal images the ALL was fully visible in 17/47, partially visible in 27/47, and not visible in 3/47 cases. With MPR the ALL was fully visible in 44/47 and not visible in 3/47 cases. The median distance of its tibial insertion to the bony joint line, Gerdy’s tubercle and the tip of the fibular head were 9, 21 and 25 mm, respectively. The inter- (ICC: 0.612; 0.645; 0.757) and intraobserver (ICC: 0.632; 0.823; 0.857) reliability was good to excellent. Complete visualization of the ALL on a single MRI image is critical for its identification and evaluation. Applying multiplanar reformation achieved reliable full-length visualization of the ALL in 94% of cases. The described MPR technique can be applied easily and fast in clinical routine. It is a reliable tool to improve the assessment of the ALL.

scholarly journals Painful Palpation of the Tibial Insertion of the Anterolateral Ligament Is Concordant With Acute Anterolateral Ligament Injury

2020 ◽  
Vol 8 (6) ◽  
pp. 232596712093020
Author(s):  
Jérôme Murgier ◽  
Pierre Thomas ◽  
Nicolas Reina ◽  
Rémi Sylvie ◽  
Emilie Bérard ◽  
...  
Keyword(s):  
Knee Injury ◽  
Pivot Shift ◽  
Intraclass Correlation ◽  
Anterolateral Ligament ◽  
Rotational Stability ◽  
Ligament Injury ◽  
Clinical Test ◽  
Tibial Insertion ◽  
Acute Knee ◽  
Acute Knee Injury

Background: The anterolateral ligament (ALL) has been shown to contribute to the rotational stability of the knee. However, no clinical sign specific to ALL injury has been described. Purpose/Hypothesis: The primary aim of this study was to determine the concordance between pain elicited upon ALL palpation and ALL injury diagnosed by ultrasonography (US). The secondary aim was to look for a relationship between ALL injury and high-grade pivot shift. We hypothesized that an ALL lesion can be diagnosed clinically in an acute knee injury by palpating its tibial insertion. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: A total of 130 patients (89 men, 41 women; mean age, 27.2 ± 8.3 years) with an acute, isolated anterior cruciate ligament injury who were scheduled for ligament reconstruction were enrolled in this study. ALL palpation was carried out a mean 8.8 ± 3.2 days after injury. Preoperatively, ALL integrity was evaluated with US, and the pivot shift was determined under general anesthesia. The agreement between pain upon ALL palpation and ALL injury detected on US was determined by calculating the intraclass correlation coefficient (ICC), along with 95% CIs. Results: Distal palpation of the ALL tibial insertion elicited pain in 67 (51.5%) patients, and upon US the ALL was found to be damaged in 64 (49.2%) patients. The agreement between pain over the ALL tibial insertion and the ALL being damaged on US was excellent (ICC, 0.801; 95% CI, 0.730-0.855). Moreover, the clinical test had excellent sensitivity (92%; 95% CI, 88%-97%) and specificity (88%; 95% CI, 82%-93%). The agreement between pain at the ALL distal insertion and the pivot shift was good (ICC, 0.654; 95% CI, 0.543-0.742), and ALL palpation had excellent diagnostic accuracy for identifying rotational instability (sensitivity, 88% [95% CI, 82%-93%]; specificity, 97% [95% CI, 94%-100%]). Conclusion: Palpation of the ALL tibial insertion highly correlates with ultrasonographic evidence of an ALL injury in the context of an acute knee injury. This simple test should become part of our standard examination when evaluating patients with acute knee injuries.

Determination of Graft Forces for Cranial Cruciate Ligament Reconstruction in the Dog

1996 ◽  
Vol 09 (04) ◽  
pp. 165-171 ◽  
Author(s):  
D. A. Hulse ◽  
M. R. Slater ◽  
J. F. Hunter ◽  
W. A. Hyman ◽  
B. A. Shelley
Keyword(s):  
Degrees Of Freedom ◽  
Cruciate Ligament ◽  
Insertion Site ◽  
Graft Fixation ◽  
Flexion Angle ◽  
Patellar Ligament ◽  
Graft Material ◽  
Test Apparatus ◽  
Cranial Cruciate Ligament ◽  
Tibial Insertion

SummaryA test apparatus that allowed the stifle to move in five degrees of freedom was used to determine the effect of graft location, graft preload, and flexion angle at the time of graft fixation on the tensile graft forces experienced by a replacement graft material used to simulate reconstruction of the cranial cruciate ligament deficient stifle. Two graft locations (tibial insertion site of the patellar ligament and tibial insertion site of the cranial cruciate ligament), two graft preloads (5 N and 20 N), and three flexion angles at the time of graft fixation (15°, 30° and 90°) were examined. The tibial insertion site and preload did not have as great an effect on graft force as did the flexion angle of the limb at time of graft fixation. Graft forces were highest when reconstructions were performed with the limb in 90° of flexion (ρ <0.0001). This study supports the notion that intracapsular grafts should be fixed with the limb in a normal standing angle.A five degree of freedom test apparatus was used to evaluate the effect of graft location, graft preload, and limb flexion angle at time of graft fixation on reconstructions of the cranial cruciate ligament deficient stifle. Our results suggest that intracapsular grafts should not be fixed with the limb in 90° of flexion, but in a normal standing angle.

scholarly journals Graft Preparation for Combined ACL and ALL Reconstruction With a Single Femoral Tunnel

2021 ◽  
Vol 1 (3) ◽  
pp. 263502542110045
Author(s):  
Camilo Partezani Helito ◽  
Tales Mollica Guimarães ◽  
Marcel Faraco Sobrado
Keyword(s):  
Anterior Cruciate Ligament ◽  
High Risk ◽  
Cruciate Ligament ◽  
Anterolateral Ligament ◽  
Anatomical Landmarks ◽  
High Risk Patients ◽  
Risk Patients ◽  
Anterior Cruciate ◽  
Semitendinosus Graft ◽  
Lemaire Procedure

Background: Combined reconstruction of the anterolateral ligament (ALL) and anterior cruciate ligament (ACL) has shown excellent results. It could potentially reduce graft failure and improve outcomes in high-risk patients. There are several surgical techniques described. Hamstrings are the most frequently used graft for ALL reconstruction. The distal portion of the iliotibial band is used for the modified Lemaire procedure. Indications: Anterior cruciate ligament reconstructions associated with the following risk factors: pivoting sports, high-demand athletes, high-grade pivot-shift, chronic ACL injury, lateral femoral condyle notch, Segond fractures, young patients (<20 years), ACL revision, generalized hyperlaxity, and Lachman >7 mm. Technique Description: Semitendinosus and gracilis tendons are harvested and their extremities are prepared with continuous suture. The semitendinosus graft is folded in 3 parts leaving the ends of the graft internalized. The triple semitendinosus will be the main component of the ACL and the single gracilis will be used for both ACL and ALL. Anterolateral ligament anatomical landmarks are proximal and posterior to the lateral epicondyle in the femur, and in the mid distance from the fibular head and the Gerdy tubercle in the tibia. The ALL is fixed in knee extension with interference screws. This video also includes a brief demonstration of graft preparation for the modified Lemaire procedure. Results: Results from our group using this technique have shown excellent clinical outcomes, minimal complications, and low failure rates in high-risk populations. This graft preparation shows excellent diameter and length for combined ACL and ALL reconstruction. Conclusion: This technique is easy to perform, with minimal complications, and should be considered in high-risk patients undergoing ACL reconstruction.

scholarly journals Injuries to the anterolateral ligament are observed more frequently compared to lesions to the deep iliotibial tract (Kaplan fibers) in anterior cruciate ligamant deficient knees using magnetic resonance imaging

2021 ◽  
Author(s):  
Armin Runer ◽  
Dietmar Dammerer ◽  
Christoph Kranewitter ◽  
Johannes M. Giesinger ◽  
Benjamin Henninger ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Cruciate Ligament ◽  
Injury Rate ◽  
Anterolateral Ligament ◽  
Anatomical Reconstruction ◽  
Level Of Evidence ◽  
Iliotibial Tract ◽  
Anterolateral Complex ◽  
Anterior Cruciate ◽  
Combined Injuries

Abstract Purpose To determine the accuracy of detection, injury rate and inter- and intrarater reproducibility in visualizing lesions to the anterolateral ligament (ALL) and the deep portion of the iliotibial tract (dITT) in anterior cruciate ligament (ACL) deficient knees. Methods Ninety-one consecutive patients, out of those 25 children (age 14.3 ± 3.5 years), with diagnosed ACL tears were included. Two musculoskeletal radiologists retrospectively reviewed MRI data focusing on accuracy of detection and potential injuries to the ALL or dITT. Lesion were diagnosed in case of discontinued fibers in combination with intra- or peri-ligamentous edema and graded as intact, partial or complete tears. Cohen’s Kappa and 95% confidence intervals (95% CI) were determined for inter- and intrarater reliability measures. Results The ALL and dITT were visible in 52 (78.8%) and 56 (84.8%) of adult-and 25 (100%) and 19 (76.0%) of pediatric patients, respectively. The ALL was injured in 45 (58.5%; partial: 36.4%, compleate: 22.1%) patients. Partial and comleate tears, where visualized in 21 (40.4%) and 16 (30.8%) adult- and seven (28.0%) and one (4%) peditric patients. A total of 16 (21.3%; partial: 13.3%, compleate: 8.0%) dITT injuries were identified. Partal and complete lesions were seen in seven (12.5%) and five (8.9%) adult- and three (15.8%) and one (5.3%) pediatric patients. Combined injuries were visualized in nine (12.7%) patients. Inter-observer (0.91–0.95) and intra-observer (0.93–0.95) reproducibility was high. Conclusion In ACL injured knees, tears of the ALL are observed more frequently compared to lesions to the deep iliotibial tract. Combined injuries of both structures are rare. Clinically, the preoperative visualization of potentially injured structures of the anterolateral knee is crucial and is important for a more personalized preoperative planning and tailored anatomical reconstruction. The clinical implication of injuries to the anterolateral complex of the knee needs further investigation. Level of evidence II.

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