Helito Camilo Partezani, do Amaral Carlos, Nakamichi Yuri da Cunha, Gobbi Riccardo Gomes, Bonadio Marcelo Batista, Natalino Renato José Mendonça, Pécora José Ricardo, Cardoso Tulio Pereira, Camanho Gilberto Luis, Demange Marco Kawamura
Knee Surgery Division, Department of Orthopaedics and Traumatology, Institute of Orthopedics and Traumatology-Hospital and Clinics, Faculty of Medicine, University of São Paulo (IOT-HCFMUSP), São Paulo, Brazil.
Department of Orthopaedic Surgery, Catholic University of São Paulo, Sorocaba, São Paulo, Brazil.
Orthop J Sports Med. 2016 Dec 22;4(12):2325967116675604. doi: 10.1177/2325967116675604. eCollection 2016 Dec.
No consensus exists regarding the anatomic characteristics of the knee anterolateral ligament (ALL). A critical analysis of the dissections described in previous studies allows the division of the ALL into 2 groups with similar characteristics. The presence of considerable variability suggests that the authors may not be referring to the same structure.
PURPOSE/HYPOTHESIS: To perform a lateral anatomic dissection, by layers, seeking to characterize the 2 variants described for the ALL on the same knee. We hypothesized that we would identify the 2 variants described for the ALL and that these variants would have distinct characteristics.
Descriptive laboratory study.
Thirteen unpaired cadaveric knees were used in this study. The dissection protocol followed the parameters described in previous studies. Immediately below the iliotibial tract, we isolated a structure designated as the superficial ALL, whereas between this structure and the articular capsule, we isolated a structure designated as the deep ALL. The 2 structures were measured for length at full extension and at 90° of flexion and for distance from the tibial insertion relative to the Gerdy tubercle. Potential contact with the lateral meniscus was also evaluated. After measurements were obtained, the 2 dissected structures underwent histologic analysis.
The superficial ALL presented a posterior and proximal origin to the center of the lateral epicondyle, its length increased on knee extension, and it exhibited no contact with the lateral meniscus. The deep ALL was located in the center of the lateral epicondyle, its length increased on knee flexion, and it presented a meniscal insertion. Both structures had a similar tibial insertion site; however, the insertion site of the deep ALL was located more posteriorly. The analysis of the histological sections for both structures indicated the presence of dense and well-organized collagen fibers.
This anatomic study clearly identified 2 structures, described as the superficial and deep ALL, which were consistent with previous but conflicting descriptions of the ALL.
This study clarifies numerous controversies encountered in anatomic studies of the ALL. Knowledge regarding the existence of 2 distinct structures in the anterolateral knee will allow more accurate evaluation of their functions and characteristics.
关于膝前外侧韧带（ALL）的解剖特征尚无共识。对先前研究中描述的解剖进行批判性分析后发现，可将ALL分为两组，其特征相似。存在相当大的变异性表明作者们可能并非在提及同一结构。
目的/假设：进行逐层外侧解剖，试图对同一膝关节上描述的ALL的两种变体进行特征描述。我们假设能够识别出为ALL描述的两种变体，且这些变体具有不同特征。
描述性实验室研究。
本研究使用了13个非配对的尸体膝关节。解剖方案遵循先前研究中描述的参数。在髂胫束正下方，我们分离出一个被称为浅层ALL的结构，而在该结构与关节囊之间，我们分离出一个被称为深层ALL的结构。测量了这两个结构在完全伸展和90°屈曲时的长度，以及相对于Gerdy结节的胫骨附着点距离。还评估了与外侧半月板的潜在接触情况。在获得测量结果后，对这两个解剖结构进行了组织学分析。
浅层ALL起源于外侧髁中心的后方和近端，其长度在膝关节伸展时增加，且不与外侧半月板接触。深层ALL位于外侧髁中心，其长度在膝关节屈曲时增加，且有半月板附着。两个结构的胫骨附着部位相似；然而，深层ALL的附着部位更靠后。对这两个结构的组织学切片分析表明存在密集且排列良好的胶原纤维。
这项解剖学研究明确识别出了两个结构，分别称为浅层和深层ALL，这与先前对ALL的相互矛盾的描述一致。
本研究澄清了ALL解剖学研究中遇到的众多争议。了解膝前外侧存在两种不同结构将有助于更准确地评估它们的功能和特征。
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