Overview
The anterolateral ligament (ALL) is a ligamentous structure on the anterolateral aspect of the knee associated with control of internal tibial rotation and the pivot-shift phenomenon.
Anatomy
The ALL arises around the lateral femoral epicondylar region and runs distally and anteriorly toward the anterolateral tibia, inserting between Gerdy tubercle and the fibular head. It has a close relationship to the lateral meniscus.
Function
The ALL acts as a secondary restraint to:
- Internal rotation of the tibia
- Anterolateral rotatory instability
Its contribution becomes particularly relevant in the ACL-deficient knee.
Injury
ALL injury frequently occurs with ACL injury and may contribute to a high-grade pivot shift.
Associated findings may include:
- Segond fracture
- Lateral capsular injury
- Other structures of the anterolateral complex
Clinical relevance
Persistent anterolateral rotatory instability may be suspected when there is:
- High-grade pivot shift
- Generalised ligamentous laxity
- Revision ACL reconstruction
- High-demand pivoting athlete
Reconstruction
Anterolateral procedures, including ALL reconstruction or lateral extra-articular tenodesis, may be added to ACL reconstruction in selected high-risk patients. They are not required routinely in every ACL reconstruction.
References
- Orthobullets evidence review. Anatomy of the anterolateral ligament of the knee.
- Contemporary ACL reconstruction literature on lateral extra-articular procedures.