Abstract
The anterolateral ligament (ALL) has recently received considerable attention as a key structure maintaining the rotational stability of the tibia. However, the morphology of the ALL, particularly the proximal attachment, is controversial. This study aimed to elucidate the morphological relationship between the ALL and its adjacent structures. A total of 25 knees from 22 cadavers were used in the current study. One knee was set at 30°, 60° and 90° of flexion. Stretched or winkled fibrous tissues were then observed with internal and external rotations of the tibia at each angle. In 22 knees, fibrous tissues that were attached to the lateroposterior area to the Gerdy’s tubercle were macroscopically observed. In the other 2 knees, the fibrous tissues were histologically investigated and analyzed using computer-assisted three-dimensional reconstruction. A taut fibrous tissue was observed between the lateroposterior area to the Gerdy’s tubercle and the posterosuperior area to the lateral epicondyle during an internal rotation of the tibia. A complex of fibrous tissues that were attached to the lateroposterior area to the Gerdy’s tubercle spread to the anterolateral aspect of the knee as a sheet-like structure. This complex tissue was composed of the fascia lata and fibrous tissues continuous from the fabellofibular ligament, intermuscular septum, and tendon of the gastrocnemius. Three-dimensional reconstruction showed that each fibrous tissue formed a sheet. The structure recognized as the ALL could not be detected; therefore, the ALL that has been reported to date is considered to be a complex of fibrous tissues with a sheet-like structure.
Highlights
A distinct ligamentous structure was rediscovered at the anterolateral site of the knee joint in 2013 (Claes et al 2013)
In our previous study conducted from a perspective of the joint capsule, we found that the width of the joint capsular attachment is wider at the posterior area to the Gerdy’s tubercle and the joint capsule is attached to this area via developed uncalcified fibrocartilages (Nasu et al 2017)
At the internal rotation of the tibia, a taut fibrous tissue was observed on the lateral aspect of the knee
Summary
A distinct ligamentous structure was rediscovered at the anterolateral site of the knee joint in 2013 (Claes et al 2013). The anterolateral ligament (ALL) has been reported by numerous researchers because the ALL is regarded as one of the key structures to maintain the. With regard to the attachments of the ALL, many researchers (Claes et al 2013; Dodds et al 2014; Porrino et al 2015; De Maeseneer et al 2015; Coquart et al 2016; Caterine et al 2017) reported that the distal attachment is located posterior to the Gerdy’s tubercle. Dodds et al (2014) demonstrated that the femoral attachment of the ALL is a mean of 8 mm proximal and 4.3 mm posterior to the most prominent point of the lateral epicondyle. Following fibrous tissues that were attached to the lateroposterior area to the Gerdy’s tubercle proximally might make the proximal attachment of the ALL clear
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