Radiographic Landmarks for Identifying the Anterolateral Ligament of the Knee

Abstract

To identify the radiographic position of the origin and insertion of the anterolateral ligament (ALL) of the knee on a lateral radiograph. Twelve unpaired, fresh-frozen cadaveric knees were dissected to expose the ALL. Theorigin and insertion of the ALL on each cadaver were then tagged using 2-mm radiopaque beads. True lateral fluoroscopic views of the knee were then obtained, and the distance from known radiographic landmarks was recorded by 2 reviewers. The origin of the ALL was found at a distance that is 37.0 ± 9.2% of the total anterior-posterior length of the femoral condyle from the posterior edge as measured along Blumensaat's line. The insertion was located at a distance that is 56.1 ± 6.9% of the total length of the tibial plateau from the posterior edge. The origin of the ALL is 5mm posterior to a line from the posterior femoral cortex and 9mm distal to a line along Blumensaat's line. The insertion is 4mm anterior to the 50% mark of the anterior-posterior width of the tibia, 14mm distal to the articular surface. The origin and insertion of the ALL can be accurately identified using intraoperative fluoroscopy. Determining radiographic parameters for the ALL will assist in developing accurate surgical techniques for ALL reconstruction.