Year 2021 Vol. 29 No 5




Institute of Traumatology and Orthopedics of NAMS of Ukraine 1, Kiev, Ukraine
Republican Scientific and Practical Center of Traumatology and Orthopedics 2, Minsk
The Republic of Belarus

Objective. To assess the variability of the anterolateral ligament according to MRT and ultrasonography data and to coordinate it with surgical treatment strategy for its injuries.
Methods. The anterolateral ligament was analyzed on 100 series of MRI images of knee joints without traumatic pathology on Philips Achieva 1.5 T tomograph using the standard research protocol in three mutually perpendicular planes and 150 series of MRT images of knee joints with injuries and without injuries of the anterolateral ligament obtained on different tomographs from 0.2 to 3 Tesla. The quality of visualization of anterolateral ligament separate portions, the number of layers, and the contact with the joint capsule were evaluated. Both knee joints were analyzed by ultrasonography in 30 patients with anterior cruciate ligament injuries of one of the knee-joint and in 30 patients with intact knee-joints.
Results. During the studies in the identification of anterolateral ligament with magnetic resonance tomography (MRT 1.5T) it was revealed at least partially in 92% of cases (in 68% as a two-layer structure; in 24% as a single-layer structure; in 14% as a thickening of the capsule or in 10% as a separate extracapsular structure), ultrasound examination in 100% (the structure was not determined, however, in 26.67% of patients without clinically pronounced pathology of the knee-joint and significant trauma in anamnesis ultrasound scan revealed a violation of the integrity of the cortical layer at the tibial attachment site),
Conclusion. According to MRT and ultrasonography data, the anterolateral ligament is a constant structure of the knee-joint, but very variable in its anatomical parameters, which in some cases may be poorly visualized on MRT, may have a two-layer structure, may be located either extracapsular or as a thickening of the knee-joint capsule. The variability of its anatomical structure makes it impossible to make the theoretical substantiation of the advantages of one separate method of its restoration, but, on the contrary, justifies a differentiated approach to the selection of optimal surgical treatment.

Keywords: anterolateral ligament, anterolateral complex, knee joint, rotational instability, MRT, ultrasonography, surgical treatment
p. 581-589 of the original issue
  1. Claes S, Vereecke E, Maes M, Victor J, Verdonk P, Bellemans J. Anatomy of the anterolateral ligament of the knee. J Anat. 2013 Oct;223(4):321-28. doi: 10.1111/joa.12087
  2. Vieira EL, Vieira EA, da Silva RT, Berlfein PA, Abdalla RJ, Cohen M. An anatomic study of the iliotibial tract. Arthroscopy. 2007 Mar;23(3):269-74. doi: 10.1016/j.arthro.2006.11.019
  3. Lee DW, Lee JH, Kim JN, Moon SG, Kim NR, Kim DH, Kim JG. Evaluation of anterolateral ligament injuries and concomitant lesions on magnetic resonance imaging after acute anterior cruciate ligament rupture. Arthroscopy. 2018 Aug;34(8):2398-406. doi: 10.1016/j.arthro.2018.02.048
  4. Fardin PBA, Lizardo JHF, Baptista JDS. Study of the anterolateral ligament of the knee in formalin-embedded cadavers. Acta Ortop Bras. 2017 Mar-Apr;25(2):89-92. doi: 10.1590/1413-785220172502162204
  5. Bonasia DE, DAmelio A, Pellegrino P, Rosso F, Rossi R. Anterolateral ligament of the knee: back to the future in anterior cruciate ligament reconstruction. Orthop Rev (Pavia). 2015 Jun 11;7(2):5773. doi: 10.4081/or.2015.5773. eCollection 2015 Jun 3.
  6. DePhillipo NN, Cinque ME, Chahla J, Geeslin AG, LaPrade RF. Anterolateral ligament reconstruction techniques, biomechanics, and clinical outcomes: a systematic review. Arthroscopy. 2017 Aug;33(8):1575-83. doi: 10.1016/j.arthro.2017.03.009
  7. LaPrade RF. Editorial commentary: defining the anatomy of the anterolateral aspect of the knee among experts is clearly needed. Arthroscopy. 2016 May;32(5):842-43. doi: 10.1016/j.arthro.2016.03.002
  8. Ferretti A. Extra-articular reconstruction in the anterior cruciate ligament deficient knee: a commentary. Joints. 2014 Jan-Mar;8;2(1):41-47. eCollection 2014 Jan-Mar.
  9. Ibrahim SA, Shohdy EM, Marwan Y, Ramadan SA, Almisfer AK, Mohammad MW, Abdulsattar WS, Khirat S. Anatomic reconstruction of the anterior cruciate ligament of the knee with or without reconstruction of the anterolateral ligament: a randomized clinical trial. Am J Sports Med. 2017 Jun;45(7):1558-66. doi: 10.1177/0363546517691517
  10. Helito CP, do Amaral C Jr, Nakamichi YD, Gobbi RG, Bonadio MB, Natalino RJ, Pécora JR, Cardoso TP, Camanho GL, Demange MK. Why do authors differ with regard to the femoral and meniscal anatomic parameters of the knee anterolateral ligament?: dissection by layers and a description of its superficial and deep layers. Orthop J Sports Med. 2016 Dec 22;4(12):2325967116675604. doi: 10.1177/2325967116675604
  11. Cho HJ, Kwak DS. Anatomical consideration of the anterolateral ligament of the knee. Biomed Res Int. 2019 Apr 11;2019:5740473. doi: 10.1155/2019/5740473. eCollection 2019.
  12. Kennedy MI, Claes S, Fuso FA, Williams BT, Goldsmith MT, Turnbull TL, Wijdicks CA, LaPrade RF. The Anterolateral ligament: an anatomic, radiographic, and biomechanical analysis. Am J Sports Med. 2015 Jul;43(7):1606-15. doi: 10.1177/0363546515578253
  13. Runer A, Birkmaier S, Pamminger M, Reider S, Herbst E, Künzel KH, Brenner E, Fink C. The anterolateral ligament of the knee: A dissection study. Knee. 2016 Jan;23(1):8-12. doi: 10.1016/j.knee.2015.09.014
  14. Faruch Bilfeld M, Cavaignac E, Wytrykowski K, Constans O, Lapègue F, Chiavassa Gandois H, Larbi A, Sans N. Anterolateral ligament injuries in knees with an anterior cruciate ligament tear: Contribution of ultrasonography and MRI. Eur Radiol. 2018 Jan;28(1):58-65. doi: 10.1007/s00330-017-4955-0
  15. Panda S, Sravanthi J, Kejriwal GS, Madhavi C. Evaluation of Anterolateral Ligament of Knee Using USG and MRI in Cases of Anterior Cruciate Ligament Tear. Int J Anat Radiol Surg. 2020;9(1):RO16-RO19. doi: 10.7860/IJARS/2020/42797:2531
  16. Sonnery-Cottet B, Daggett M, Fayard JM, Ferretti A, Helito CP, Lind M, Monaco E, de Pádua VBC, Thaunat M, Wilson A, Zaffagnini S, Zijl J, Claes S. Anterolateral Ligament Expert Group consensus paper on the management of internal rotation and instability of the anterior cruciate ligament deficient knee. J Orthop Traumatol. 2017 Jun;18(2):91-106. doi: 10.1007/s10195-017-0449-8
  17. Young BL, Ruder JA, Trofa DP, Fleischli JE. Visualization of concurrent anterolateral and anterior cruciate ligament injury on magnetic resonance imaging. Arthroscopy. 2020 Apr;36(4):1086-91. doi: 10.1016/j.arthro.2019.09.039
Address for correspondence:
01601 Ukraine,
Kiev, Bulvarno-Kudryavskaya Str., 27,
Institute of Traumatology and Orthopedics,
the Department of Sports and Ballet Trauma
of NAMS of Ukraine,
tel. +38(068)321 42 87.
Kotiuk Viktor V.
Information about the authors:
Kostrub Oleksandr O., MD, Professor, Head of the Department of Sports and Ballet Trauma, Institute of Traumatology and Orthopedics of NAMS of Ukraine, Kiev, Ukraine.
Poliachenko Iurii V., MD, Professor, Acting Director of Institute of Traumatology and Orthopedics of NAMS of Ukraine, Kiev, Ukraine
Gerasimenko Mikhail A., MD, Professor, Director of Republican Scientific and Practical Center of Traumatology and Orthopedics, Minsk, Republic of Belarus
Kotiuk Viktor V., PhD, Senior Researcher of the Department of Sports and Ballet Trauma, Institute of Traumatology and Orthopedics of NAMS of Ukraine, Kiev, Ukraine.
Blonskii Roman I., MD, Leading Researcher of the Department of Sports and Ballet Trauma, Institute of Traumatology and Orthopedics of NAMS of Ukraine, Kiev, Ukraine.
Mazevych Vadym B., Researcher of the Diagnostics Department, Institute of Traumatology and Orthopedics of NAMS of Ukraine, Kiev, Ukraine.
Vadzyuk Nazar S., PhD, Senior Researcher of the Department of Sports and Ballet Trauma, Institute of Traumatology and Orthopedics of NAMS of Ukraine, Kiev, Ukraine.
Contacts | ©Vitebsk State Medical University, 2007-2023