Skip to main content
SpringerLink
Log in

The anterolateral complex of the knee: a pictorial essay

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Injuries to the anterolateral complex of the knee can result in increased rotatory knee instability. However, to diagnose and treat patients with persistent instability properly, surgeons need to understand the multifactorial genesis as well as the complex anatomy of the anterolateral aspect of the knee in its entirety. While recent research focused primarily on one structure (anterolateral ligament—ALL), the purpose of this pictorial essay is to provide a detailed layer-by-layer description of the anterolateral complex of the knee, consisting of the iliotibial band with its superficial, middle, deep, and capsulo-osseous layer as well as the anterolateral joint capsule. This may help surgeons to not only understand the anatomy of this particular part of the knee, but may also provide guidance when performing extra-articular procedures in patients with rotatory knee instability.

Level of evidence V.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Alentorn-Geli E, Myer GD, Silvers HJ, Samitier G, Romero D, Lazaro-Haro C, Cugat R (2009) Prevention of non-contact anterior cruciate ligament injuries in soccer players. Part 1: Mechanisms of injury and underlying risk factors. Knee Surg Sports Traumatol Arthrosc 17(7):705–729

    Article  PubMed  Google Scholar 

  2. Bonanzinga T, Signorelli C, Grassi A, Lopomo N, Bragonzoni L, Zaffagnini S, Marcacci M (2016) Kinematics of ACL and anterolateral ligament. Part I: combined lesion. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-016-4259-y

    Google Scholar 

  3. Brenner E (2014) Human body preservation - old and new techniques. J Anat 224(3):316–344

    Article  PubMed  PubMed Central  Google Scholar 

  4. Bull AM, Earnshaw PH, Smith A, Katchburian MV, Hassan AN, Amis AA (2002) Intraoperative measurement of knee kinematics in reconstruction of the anterior cruciate ligament. J Bone Joint Surg Br 84(7):1075–1081

    Article  CAS  PubMed  Google Scholar 

  5. Caterine S, Litchfield R, Johnson M, Chronik B, Getgood A (2015) A cadaveric study of the anterolateral ligament: re-introducing the lateral capsular ligament. Knee Surg Sports Traumatol Arthrosc 23(11):3186–3195

    Article  PubMed  Google Scholar 

  6. Claes S, Vereecke E, Maes M, Victor J, Verdonk P, Bellemans J (2013) Anatomy of the anterolateral ligament of the knee. J Anat 223(4):321–328

    Article  PubMed  PubMed Central  Google Scholar 

  7. Daggett M, Ockuly AC, Cullen M, Busch K, Lutz C, Imbert P, Sonnery-Cottet B (2016) Femoral origin of the anterolateral ligament: an anatomic analysis. Arthroscopy 32(5):835–841

    Article  PubMed  Google Scholar 

  8. Dodds AL, Halewood C, Gupte CM, Williams A, Amis AA (2014) The anterolateral ligament: anatomy, length changes and association with the Segond fracture. Bone Joint J 96-B(3):325–331

    Article  CAS  PubMed  Google Scholar 

  9. Dombrowski ME, Costello JM, Ohashi B, Murawski CD, Rothrauff BB, Arilla FV, Friel NA, Fu FH, Debski RE, Musahl V (2016) Macroscopic anatomical, histological and magnetic resonance imaging correlation of the lateral capsule of the knee. Knee Surg Sports Traumatol Arthrosc 24(9):2854–2860

    Article  PubMed  Google Scholar 

  10. Domnick C, Herbort M, Raschke MJ, Schliemann B, Siebold R, Smigielski R, Fink C (2015) Converting round tendons to flat tendon constructs: Does the preparation process have an influence on the structural properties? Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-015-3749-7

    Google Scholar 

  11. Ellison AE, Berg EE (1985) Embryology, anatomy, and function of the anterior cruciate ligament. Orthop Clin North Am 16(1):3–14

    CAS  PubMed  Google Scholar 

  12. Ferretti A, Monaco E, Fabbri M, Maestri B, De Carli A (2016) Prevalence and classification of injuries of anterolateral complex in acute anterior cruciate ligament tears. Arthroscopy. doi:10.1016/j.arthro.2016.05.010

    Google Scholar 

  13. Forkel P, Reuter S, Sprenker F, Achtnich A, Herbst E, Imhoff A, Petersen W (2015) Different patterns of lateral meniscus root tears in ACL injuries: application of a differentiated classification system. Knee Surg Sports Traumatol Arthrosc 23(1):112–118

    Article  PubMed  Google Scholar 

  14. Guenther D, Griffith C, Lesniak B, Lopomo N, Grassi A, Zaffagnini S, Fu FH, Musahl V (2015) Anterolateral rotatory instability of the knee. Knee Surg Sports Traumatol Arthrosc 23(10):2909–2917

    Article  PubMed  Google Scholar 

  15. Hassler H, Jakob RP (1981) On the cause of the anterolateral instability of the knee joint. A study on 20 cadaver knee joints with special regard to the tractus iliotibialis (author’s transl). Arch Orthop Trauma Surg 98(1):45–50

    Article  CAS  PubMed  Google Scholar 

  16. Herbst E, Hoser C, Tecklenburg K, Filipovic M, Dallapozza C, Herbort M, Fink C (2015) The lateral femoral notch sign following ACL injury: frequency, morphology and relation to meniscal injury and sports activity. Knee Surg Sports Traumatol Arthrosc 23(8):2250–2258

    Article  PubMed  Google Scholar 

  17. Hewett TE, Myer GD, Ford KR (2006) Anterior cruciate ligament injuries in female athletes: Part 1, mechanisms and risk factors. Am J Sports Med 34(2):299–311

    Article  PubMed  Google Scholar 

  18. Hewison CE, Tran MN, Kaniki N, Remtulla A, Bryant D, Getgood AM (2015) Lateral extra-articular tenodesis reduces rotational laxity when combined with anterior cruciate ligament reconstruction: a systematic review of the literature. Arthroscopy 31(10):2022–2034

    Article  PubMed  Google Scholar 

  19. Hughston JC, Andrews JR, Cross MJ, Moschi A (1976) Classification of knee ligament instabilities. Part I. The medial compartment and cruciate ligaments. J Bone Joint Surg Am 58(2):159–172

    Article  CAS  PubMed  Google Scholar 

  20. Hughston JC, Andrews JR, Cross MJ, Moschi A (1976) Classification of knee ligament instabilities. Part II. The lateral compartment. J Bone Joint Surg Am 58(2):173–179

    Article  CAS  PubMed  Google Scholar 

  21. Kaplan EB (1958) The iliotibial tract; clinical and morphological significance. J Bone Joint Surg Am 40-A(4):817–832

    Article  CAS  PubMed  Google Scholar 

  22. Kennedy MI, Claes S, Fuso FA, Williams BT, Goldsmith MT, Turnbull TL, Wijdicks CA, LaPrade RF (2015) The anterolateral ligament: an anatomic, radiographic, and biomechanical analysis. Am J Sports Med 43(7):1606–1615

    Article  PubMed  Google Scholar 

  23. Kittl C, El-Daou H, Athwal KK, Gupte CM, Weiler A, Williams A, Amis AA (2016) The role of the anterolateral structures and the ACL in controlling laxity of the intact and ACL-deficient knee. Am J Sports Med 44(2):345–354

    Article  PubMed  Google Scholar 

  24. Lobenhoffer P, Posel P, Witt S, Piehler J, Wirth CJ (1987) Distal femoral fixation of the iliotibial tract. Arch Orthop Trauma Surg 106(5):285–290

    Article  CAS  PubMed  Google Scholar 

  25. Markolf KL, Mensch JS, Amstutz HC (1976) Stiffness and laxity of the knee—the contributions of the supporting structures. A quantitative in vitro study. J Bone Joint Surg Am 58(5):583–594

    Article  CAS  PubMed  Google Scholar 

  26. Merican AM, Amis AA (2008) Anatomy of the lateral retinaculum of the knee. J Bone Joint Surg Br 90(4):527–534

    Article  CAS  PubMed  Google Scholar 

  27. Miller RM, Rahnemai-Azar AA, Surer L, Arilla FV, Fu FH, Debski RE, Musahl V (2016) Tensile properties of a split quadriceps graft for ACL reconstruction. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-016-4019-z

    Google Scholar 

  28. Monaco E, Ferretti A, Labianca L, Maestri B, Speranza A, Kelly MJ, D’Arrigo C (2012) Navigated knee kinematics after cutting of the ACL and its secondary restraint. Knee Surg Sports Traumatol Arthrosc 20(5):870–877

    Article  CAS  PubMed  Google Scholar 

  29. Musahl V, Ayeni OR, Citak M, Irrgang JJ, Pearle AD, Wickiewicz TL (2010) The influence of bony morphology on the magnitude of the pivot shift. Knee Surg Sports Traumatol Arthrosc 18(9):1232–1238

    Article  PubMed  Google Scholar 

  30. Musahl V, Citak M, O’Loughlin PF, Choi D, Bedi A, Pearle AD (2010) The effect of medial versus lateral meniscectomy on the stability of the anterior cruciate ligament-deficient knee. Am J Sports Med 38(8):1591–1597

    Article  PubMed  Google Scholar 

  31. Musahl V, Rahnemai-Azar AA, Costello J, Arner JW, Fu FH, Hoshino Y, Lopomo N, Samuelsson K, Irrgang JJ (2016) The influence of meniscal and anterolateral capsular injury on knee laxity in patients with anterior cruciate ligament injuries. Am J Sports Med. doi:10.1177/0363546516659649

    Google Scholar 

  32. O’Donoghue DH (1964) The unhappy triad: etiology, diagnosis and treatment. Am J Orthop 6:242–247

    PubMed  Google Scholar 

  33. Parsons EM, Gee AO, Spiekerman C, Cavanagh PR (2015) The biomechanical function of the anterolateral ligament of the knee. Am J Sports Med 43(3):669–674

    Article  PubMed  PubMed Central  Google Scholar 

  34. Rahnemai-Azar AA, Abebe ES, Johnson P, Labrum J, Fu FH, Irrgang JJ, Samuelsson K, Musahl V (2016) Increased lateral tibial slope predicts high-grade rotatory knee laxity pre-operatively in ACL reconstruction. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-016-4157-3

    Google Scholar 

  35. Rahnemai-Azar AA, Miller RM, Guenther D, Fu FH, Lesniak BP, Musahl V, Debski RE (2016) Structural properties of the anterolateral capsule and iliotibial band of the knee. Am J Sports Med 44(4):892–897

    Article  PubMed  Google Scholar 

  36. Rasmussen MT, Nitri M, Williams BT, Moulton SG, Cruz RS, Dornan GJ, Goldsmith MT, LaPrade RF (2016) An in vitro robotic assessment of the anterolateral ligament, part 1: secondary role of the anterolateral ligament in the setting of an anterior cruciate ligament injury. Am J Sports Med 44(3):585–592

    Article  PubMed  Google Scholar 

  37. Runer A, Birkmaier S, Pamminger M, Reider S, Herbst E, Kunzel KH, Brenner E, Fink C (2016) The anterolateral ligament of the knee: a dissection study. Knee 23(1):8–12

    Article  PubMed  Google Scholar 

  38. Saiegh YA, Suero EM, Guenther D, Hawi N, Decker S, Krettek C, Citak M, Omar M (2015) Sectioning the anterolateral ligament did not increase tibiofemoral translation or rotation in an ACL-deficient cadaveric model. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-015-3787-1

    PubMed  Google Scholar 

  39. Seebacher JR, Inglis AE, Marshall JL, Warren RF (1982) The structure of the posterolateral aspect of the knee. J Bone Joint Surg Am 64(4):536–541

    Article  CAS  PubMed  Google Scholar 

  40. Shelbourne KD, Nitz PA (1991) The O’Donoghue triad revisited. Combined knee injuries involving anterior cruciate and medial collateral ligament tears. Am J Sports Med 19(5):474–477

    Article  CAS  PubMed  Google Scholar 

  41. Slette EL, Mikula JD, Schon JM, Marchetti DC, Kheir MM, Turnbull TL, LaPrade RF (2016) Biomechanical results of lateral extra-articular tenodesis procedures of the knee: a systematic review. Arthroscopy. doi:10.1016/j.arthro.2016.04.028

    Google Scholar 

  42. Staubli HU, Schatzmann L, Brunner P, Rincon L, Nolte LP (1996) Quadriceps tendon and patellar ligament: cryosectional anatomy and structural properties in young adults. Knee Surg Sports Traumatol Arthrosc 4(2):100–110

    Article  CAS  PubMed  Google Scholar 

  43. Stijak L, Bumbasirevic M, Radonjic V, Kadija M, Puskas L, Milovanovic D, Filipovic B (2016) Anatomic description of the anterolateral ligament of the knee. Knee Surg Sports Traumatol Arthrosc 24(7):2083–2088

    Article  PubMed  Google Scholar 

  44. Tanaka M, Vyas D, Moloney G, Bedi A, Pearle AD, Musahl V (2012) What does it take to have a high-grade pivot shift? Knee Surg Sports Traumatol Arthrosc 20(4):737–742

    Article  CAS  PubMed  Google Scholar 

  45. Terry GC, Hughston JC, Norwood LA (1986) The anatomy of the iliopatellar band and iliotibial tract. Am J Sports Med 14(1):39–45

    Article  CAS  PubMed  Google Scholar 

  46. Terry GC, LaPrade RF (1996) The biceps femoris muscle complex at the knee. Its anatomy and injury patterns associated with acute anterolateral-anteromedial rotatory instability. Am J Sports Med 24(1):2–8

    Article  CAS  PubMed  Google Scholar 

  47. Terry GC, Norwood LA, Hughston JC, Caldwell KM (1993) How iliotibial tract injuries of the knee combine with acute anterior cruciate ligament tears to influence abnormal anterior tibial displacement. Am J Sports Med 21(1):55–60

    Article  CAS  PubMed  Google Scholar 

  48. Vieira EL, Vieira EA, da Silva RT, Berlfein PA, Abdalla RJ, Cohen M (2007) An anatomic study of the iliotibial tract. Arthroscopy 23(3):269–274

    Article  PubMed  Google Scholar 

  49. Vincent JP, Magnussen RA, Gezmez F, Uguen A, Jacobi M, Weppe F, Al-Saati MF, Lustig S, Demey G, Servien E, Neyret P (2012) The anterolateral ligament of the human knee: an anatomic and histologic study. Knee Surg Sports Traumatol Arthrosc 20(1):147–152

    Article  PubMed  Google Scholar 

  50. Watanabe J, Suzuki D, Mizoguchi S, Yoshida S, Fujimiya M (2016) The anterolateral ligament in a Japanese population: study on prevalence and morphology. J Orthop Sci 21(5):647–651

    Article  PubMed  Google Scholar 

  51. Wilson WT, Deakin AH, Payne AP, Picard F, Wearing SC (2012) Comparative analysis of the structural properties of the collateral ligaments of the human knee. J Orthop Sports Phys Ther 42(4):345–351

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

Funding was provided by the Department of Orthopaedic Surgery, University of Pittsburgh Medical Center.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 3471 Fifth Avenue, Pittsburgh, PA, 15213, USA

    Elmar Herbst, Marcio Albers, Jeremy M. Burnham, Humza S. Shaikh, Jan-Hendrik Naendrup, Freddie H. Fu & Volker Musahl

  2. Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany

    Elmar Herbst

Authors
  1. Elmar Herbst
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marcio Albers
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jeremy M. Burnham
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Humza S. Shaikh
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jan-Hendrik Naendrup
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Freddie H. Fu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Volker Musahl
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Volker Musahl.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Herbst, E., Albers, M., Burnham, J.M. et al. The anterolateral complex of the knee: a pictorial essay. Knee Surg Sports Traumatol Arthrosc 25, 1009–1014 (2017). https://doi.org/10.1007/s00167-017-4449-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-017-4449-2

Keywords

Search

Navigation