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Authors' Reply

      We thank Sonnery-Cottet et al. for raising points in their letter to the editor, giving us the opportunity for much needed clarification of confusing statements for the reader of both journals—Arthroscopy and Knee Surgery, Sports Traumatology, Arthroscopy—regarding the anterolateral complex of the knee. The main points raised are consistent identification of the anterolateral ligament (ALL), the role of the anterolateral complex in restoring rotational knee stability, and overconstraint. We would also like to congratulate Sonnery-Cottet et al.
      • Sonnery-Cottet B.
      • Thaunat M.
      • Freychet B.
      • Pupim B.H.
      • Murphy C.G.
      • Claes S.
      Outcome of a combined anterior cruciate ligament and anterolateral ligament reconstruction technique with a minimum 2-year follow-up.
      on their excellent study showing good outcomes of combined anterior cruciate ligament (ACL) and ALL reconstructions with only 9.2% residual pivot shift at 2 years' follow-up.
      As editors of Knee Surgery, Sports Traumatology, Arthroscopy, we have seen an inflation of manuscripts appearing in the literature. There are an even higher number of submitted manuscripts with few identifiable scientific methods. In particular, a search of MEDLINE shows that more than 20 studies detailing the anatomic description of the anterolateral complex have been published since October 2013.
      • Claes S.
      • Vereecke E.
      • Maes M.
      • Victor J.
      • Verdonk P.
      • Bellemans J.
      Anatomy of the anterolateral ligament of the knee.
      • Runer A.
      • Birkmaier S.
      • Pamminger M.
      • et al.
      The anterolateral ligament of the knee: A dissection study.
      • Daggett M.
      • Ockuly A.C.
      • Cullen M.
      • et al.
      Femoral origin of the anterolateral ligament: An anatomic analysis.
      • Cavaignac E.
      • Wytrykowski K.
      • Reina N.
      • et al.
      Ultrasonographic identification of the anterolateral ligament of the knee.
      • Claes S.
      • Luyckx T.
      • Vereecke E.
      • Bellemans J.
      The Segond fracture: A bony injury of the anterolateral ligament of the knee.

      Ingham SJ, de Carvalho RT, Martins CA, et al. Anterolateral ligament anatomy: A comparative anatomical study [published online December 28, 2015]. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-015-3956-2.

      • Helito C.P.
      • Helito P.V.
      • Bonadio M.B.
      • et al.
      Evaluation of the length and isometric pattern of the anterolateral ligament with serial computer tomography.
      • Macchi V.
      • Porzionato A.
      • Morra A.
      • et al.
      The anterolateral ligament of the knee: A radiologic and histotopographic study.
      • Helito C.P.
      • Bonadio M.B.
      • Soares T.Q.
      • et al.
      The meniscal insertion of the knee anterolateral ligament.
      • Helito C.P.
      • Bonadio M.B.
      • Gobbi R.G.
      • et al.
      Is it safe to reconstruct the knee anterolateral ligament with a femoral tunnel? Frequency of lateral collateral ligament and popliteus tendon injury.
      • Kennedy M.I.
      • Claes S.
      • Fuso F.A.
      • et al.
      The anterolateral ligament: An anatomic, radiographic, and biomechanical analysis.
      • Sonnery-Cottet B.
      • Archbold P.
      • Rezende F.C.
      • Neto A.M.
      • Fayard J.M.
      • Thaunat M.
      Arthroscopic identification of the anterolateral ligament of the knee.
      • Helito C.P.
      • Demange M.K.
      • Bonadio M.B.
      • et al.
      Radiographic landmarks for locating the femoral origin and tibial insertion of the knee anterolateral ligament.
      • Dodds A.L.
      • Halewood C.
      • Gupte C.M.
      • Williams A.
      • Amis A.A.
      The anterolateral ligament: Anatomy, length changes and association with the Segond fracture.
      • Helito C.P.
      • Demange M.K.
      • Bonadio M.B.
      • et al.
      Anatomy and histology of the knee anterolateral ligament.
      • Vincent J.P.
      • Magnussen R.A.
      • Gezmez F.
      • et al.
      The anterolateral ligament of the human knee: An anatomic and histologic study.
      • Shea K.G.
      • Polousky J.D.
      • Jacobs Jr., J.C.
      • Yen Y.M.
      • Ganley T.J.
      The anterolateral ligament of the knee: An inconsistent finding in pediatric cadaveric specimens.

      Saiegh YA, Suero EM, Guenther D, et al. Sectioning the anterolateral ligament did not increase tibiofemoral translation or rotation in an ACL-deficient cadaveric model [published online September 16, 2015]. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-015-3787-1.

      • Van der Watt L.
      • Khan M.
      • Rothrauff B.B.
      • et al.
      The structure and function of the anterolateral ligament of the knee: A systematic review.
      • Pomajzl R.
      • Maerz T.
      • Shams C.
      • Guettler J.
      • Bicos J.
      A review of the anterolateral ligament of the knee: Current knowledge regarding its incidence, anatomy, biomechanics, and surgical dissection.
      • Roessler P.P.
      • Schuttler K.F.
      • Heyse T.J.
      • Wirtz D.C.
      • Efe T.
      The anterolateral ligament (ALL) and its role in rotational extra-articular stability of the knee joint: A review of anatomy and surgical concepts.

      Kosy JD, Mandalia VI. Revisiting the anterolateral ligament of the knee [published online December 18, 2015]. J Knee Surg. doi:10.1055/s-0035-1569148.

      • Bonasia D.E.
      • D'Amelio A.
      • Pellegrino P.
      • Rosso F.
      • Rossi R.
      Anterolateral ligament of the knee: Back to the future in anterior cruciate ligament reconstruction.
      • Caterine S.
      • Litchfield R.
      • Johnson M.
      • Chronik B.
      • Getgood A.
      A cadaveric study of the anterolateral ligament: Re-introducing the lateral capsular ligament.
      • Rezansoff A.J.
      • Caterine S.
      • Spencer L.
      • Tran M.N.
      • Litchfield R.B.
      • Getgood A.M.
      Radiographic landmarks for surgical reconstruction of the anterolateral ligament of the knee.
      • Guenther D.
      • Griffith C.
      • Lesniak B.
      • et al.
      Anterolateral rotatory instability of the knee.
      • Stijak L.
      • Bumbasirevic M.
      • Radonjic V.
      • et al.
      Anatomic description of the anterolateral ligament of the knee.
      The findings and conclusions of these studies differ from one another with respect to origin, insertion, and course of the proposed ligament. We agree, however, with classic literature from Terry et al.,
      • Terry G.C.
      • Hughston J.C.
      • Norwood L.A.
      The anatomy of the iliopatellar band and iliotibial tract.
      Hughston et al.,
      • Hughston J.C.
      • Andrews J.R.
      • Cross M.J.
      • Moschi A.
      Classification of knee ligament instabilities. Part II. The lateral compartment.
      Müller,
      • Müller W.
      Current aspects of functional anatomy of the knee joint.
      and other authors,
      • Hirschmann M.T.
      • Muller W.
      Complex function of the knee joint: The current understanding of the knee.
      who described meticulous dissections and reported their findings in numerous detailed publications. Therefore, the editorial “Anterolateral ligament of the knee, fact or fiction?” was published in Knee Surgery, Sports Traumatology, Arthroscopy to provide clarification for the reader and caution against premature adoption of a surgical technique for a proposed anterolateral complex structure, on whose origin, insertion, and function experts cannot even agree.
      • Musahl V.
      • Rahnemai-Azar A.A.
      • van Eck C.F.
      • Guenther D.
      • Fu F.H.
      Anterolateral ligament of the knee, fact or fiction?.
      We would like to thank Sonnery-Cottet et al. for a healthy debate regarding anatomic dissections and biomechanical studies. There have been more than 10 studies investigating the role of the anterolateral complex in controlling rotatory knee instability.
      • Helito C.P.
      • Helito P.V.
      • Bonadio M.B.
      • et al.
      Evaluation of the length and isometric pattern of the anterolateral ligament with serial computer tomography.
      • Kennedy M.I.
      • Claes S.
      • Fuso F.A.
      • et al.
      The anterolateral ligament: An anatomic, radiographic, and biomechanical analysis.

      Saiegh YA, Suero EM, Guenther D, et al. Sectioning the anterolateral ligament did not increase tibiofemoral translation or rotation in an ACL-deficient cadaveric model [published online September 16, 2015]. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-015-3787-1.

      • Kittl C.
      • El-Daou H.
      • Athwal K.K.
      • et al.
      The role of the anterolateral structures and the ACL in controlling laxity of the intact and ACL-deficient knee.

      Tavlo M, Eljaja S, Jensen JT, Siersma VD, Krogsgaard MR. The role of the anterolateral ligament in ACL insufficient and reconstructed knees on rotatory stability: A biomechanical study on human cadavers. Scand J Med Sci Sports 2016;26:960-966.

      • Lutz C.
      • Sonnery-Cottet B.
      • Niglis L.
      • Freychet B.
      • Clavert P.
      • Imbert P.
      Behavior of the anterolateral structures of the knee during internal rotation.
      • Spencer L.
      • Burkhart T.A.
      • Tran M.N.
      • et al.
      Biomechanical analysis of simulated clinical testing and reconstruction of the anterolateral ligament of the knee.

      Imbert P, Belvedere C, Leardini A. Knee laxity modifications after ACL rupture and surgical intra- and extra-articular reconstructions: Intra-operative measures in reconstructed and healthy knees [published online June 3, 2015]. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-015-3653-1.

      • Kittl C.
      • Halewood C.
      • Stephen J.M.
      • et al.
      Length change patterns in the lateral extra-articular structures of the knee and related reconstructions.
      • Thein R.
      • Boorman-Padgett J.
      • Stone K.
      • Wickiewicz T.L.
      • Imhauser C.W.
      • Pearle A.D.
      Biomechanical assessment of the anterolateral ligament of the knee: A secondary restraint in simulated tests of the pivot shift and of anterior stability.
      • Rasmussen M.T.
      • Nitri M.
      • Williams B.T.
      • et al.
      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.
      • Zens M.
      • Niemeyer P.
      • Ruhhammer J.
      • et al.
      Length changes of the anterolateral ligament during passive knee motion: A human cadaveric study.
      • Parsons E.M.
      • Gee A.O.
      • Spiekerman C.
      • Cavanagh P.R.
      The biomechanical function of the anterolateral ligament of the knee.
      However, none of these studies have demonstrated or clarified how dissection proceeds from layer 1 (iliotibial tract) to layer 3 (capsule). Only a few studies have shown a supportive role for the anterolateral complex in controlling rotatory knee instability.

      Tavlo M, Eljaja S, Jensen JT, Siersma VD, Krogsgaard MR. The role of the anterolateral ligament in ACL insufficient and reconstructed knees on rotatory stability: A biomechanical study on human cadavers. Scand J Med Sci Sports 2016;26:960-966.

      • Rasmussen M.T.
      • Nitri M.
      • Williams B.T.
      • et al.
      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.
      • Parsons E.M.
      • Gee A.O.
      • Spiekerman C.
      • Cavanagh P.R.
      The biomechanical function of the anterolateral ligament of the knee.
      To add to the debate, there are several further studies published proposing biomechanical effects of the anterolateral complex, but lacking design or data to support their claims. To clarify the confusion about anatomy and biomechanics, we have since published a pictorial essay and rigorous biomechanical analyses

      Rahnemai-Azar AA, Guenther D, Irarrazaval S, et al. The role of anterolateral capsule on stability of the knee, a multidisciplinary approach. Presented at the Annual Meeting of the American Academy of Orthopaedic Surgeons, Orlando, FL, March 2016.

      (also available online through VuMedi) detailing a step-by-step layered exposure and identification of the anterolateral capsule structures and their biomechanical function.

      Rahnemai-Azar AA, Guenther D, Irarrazaval S, et al. The role of anterolateral capsule on stability of the knee, a multidisciplinary approach. Presented at the Annual Meeting of the American Academy of Orthopaedic Surgeons, Orlando, FL, March 2016.

      Bell K, Rahnemai-Azar A, Irarrazaval S, et al. The effect of anterolateral capsule injuries and reconstructions on the simulated pivot shift test. Presented at the Annual Meeting of the Orthopaedic Research Society, Orlando, FL, March 2016.

      Guenther D, Bell K, Sexton S, et al. Surface strain in the anterolateral capsule of the knee. Presented at the Annual Meeting of the Orthopaedic Research Society, Orlando, FL, March 2016.

      Guenther D, Rahnemai-Aazr AA, Bell K, et al. Knee stability provided by anterolateral structures. Presented at the Annual Meeting of the American Academy of Orthopaedic Surgeons, Orlando, FL, March 2016.

      • Rahnemai-Azar A.A.
      • Miller R.M.
      • Guenther D.
      • et al.
      Structural properties of the anterolateral capsule and iliotibial band of the knee.
      For clarification regarding potential overconstraint of the lateral knee when using the iliotibial tract for purposes of tenodesis, the reader should take the following studies into consideration: The iliotibial band has almost 50% higher ultimate load, half the ultimate elongation, and almost 3 times higher stiffness compared with the anterolateral capsule.
      • Rahnemai-Azar A.A.
      • Miller R.M.
      • Guenther D.
      • et al.
      Structural properties of the anterolateral capsule and iliotibial band of the knee.
      Distinguishing the role of the ALL from the capsulo-osseous layer of the iliotibial tract, Kittl et al.
      • Kittl C.
      • El-Daou H.
      • Athwal K.K.
      • et al.
      The role of the anterolateral structures and the ACL in controlling laxity of the intact and ACL-deficient knee.
      showed that the iliotibial tract controls rotatory knee stability whereas the ALL has almost no role. Thein et al.
      • Thein R.
      • Boorman-Padgett J.
      • Stone K.
      • Wickiewicz T.L.
      • Imhauser C.W.
      • Pearle A.D.
      Biomechanical assessment of the anterolateral ligament of the knee: A secondary restraint in simulated tests of the pivot shift and of anterior stability.
      showed that there is no need for ALL reconstruction in a well-functioning ACL-reconstructed knee due to a minimal role of the anterolateral complex in physiological ranges. Schon et al.

      Schon J, Moatshe G, Brady AW, et al. Anatomic anterolateral ligament reconstruction of the knee leads to overconstraint at any fixation angle [Excellence in Research Award]. Presented at the Annual Meeting of the American Orthopaedic Society for Sports Medicine, Colorado Springs, CO, July 2016.

      showed that anatomic ALL reconstruction cannot restore stability of the knee without significant overconstraint at any flexion angle.
      Amis and colleagues
      • Bull A.M.
      • Earnshaw P.H.
      • Smith A.
      • Katchburian M.V.
      • Hassan A.N.
      • Amis A.A.
      Intraoperative measurement of knee kinematics in reconstruction of the anterior cruciate ligament.
      • Stephen J.M.
      • Halewood C.
      • Kittl C.
      • Bollen S.R.
      • Williams A.
      • Amis A.A.
      Posteromedial meniscocapsular lesions increase tibiofemoral joint laxity with anterior cruciate ligament deficiency, and their repair reduces laxity.
      at the Imperial College of London are a driving force of scientific research and helped elucidate many issues of rotatory knee instability over the past 20 years. For example, it was clear that rotatory knee instability is influenced by more than just the ACL when the concept of “envelope of motion” was introduced.
      • Bull A.M.
      • Earnshaw P.H.
      • Smith A.
      • Katchburian M.V.
      • Hassan A.N.
      • Amis A.A.
      Intraoperative measurement of knee kinematics in reconstruction of the anterior cruciate ligament.
      It is therefore both the anterolateral complex and the posteromedial corner that have a role in stabilizing the knee through a multitude of structures, most importantly the iliotibial tract on the lateral side and the posteromedial capsule and root on the medial side.
      • Kittl C.
      • El-Daou H.
      • Athwal K.K.
      • et al.
      The role of the anterolateral structures and the ACL in controlling laxity of the intact and ACL-deficient knee.
      • Stephen J.M.
      • Halewood C.
      • Kittl C.
      • Bollen S.R.
      • Williams A.
      • Amis A.A.
      Posteromedial meniscocapsular lesions increase tibiofemoral joint laxity with anterior cruciate ligament deficiency, and their repair reduces laxity.
      In clinical science, this has been shown by Marcacci and colleagues
      • Marcacci M.
      • Zaffagnini S.
      • Iacono F.
      • Neri M.P.
      • Loreti I.
      • Petitto A.
      Arthroscopic intra- and extra-articular anterior cruciate ligament reconstruction with gracilis and semitendinosus tendons.
      • Bignozzi S.
      • Zaffagnini S.
      • Lopomo N.
      • Martelli S.
      • Iacono F.
      • Marcacci M.
      Does a lateral plasty control coupled translation during antero-posterior stress in single-bundle ACL reconstruction? An in vivo study.
      • Marcacci M.
      • Zaffagnini S.
      • Giordano G.
      • Iacono F.
      • Presti M.L.
      Anterior cruciate ligament reconstruction associated with extra-articular tenodesis: A prospective clinical and radiographic evaluation with 10- to 13-year follow-up.
      and Zaffagnini et al.,
      • Zaffagnini S.
      • Signorelli C.
      • Lopomo N.
      • et al.
      Anatomic double-bundle and over-the-top single-bundle with additional extra-articular tenodesis: An in vivo quantitative assessment of knee laxity in two different ACL reconstructions.
      who demonstrated that rotatory knee instability can be reduced by adding a lateral-plasty to ACL reconstruction and can continue, with good 10-year long-term results for patients. Most recently, Sonnery-Cottet et al.
      • Sonnery-Cottet B.
      • Thaunat M.
      • Freychet B.
      • Pupim B.H.
      • Murphy C.G.
      • Claes S.
      Outcome of a combined anterior cruciate ligament and anterolateral ligament reconstruction technique with a minimum 2-year follow-up.
      were able to show that combined ACL and ALL reconstructions can also reduce rotatory knee instability.
      A healthy scientific debate will encourage future research and expand our knowledge of orthopaedics. Controversies in our understanding of rotatory knee instability and the role of the anterolateral complex will continue to exist. We are grateful to Sonnery-Cottet et al. for giving us the opportunity to clarify some of the controversies and pointing out deficiencies in our clinical science. They deserve credit for publishing their 2-year clinical results. There is certainly a subgroup of patients whose ACL-related anterolateral rotatory knee instability might warrant surgery for the anterolateral complex in addition to anatomic ACL reconstruction. However, we currently do not know exactly who these patients are because rotatory knee instability is multifactorial. The factors influencing rotatory knee instability are patient aspects such as injury mechanism; timing from injury; injury to soft-tissue structures such as the collateral ligaments, menisci, meniscus roots, and capsule; ACL injury pattern including partial tears; bony factors such as coronal-plane and sagittal-plane alignment and notch width index; proprioceptive considerations such as neuromuscular control, knee abduction moments, and landing patterns; biodynamic factors such as functional joint space, muscle function, and altered joint contact path; and biological factors such as presence of proinflammatory cytokines, premature osteoarthritis, and altered genetic profiles. In summary, there is much to be learned about rotatory knee instability, and in addition, to basic science studies, there is a need for large-scale clinical studies.

      References

        • Sonnery-Cottet B.
        • Thaunat M.
        • Freychet B.
        • Pupim B.H.
        • Murphy C.G.
        • Claes S.
        Outcome of a combined anterior cruciate ligament and anterolateral ligament reconstruction technique with a minimum 2-year follow-up.
        Am J Sports Med. 2015; 43: 1598-1605
        • Claes S.
        • Vereecke E.
        • Maes M.
        • Victor J.
        • Verdonk P.
        • Bellemans J.
        Anatomy of the anterolateral ligament of the knee.
        J Anat. 2013; 223: 321-328
        • Runer A.
        • Birkmaier S.
        • Pamminger M.
        • et al.
        The anterolateral ligament of the knee: A dissection study.
        Knee. 2016; 23: 8-12
        • Daggett M.
        • Ockuly A.C.
        • Cullen M.
        • et al.
        Femoral origin of the anterolateral ligament: An anatomic analysis.
        Arthroscopy. 2016; 32: 835-841
        • Cavaignac E.
        • Wytrykowski K.
        • Reina N.
        • et al.
        Ultrasonographic identification of the anterolateral ligament of the knee.
        Arthroscopy. 2016; 32: 120-126
        • Claes S.
        • Luyckx T.
        • Vereecke E.
        • Bellemans J.
        The Segond fracture: A bony injury of the anterolateral ligament of the knee.
        Arthroscopy. 2014; 30: 1475-1482
      1. Ingham SJ, de Carvalho RT, Martins CA, et al. Anterolateral ligament anatomy: A comparative anatomical study [published online December 28, 2015]. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-015-3956-2.

        • Helito C.P.
        • Helito P.V.
        • Bonadio M.B.
        • et al.
        Evaluation of the length and isometric pattern of the anterolateral ligament with serial computer tomography.
        Orthop J Sports Med. 2014; 2 (2325967114562205)
        • Macchi V.
        • Porzionato A.
        • Morra A.
        • et al.
        The anterolateral ligament of the knee: A radiologic and histotopographic study.
        Surg Radiol Anat. 2016; 38: 341-348
        • Helito C.P.
        • Bonadio M.B.
        • Soares T.Q.
        • et al.
        The meniscal insertion of the knee anterolateral ligament.
        Surg Radiol Anat. 2016; 38: 223-228
        • Helito C.P.
        • Bonadio M.B.
        • Gobbi R.G.
        • et al.
        Is it safe to reconstruct the knee anterolateral ligament with a femoral tunnel? Frequency of lateral collateral ligament and popliteus tendon injury.
        Int Orthop. 2016; 40: 821-825
        • Kennedy M.I.
        • Claes S.
        • Fuso F.A.
        • et al.
        The anterolateral ligament: An anatomic, radiographic, and biomechanical analysis.
        Am J Sports Med. 2015; 43: 1606-1615
        • Sonnery-Cottet B.
        • Archbold P.
        • Rezende F.C.
        • Neto A.M.
        • Fayard J.M.
        • Thaunat M.
        Arthroscopic identification of the anterolateral ligament of the knee.
        Arthrosc Tech. 2014; 3: e389-e392
        • Helito C.P.
        • Demange M.K.
        • Bonadio M.B.
        • et al.
        Radiographic landmarks for locating the femoral origin and tibial insertion of the knee anterolateral ligament.
        Am J Sports Med. 2014; 42: 2356-2362
        • Dodds A.L.
        • Halewood C.
        • Gupte C.M.
        • Williams A.
        • Amis A.A.
        The anterolateral ligament: Anatomy, length changes and association with the Segond fracture.
        Bone Joint J. 2014; 96-B: 325-331
        • Helito C.P.
        • Demange M.K.
        • Bonadio M.B.
        • et al.
        Anatomy and histology of the knee anterolateral ligament.
        Orthop J Sports Med. 2013; 1 (2325967113513546)
        • Vincent J.P.
        • Magnussen R.A.
        • Gezmez F.
        • et al.
        The anterolateral ligament of the human knee: An anatomic and histologic study.
        Knee Surg Sports Traumatol Arthrosc. 2012; 20: 147-152
        • Shea K.G.
        • Polousky J.D.
        • Jacobs Jr., J.C.
        • Yen Y.M.
        • Ganley T.J.
        The anterolateral ligament of the knee: An inconsistent finding in pediatric cadaveric specimens.
        J Pediatr Orthop. 2016; 36: e51-e54
      2. Saiegh YA, Suero EM, Guenther D, et al. Sectioning the anterolateral ligament did not increase tibiofemoral translation or rotation in an ACL-deficient cadaveric model [published online September 16, 2015]. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-015-3787-1.

        • Van der Watt L.
        • Khan M.
        • Rothrauff B.B.
        • et al.
        The structure and function of the anterolateral ligament of the knee: A systematic review.
        Arthroscopy. 2015; 31: 569-582.e3
        • Pomajzl R.
        • Maerz T.
        • Shams C.
        • Guettler J.
        • Bicos J.
        A review of the anterolateral ligament of the knee: Current knowledge regarding its incidence, anatomy, biomechanics, and surgical dissection.
        Arthroscopy. 2015; 31: 583-591
        • Roessler P.P.
        • Schuttler K.F.
        • Heyse T.J.
        • Wirtz D.C.
        • Efe T.
        The anterolateral ligament (ALL) and its role in rotational extra-articular stability of the knee joint: A review of anatomy and surgical concepts.
        Arch Orthop Trauma Surg. 2016; 136: 305-313
      3. Kosy JD, Mandalia VI. Revisiting the anterolateral ligament of the knee [published online December 18, 2015]. J Knee Surg. doi:10.1055/s-0035-1569148.

        • Bonasia D.E.
        • D'Amelio 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; 7: 5773
        • Caterine S.
        • Litchfield R.
        • Johnson M.
        • Chronik B.
        • Getgood A.
        A cadaveric study of the anterolateral ligament: Re-introducing the lateral capsular ligament.
        Knee Surg Sports Traumatol Arthrosc. 2015; 23: 3186-3195
        • Rezansoff A.J.
        • Caterine S.
        • Spencer L.
        • Tran M.N.
        • Litchfield R.B.
        • Getgood A.M.
        Radiographic landmarks for surgical reconstruction of the anterolateral ligament of the knee.
        Knee Surg Sports Traumatol Arthrosc. 2015; 23: 3196-3201
        • Guenther D.
        • Griffith C.
        • Lesniak B.
        • et al.
        Anterolateral rotatory instability of the knee.
        Knee Surg Sports Traumatol Arthrosc. 2015; 23: 2909-2917
        • Stijak L.
        • Bumbasirevic M.
        • Radonjic V.
        • et al.
        Anatomic description of the anterolateral ligament of the knee.
        Knee Surg Sports Traumatol Arthrosc. 2016; 24: 2083-2088
        • Terry G.C.
        • Hughston J.C.
        • Norwood L.A.
        The anatomy of the iliopatellar band and iliotibial tract.
        Am J Sports Med. 1986; 14: 39-45
        • Hughston J.C.
        • Andrews J.R.
        • Cross M.J.
        • Moschi A.
        Classification of knee ligament instabilities. Part II. The lateral compartment.
        J Bone Joint Surg Am. 1976; 58: 173-179
        • Müller W.
        Current aspects of functional anatomy of the knee joint.
        Hefte Unfallheilkd. 1977; ([in German]): 131-137
        • Hirschmann M.T.
        • Muller W.
        Complex function of the knee joint: The current understanding of the knee.
        Knee Surg Sports Traumatol Arthrosc. 2015; 23: 2780-2788
        • Musahl V.
        • Rahnemai-Azar A.A.
        • van Eck C.F.
        • Guenther D.
        • Fu F.H.
        Anterolateral ligament of the knee, fact or fiction?.
        Knee Surg Sports Traumatol Arthrosc. 2016; 24: 2-3
        • Kittl C.
        • El-Daou H.
        • Athwal K.K.
        • et al.
        The role of the anterolateral structures and the ACL in controlling laxity of the intact and ACL-deficient knee.
        Am J Sports Med. 2016; 44: 345-354
      4. Tavlo M, Eljaja S, Jensen JT, Siersma VD, Krogsgaard MR. The role of the anterolateral ligament in ACL insufficient and reconstructed knees on rotatory stability: A biomechanical study on human cadavers. Scand J Med Sci Sports 2016;26:960-966.

        • Lutz C.
        • Sonnery-Cottet B.
        • Niglis L.
        • Freychet B.
        • Clavert P.
        • Imbert P.
        Behavior of the anterolateral structures of the knee during internal rotation.
        Orthop Traumatol Surg Res. 2015; 101: 523-528
        • Spencer L.
        • Burkhart T.A.
        • Tran M.N.
        • et al.
        Biomechanical analysis of simulated clinical testing and reconstruction of the anterolateral ligament of the knee.
        Am J Sports Med. 2015; 43: 2189-2197
      5. Imbert P, Belvedere C, Leardini A. Knee laxity modifications after ACL rupture and surgical intra- and extra-articular reconstructions: Intra-operative measures in reconstructed and healthy knees [published online June 3, 2015]. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-015-3653-1.

        • Kittl C.
        • Halewood C.
        • Stephen J.M.
        • et al.
        Length change patterns in the lateral extra-articular structures of the knee and related reconstructions.
        Am J Sports Med. 2015; 43: 354-362
        • Thein R.
        • Boorman-Padgett J.
        • Stone K.
        • Wickiewicz T.L.
        • Imhauser C.W.
        • Pearle A.D.
        Biomechanical assessment of the anterolateral ligament of the knee: A secondary restraint in simulated tests of the pivot shift and of anterior stability.
        J Bone Joint Surg Am. 2016; 98: 937-943
        • Rasmussen M.T.
        • Nitri M.
        • Williams B.T.
        • et al.
        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. 2016; 44: 585-592
        • Zens M.
        • Niemeyer P.
        • Ruhhammer J.
        • et al.
        Length changes of the anterolateral ligament during passive knee motion: A human cadaveric study.
        Am J Sports Med. 2015; 43: 2545-2552
        • Parsons E.M.
        • Gee A.O.
        • Spiekerman C.
        • Cavanagh P.R.
        The biomechanical function of the anterolateral ligament of the knee.
        Am J Sports Med. 2015; 43: 669-674
      6. Rahnemai-Azar AA, Guenther D, Irarrazaval S, et al. The role of anterolateral capsule on stability of the knee, a multidisciplinary approach. Presented at the Annual Meeting of the American Academy of Orthopaedic Surgeons, Orlando, FL, March 2016.

      7. Bell K, Rahnemai-Azar A, Irarrazaval S, et al. The effect of anterolateral capsule injuries and reconstructions on the simulated pivot shift test. Presented at the Annual Meeting of the Orthopaedic Research Society, Orlando, FL, March 2016.

      8. Guenther D, Bell K, Sexton S, et al. Surface strain in the anterolateral capsule of the knee. Presented at the Annual Meeting of the Orthopaedic Research Society, Orlando, FL, March 2016.

      9. Guenther D, Rahnemai-Aazr AA, Bell K, et al. Knee stability provided by anterolateral structures. Presented at the Annual Meeting of the American Academy of Orthopaedic Surgeons, Orlando, FL, March 2016.

        • Rahnemai-Azar A.A.
        • Miller R.M.
        • Guenther D.
        • et al.
        Structural properties of the anterolateral capsule and iliotibial band of the knee.
        Am J Sports Med. 2016; 44: 892-897
      10. Schon J, Moatshe G, Brady AW, et al. Anatomic anterolateral ligament reconstruction of the knee leads to overconstraint at any fixation angle [Excellence in Research Award]. Presented at the Annual Meeting of the American Orthopaedic Society for Sports Medicine, Colorado Springs, CO, July 2016.

        • Bull A.M.
        • Earnshaw P.H.
        • Smith A.
        • Katchburian M.V.
        • Hassan A.N.
        • Amis A.A.
        Intraoperative measurement of knee kinematics in reconstruction of the anterior cruciate ligament.
        J Bone Joint Surg Br. 2002; 84: 1075-1081
        • Stephen J.M.
        • Halewood C.
        • Kittl C.
        • Bollen S.R.
        • Williams A.
        • Amis A.A.
        Posteromedial meniscocapsular lesions increase tibiofemoral joint laxity with anterior cruciate ligament deficiency, and their repair reduces laxity.
        Am J Sports Med. 2016; 44: 400-408
        • Marcacci M.
        • Zaffagnini S.
        • Iacono F.
        • Neri M.P.
        • Loreti I.
        • Petitto A.
        Arthroscopic intra- and extra-articular anterior cruciate ligament reconstruction with gracilis and semitendinosus tendons.
        Knee Surg Sports Traumatol Arthrosc. 1998; 6: 68-75
        • Bignozzi S.
        • Zaffagnini S.
        • Lopomo N.
        • Martelli S.
        • Iacono F.
        • Marcacci M.
        Does a lateral plasty control coupled translation during antero-posterior stress in single-bundle ACL reconstruction? An in vivo study.
        Knee Surg Sports Traumatol Arthrosc. 2009; 17: 65-70
        • Marcacci M.
        • Zaffagnini S.
        • Giordano G.
        • Iacono F.
        • Presti M.L.
        Anterior cruciate ligament reconstruction associated with extra-articular tenodesis: A prospective clinical and radiographic evaluation with 10- to 13-year follow-up.
        Am J Sports Med. 2009; 37: 707-714
        • Zaffagnini S.
        • Signorelli C.
        • Lopomo N.
        • et al.
        Anatomic double-bundle and over-the-top single-bundle with additional extra-articular tenodesis: An in vivo quantitative assessment of knee laxity in two different ACL reconstructions.
        Knee Surg Sports Traumatol Arthrosc. 2012; 20: 153-159

      Linked Article

      • Regarding “Anterolateral Ligament of the Knee, Fact or Fiction?”
        ArthroscopyVol. 32Issue 9
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          We are in total agreement with Lubowitz et al.1 and read with interest that the anterolateral ligament (ALL) is considered fictional by some authors. Musahl et al.2 state that in anatomic and radiologic evaluation, a “thickening” of the anterolateral capsule was identified in only 30% of patients. They also consider that ALL reconstruction is unable to restore rotational stability3 and may result in overconstraint.4
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