Truly Existing or Hyped up? Unravelling the Current Knowledge Regarding the Anatomy, Radiology, Histology and Biomechanics of the Enigmatic Anterolateral Ligament of the Knee Joint

Abstract

Ever since its description, anterolateral ligament (ALL) of the knee joint remains as the hotspot of controversies.<br />Though it has been described under various descriptions, the structure gained its limelight when it was christened<br />as anterolateral ligament by Claes in 2013. The main reason for the controversies around it is the lack of concrete<br />evidences regarding its attachments, morphology, biomechanical aspects and radiological appearance. Similarly the<br />role of ALL in pivot shift phenomenon also remains as a point of debate. The advocates of ALL suggest that because<br />of its ability to modulate internal rotation and attachment to the lateral meniscus, ALL contributes to the pivot shift<br />phenomenon. Similarly, the orientation of ALL stands as the reason for varied documentation with respect to imaging<br />techniques. With the growing body of evidence, it is imperative to fix our stand regarding the structure because, if<br />found to be morphologically persistent, it can be used for concomitant anterolateral stabilization along with anterior<br />cruciate ligament reinforcement surgeries. The present review tries to systematically review the anatomy, variations in<br />classifications, descriptions, histology, radiology and biomechanical features of ALL. At the end of the review, we would<br />like to find the answer for the question: Is ALL a distinct ligamentous structure located at the anterolateral aspect of the<br />knee? What is the contribution of it to the tibial internal rotation stability?<br />Level of evidence: II