scholarly journals The Anterolateral Complex of the Knee

2017 ◽  
Vol 5 (10) ◽  
pp. 232596711773080 ◽  
Author(s):  
Elmar Herbst ◽  
Marcio Albers ◽  
Jeremy M. Burnham ◽  
Freddie H. Fu ◽  
Volker Musahl
Keyword(s):  
Functional Unit ◽  
Femoral Condyle ◽  
Biceps Femoris ◽  
Anterolateral Ligament ◽  
Iliotibial Band ◽  
Layer By Layer ◽  
Anatomic Structure ◽  
Capsular Ligament ◽  
Anterolateral Complex ◽  
Anterolateral Capsule

Background: Significant controversy exists regarding the anterolateral structures of the knee. Purpose: To determine the layer-by-layer anatomic structure of the anterolateral complex of the knee. Study Design: Descriptive laboratory study. Methods: Twenty fresh-frozen cadaveric knees (age range, 38-56 years) underwent a layer-by-layer dissection to systematically expose and identify the various structures of the anterolateral complex. Quantitative measurements were performed, and each layer was documented with high-resolution digital imaging. Results: The anterolateral complex of the knee consisted of different distinct layers, with the superficial and deep iliotibial band (ITB) representing layer 1. The superficial ITB had a distinct connection to the distal femoral metaphysis and femoral condyle (Kaplan fibers), and the deep layers of the ITB were identified originating at the level of the Kaplan fibers proximally. This functional unit, consisting of the superficial and deep ITB, was reinforced by the capsulo-osseous layer of the ITB, which was continuous with the fascia of the lateral gastrocnemius and biceps femoris muscles. These 3 components of the ITB became confluent distally, and the insertion spanned from the Gerdy tubercle anteriorly to the lateral tibia posteriorly on a small tubercle (lateral tibial tuberosity). Layer 3 consisted of the anterolateral capsule, in which 35% (7/20) of specimens had a discreet mid-third capsular ligament. Conclusion: The anterolateral complex consists of the superficial and deep ITB, the capsulo-osseous layer of the ITB, and the anterolateral capsule. The anterolateral complex is defined by the part of the ITB between the Kaplan fibers proximally and its tibial insertion, which forms a functional unit. A discrete anterolateral ligament was not observed; however, the anterolateral ligament described in recent studies likely refers to the capsulo-osseous layer or the mid-third capsular ligament. Clinical Relevance: The anterolateral knee structures form a complex functional unit. Surgeons should use caution when attempting to restore this intricate structure with extra-articular procedures designed to re-create a single discreet ligament.

scholarly journals Anatomic Study and Reanalysis of the Nomenclature of the Anterolateral Complex of the Knee Focusing on the Distal Iliotibial Band: Identification and Description of the Condylar Strap

2019 ◽  
Vol 7 (1) ◽  
pp. 232596711881806 ◽  
Author(s):  
Philippe Landreau ◽  
Antoine Catteeuw ◽  
Fawaz Hamie ◽  
Adnan Saithna ◽  
Bertrand Sonnery-Cottet ◽  
...  
Keyword(s):  
Qualitative Evaluation ◽  
Iliotibial Band ◽  
Lateral Ligament ◽  
Macroscopic Anatomy ◽  
Anatomic Structure ◽  
Capsular Ligament ◽  
Deep Surface ◽  
Mean Width ◽  
Anterolateral Complex ◽  
Lateral Capsular Ligament

Background: The capsulo-osseous layer (COL), short lateral ligament, mid–third lateral capsular ligament, lateral capsular ligament, and anterolateral ligament (ALL) are terms that have been used interchangeably to describe what is probably the same structure. This has resulted in confusion regarding the anatomy and function of the anterolateral complex of the knee and its relation to the distal iliotibial band (ITB). Purpose: To characterize the macroscopic anatomy of the anterolateral complex of the knee, in particular the femoral condylar attachment of the distal ITB. We identified a specific and consistent anatomic structure that has not been accurately described previously; it connects the deep surface of the ITB to the condylar area and is distinct from the ALL, COL, and Kaplan fibers. Study Design: Descriptive laboratory study. Methods: Sixteen fresh-frozen human cadaveric knees were used to study the anterolateral complex of the knee. Standardized dissections were performed that included qualitative and quantitative assessments of the anatomy through both anterior (n = 5) and posterior (n = 11) approaches. Results: The femoral condylar attachment of the distal ITB was not reliably identified by anterior dissection but was in all posterior dissections. A distinct anatomic structure, hereafter termed the “condylar strap” (CS), was identified between the femur and the lateral gastrocnemius on one side and the deep surface of the ITB on the other, in all posteriorly dissected specimens. The structure had a mean thickness of 0.88 mm, and its femoral insertion was located between the distal Kaplan fibers and the epicondyle. The proximal femoral attachment of the structure had a mean width of 15.82 mm, and the width of the distal insertion of the structure on the ITB was 13.27 mm. The mean length of the structure was 26.33 mm on its distal border and 21.88 mm on its proximal border. The qualitative evaluation of behavior in internal rotation revealed that this anatomic structure became tensioned and created a tenodesis effect on the ITB. Conclusion: There is a consistent structure that attaches to the deep ITB and the femoral epicondylar area. The orientation of fibers suggests that it may have a role in anterolateral knee stability. Clinical Relevance: This new anatomic description may help surgeons to optimize technical aspects of lateral extra-articular procedures in cases of anterolateral knee laxity.

Segond fracture: involvement of the iliotibial band, anterolateral ligament, and anterior arm of the biceps femoris in knee trauma

2014 ◽  
Vol 44 (3) ◽  
pp. 413-421 ◽  
Author(s):  
Michel De Maeseneer ◽  
Cedric Boulet ◽  
Inneke Willekens ◽  
Leon Lenchik ◽  
Johan De Mey ◽  
...  
Keyword(s):  
Biceps Femoris ◽  
Anterolateral Ligament ◽  
Iliotibial Band ◽  
Segond Fracture ◽  
Knee Trauma

Anatomic and Histological Investigation of the Anterolateral Capsular Complex in the Fetal Knee

2017 ◽  
Vol 45 (6) ◽  
pp. 1383-1387 ◽  
Author(s):  
Soheil Sabzevari ◽  
Amir Ata Rahnemai-Azar ◽  
Marcio Albers ◽  
Monica Linde ◽  
Patrick Smolinski ◽  
...  
Keyword(s):  
Gestational Age ◽  
Histological Analysis ◽  
External Rotation ◽  
Lower Limbs ◽  
Iliotibial Band ◽  
Popliteus Tendon ◽  
Superficial Fascia ◽  
Anterolateral Complex ◽  
Anterolateral Capsule ◽  
Ligamentous Structure

Background: There is currently disagreement with regard to the presence of a distinct ligament in the anterolateral capsular complex of the knee and its role in the pivot-shift mechanism and rotatory laxity of the knee. Purpose: To investigate the anatomic and histological properties of the anterolateral capsular complex of the fetal knee to determine whether there exists a distinct ligamentous structure running from the lateral femoral epicondyle inserting into the anterolateral tibia. Study Design: Descriptive laboratory study. Methods: Twenty-one unpaired, fresh fetal lower limbs, gestational age 18 to 22 weeks, were used for anatomic investigation. Two experienced orthopaedic surgeons performed the anatomic dissection using loupes (magnification ×3.5). Attention was focused on the anterolateral and lateral structures of the knee. After the skin and superficial fascia were removed, the iliotibial band was carefully separated from underlying structures. The anterolateral capsule was then examined under internal and external rotation and varus-valgus manual loading and at different knee flexion angles for the presence of any ligamentous structures. Eight additional unpaired, fetal lower limbs, gestational age 11 to 23 weeks, were used for histological analysis. Results: This study was not able to prove the presence of a distinct capsular or extracapsular ligamentous structure in the anterolateral capsular complex area. The presence of the fibular collateral ligament, a distal attachment of the biceps femoris, the entire lateral capsule, the iliotibial band, and the popliteus tendon in the anterolateral and lateral area of the knee was confirmed in all the samples. Histological analysis of the anterolateral capsule revealed a loose, hypocellular connective tissue with less organized collagen fibers compared with ligament and tendinous structures. Conclusion: The main finding of this study was that the presence of a distinct ligamentous structure in the anterolateral complex is not supported from a developmental point of view, while all other anatomic structures were present. Clinical Relevance: The inability to prove the existence of a distinct ligamentous structure, called the anterolateral ligament, in the anterolateral knee capsule may indicate that the other components of the anterolateral complex, such as the lateral capsule, the iliotibial band, and its capsule-osseous layer, are more important for knee rotatory stability.

scholarly journals The Anterolateral Complex of the Knee

2018 ◽  
Vol 6 (4_suppl2) ◽  
pp. 2325967118S0003
Author(s):  
Elmar Herbst ◽  
Marcio Albers ◽  
Andreas Imhoff ◽  
Freddie Fu ◽  
Volker Musahl
Keyword(s):  
Insertion Site ◽  
Posterior Part ◽  
Biceps Muscle ◽  
Capsular Ligament ◽  
Femoral Metaphysis ◽  
Complex Anatomy ◽  
Anterolateral Complex ◽  
Anterolateral Capsule ◽  
Distal Femoral Metaphysis ◽  
Gerdy’S Tubercle

The objective of this study was to clarify the layer-by-layer anatomy of the anterolateral complex of the knee. Twenty fresh-frozen human cadaveric knees (age range 38 - 56 yrs.) without any history of knee injury or surgery were used for this dissection study. After skin and subcutaneous tissue removal, the ITB was incised in its most anterior part and reflected posteriorly followed by blunt dissection of its deeper layers. Subsequently, an incision was made between the ITB and the short head of the biceps muscle with consecutive evaluation of the insertion site of the biceps tendon and its extensions. Once the deep layers of the ITB were identified, the connections to the lateral intermuscular septum and Kaplan fibers were cut. The superficial ITB was then reflected distally in order to assess the geographical relationship between the superficial and deep ITB as well as the distal anteromedial aspect of the biceps muscle. Finally, the anterolateral capsule was incised to evaluate its connections to the surrounding anatomic structures. The anterolateral aspect of the knee consists of three distinct layers. Superficially, the ITB with its insertion to Gerdy’s tubercle and extensions to the patella (iliopatellar band) was appreciated. Posterior reflection of the superficial ITB revealed a firm distinct connection of Kaplan fibers to the distal femoral metaphysis. The deep layer of the ITB runs from the Kaplan fibers in a distal direction and forms a functional arc. This arc is reinforced by the capsulo-osseous layer of the ITB, which originates from an area distal to the Kaplan fibers, the fascia of the lateral gastrocnemius and plantaris muscles. The distal half of the capsulo-osseous layer merges posteriorly with the fascia of the biceps muscle. The three layers of the ITB become confluent distally. Its insertion spanned from Gerdy’s tubercle to an area just posteriorly, with the capsulo-osseous layer forming the posterior part. The biceps muscle has fascial and aporoneurotical extensions, which insert to the proximal tibia together with the capsulo-osseous layer of the ITB. Layer 3 consists of the anterolateral capsule. In 7/20 (35%) specimens the mid-third capsular ligament was observed as a thickening within, but not separate from the anterolateral capsule. The anterolateral complex of the knee consists of the ITB with its three layers, the functional arc formed by the fibers between the distal femoral metaphysis and Gerdy’s tubercle, and the anterolateral capsule. In 35% of specimens a capsular thickening (mid-third capsular ligament) was identified. Surgeons should consider the complex anatomy of this functional unit, i.e. the anterolateral complex, when considering lateral extra-articular procedures.

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.

scholarly journals A New Reconstructive Technique of the Anterolateral Ligament with Iliotibial Band-Strip

2017 ◽  
Vol 11 (1) ◽  
pp. 321-326 ◽  
Author(s):  
Bart Stuyts ◽  
Elke Van den Eeden ◽  
Jan Victor
Keyword(s):  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Proximal Part ◽  
Anterolateral Ligament ◽  
Anatomical Reconstruction ◽  
Iliotibial Band ◽  
Anatomical Location ◽  
Anterior Cruciate ◽  
The Sacrifice ◽  
Insight Into

Background:Anterior cruciate ligament (ACL) reconstruction is a well-established surgical procedure for the correction of ACL ruptures. However, the incidence of instability following ACL reconstruction is substantial. Recent studies have led to greater insight into the anatomy and the radiographic characteristics of the native anterolateral ligament (ALL), along with its possible role in residual instability after ACL reconstruction.Method:The current paper describes a lateral extra-articular tenodesis to reconstruct the ALL during ACL procedures, using a short iliotibial band strip. The distal insertion of this strip is left intact on the anterolateral side of the proximal tibia, and the proximal part is fixed at the anatomic femoral insertion of the ALL.Results:Our technique avoids the sacrifice of one of the hamstring tendons for the ALL reconstruction. Additionally, there is no interference with the anatomical location or function of the LCL.Conclusion:Our technique offers a minimally invasive and nearly complete anatomical reconstruction of the ALL with minimal additional operative time.

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.

The Magnetic Resonance Imaging Appearance of Individual Structures of the Posterolateral Knee

2000 ◽  
Vol 28 (2) ◽  
pp. 191-199 ◽  
Author(s):  
Robert F. LaPrade ◽  
Thomas J. Gilbert ◽  
Timothy S. Bollom ◽  
Fred Wentorf ◽  
Gregory Chaljub
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Biceps Femoris ◽  
Surgical Reconstruction ◽  
Iliotibial Band ◽  
Resonance Imaging ◽  
Popliteofibular Ligament ◽  
Imaging Appearance ◽  
Magnetic Resonance Imaging Appearance ◽  
Lateral Capsular Ligament

The purpose of this study was to contrast the magnetic resonance imaging appearance of uninjured components of the posterolateral knee with that of injured structures, and to assess the accuracy of magnetic resonance imaging in identifying posterolateral knee complex injuries. Thin-slice coronal oblique T1-weighted images through the entire fibular head were used to identify the posterolateral structures in seven uninjured knees. The appearance of corresponding grade III injuries to these structures was identified prospectively in 20 patients and verified at the time of surgical reconstruction. The sensitivity, specificity, and accuracy of imaging for the most frequently injured posterolateral knee structures in this series were as follows: iliotibial band-deep layer (91.7%, 100%, and 95%), short head of the biceps femoris-direct arm (81.3%, 100%, and 85%), short head of the biceps femoris-anterior arm (92.9%, 100%, and 95%), midthird lateral capsular ligament-meniscotibial (93.8%, 100%, and 95%), fibular collateral ligament (94.4%, 100%, and 95%), popliteus origin on femur (93.3%, 80%, and 90%), popliteofibular ligament (68.8%, 66.7%, and 68%), and the fabellofibular ligament (85.7%, 85.7%, and 85.7%). Magnetic resonance imaging of the knee was accurate in the identification of these injuries.

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