Russian Medical Academy of Continuous Professional Education, Barrikadnaya St., 2/1, Moscow, 123242, Russia.
Central Clinical Hospital of the Russian Academy of Sciences, Litovskiy Blvd., 1a, Moscow, 117593, Russia.
Int Orthop. 2018 Dec;42(12):2859-2864. doi: 10.1007/s00264-018-4049-x. Epub 2018 Jul 3.
The anterolateral ligament (ALL) was discovered in 1879. For over 130 years, this anatomical structure did not enjoy much attention, but the situation started to change when a number of researchers described its contribution to the rotational stability of the knee joint.
To estimate the occurrence of the ALL and describe the aspects of its anatomy that should be factored into the outcome of stabilizing surgeries of the knee joint.
The study was conducted in 60 knee specimens of 30 unfixed human cadavers. Once the anterolateral ligament was identified, we assessed its relationships with the body of the lateral meniscus, the lateral collateral ligament to which it is attached mainly by connective tissue fibers, and the lateral inferior genicular blood vessels. We also identified ALL attachment points on the lateral epicondyle of the femur and the lateral condyle of the tibia.
ALL has been identified in 56.6% of the dissected knee pairs in both knees. ALL was present in 66.7% of female joints (24 of 36 specimens) and in 41.6% of male joints (10 of 24 specimens). The average length of the ALL was 38.5 ± 4.4 mm. The average width near the joint space was 4.45 ± 0.85 mm. The attachment point on the lateral epicondyle of the femur varied: it was posterior-proximal to the lateral collateral ligament in 64.7% of the dissected knees, anterior to the lateral collateral ligament in 23.5% of cases, and on the popliteus tendon insertion or next to it in 11.8% of cases. The point of the anterolateral ligament's attachment on the lateral condyle of the tibia typically lied halfway between the fibular head and Gerdy's tubercle.
The best site for a bone tunnel is the region on the lateral epicondyle of the femur, lying posterior and proximal to the origin of the lateral collateral ligament. The identified anatomical pattern in the course of the lateral inferior genicular vessels will help to spare these important blood suppliers in the course of a reconstructive surgery of the anterolateral knee joint region.
前外侧韧带（ALL）于 1879 年被发现。130 多年来，这种解剖结构并没有引起太多关注，但当一些研究人员描述它对膝关节旋转稳定性的贡献时，情况开始发生变化。
估计 ALL 的发生，并描述其解剖结构的各个方面，这些方面应纳入膝关节稳定手术的结果。
本研究在 30 具未经固定的人体尸体的 60 个膝关节标本中进行。一旦确定了前外侧韧带，我们就评估了它与外侧半月板体、主要由结缔组织纤维附着的外侧副韧带以及外侧下髁血管的关系。我们还确定了股骨外侧髁和胫骨外侧髁上的 ALL 附着点。
在双侧膝关节的 56.6%的解剖膝关节中发现了 ALL。女性关节（36 个标本中的 24 个）中 ALL 的存在率为 66.7%（24 个中的 10 个），男性关节（24 个中的 10 个）为 41.6%。ALL 的平均长度为 38.5±4.4mm。关节间隙附近的平均宽度为 4.45±0.85mm。股骨外侧髁上的附着点变化：在 64.7%的解剖膝关节中，它位于外侧副韧带的后近端，在 23.5%的病例中位于外侧副韧带的前侧，在 11.8%的病例中位于腓肠肌腱插入处或其附近。前外侧韧带在胫骨外侧髁上的附着点通常位于腓骨头和 Gerdy 结节之间的中点。
最佳的骨隧道位置是股骨外侧髁上位于外侧副韧带起点后近端的区域。在外侧下髁血管的走行中确定的解剖模式将有助于在重建膝关节前外侧区域的手术中保护这些重要的血供。
