Purpose
To describe the morphology and distribution of the anterolateral ligament of the knee
(ALL) nerve endings, aiming to understand the interaction between the proprioceptive
system and knee mechanics.
Methods
Twenty ALLs were obtained from fresh frozen cadavers. The ligaments were measured,
weighed, and cut. Sections (10 μm) were prepared in hematoxylin and eosin–stained
slides to analyze tissue integrity, and 50-μm sections were subjected to immunofluorescence
with the protein gene product 9.5 as primary antibody and Alexa Fluor 488 as secondary
antibody, followed by microscopic analysis.
Results
The ALL was identified in 100% of the dissections, exhibiting a mean (± standard deviation)
length of 4.0 ± 0.4 cm, a mean width of 5.5 ± 0.8 mm, and a mean weight of 0.9 ± 0.2 g.
The histological sections in hematoxylin and eosin showed dense, well-organized collagen
and the presence of vascular tissue. All the specimens analyzed contained type I (Ruffini-like)
mechanoreceptors and free nerve endings (type IV), varying from parallel to intertwined
fibers. Unclassified nerve endings with different irregular shapes were also found.
The neural elements occupied 0.6% ± 0.3% of the ligament area, and most were observed
near the origin of ALL insertions.
Conclusion
The ALL exhibits a peripheral nerve structure, primarily type I and IV mechanoreceptors.
These findings suggest that the ALL is important for the proprioception and anterolateral
stabilization of the knee.
Clinical Relevance
It is important to understand ALL innervation and infer how an injury could compromise
the proprioceptive role of the lateral compartment, as the ligaments contribute dynamically
to stability through proprioceptive control of muscle forces. The findings confirm
that the ALL is highly innervated by mechanoreceptors and may have a proprioceptive
role in conjunction with the lateral collateral ligament in the lateral region of
the knee.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to ArthroscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The anterolateral ligament of the human knee: An anatomic and histologic study.Knee Surg Sport Traumatol Arthrosc. 2012; 20: 147-152
- Anatomy of the anterolateral ligament of the knee.J Anat. 2013; 223: 321-328
- Anatomy and histology of the knee anterolateral ligament.Orthop J Sport Med. 2013; 1 (2325967113513546)
- The structure and function of the anterolateral ligament of the knee: A systematic review.Arthroscopy. 2015; 31: 569-582.e3
- A review of the anterolateral ligament of the knee: Current knowledge regarding its incidence, anatomy, biomechanics, and surgical dissection.Arthroscopy. 2015; 31: 583-591
- Anatomy of the anterolateral ligament of the knee: A systematic review.Arthroscopy. 2019; 35: 670-681
- The Segond fracture: A bony injury of the anterolateral ligament of the knee.Arthroscopy. 2014; 30: 1475-1482
- Combined reconstruction of the anterolateral ligament in chronic ACL injuries leads to better clinical outcomes than isolated ACL reconstruction.Knee Surg Sport Traumatol Arthrosc. 2018; : 1-8
- 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
- Surgical indications for anterior cruciate ligament reconstruction combined with extra-articular lateral tenodesis or anterolateral ligament reconstruction.Rev Bras Ortop. 2018; 53: 661-667
- Isometric characteristics of the anterolateral ligament of the knee: A cadaveric navigation study.Arthroscopy. 2016; 32: 2017-2024
- The involvement of the anterolateral ligament in rotational control of the knee.Am J Sports Med. 2015; 44: 1209-1214
- The meniscal insertion of the knee anterolateral ligament.Surg Radiol Anat. 2016; 38: 223-228
- Anterolateral ligament of the fetal knee: An anatomic and histological study.Am J Sports Med. 2017; 45: 91-96
- The anterolateral ligament of the knee: A radiologic and histotopographic study.Surg Radiol Anat. 2016; 38: 341-348
- A cadaveric study of the anterolateral ligament: Re-introducing the lateral capsular ligament.Knee Surg Sport Traumatol Arthrosc. 2015; 23: 3186-3195
- Mechanoreceptors in human cruciate ligaments: A histological study.J Bone Joint Surg Am. 1984; 66: 1072-1076
- Neural anatomy of the human anterior cruciate ligament.J Bone Joint Surg Am. 1987; 69: 243-247
- Mechanoreceptors in the human anterior cruciate ligament.Anat Rec. 1986; 214: 204-209
- Immunohistochemical analysis of mechanoreceptors in the human posterior cruciate ligament: A demonstration of its proprioceptive role and clinical relevance.J Arthroplasty. 1998; 13: 916-922
- Mechanoreceptors in the posterior cruciate ligament: Histologic study on cadaver knees.Acta Orthop. 1991; 62: 276-278
- Neural system of the human posterior cruciate ligament in osteoarthritis.J Arthroplasty. 1995; 10: 679-682
- Anatomical study of the lateral collateral ligament and its circumference structures in the human knee joint.Surg Radiol Anat. 2010; 32: 99-106
- Mechanoreceptors of the ligaments and tendons around the knee.Clin Anat. 2016; 29: 789-795
- Surgical dissection of the anterolateral ligament.Arthrosc Tech. 2016; 5: e185-e188
- Fluorescence immunohistochemistry and confocal scanning laser microscopy: A protocol for studies of joint innervation.Acta Orthop Scand. 2003; 74: 689-696
- The innervation of the knee joint. An anatomical and histological study in the cat.J Anat. 1967; 101: 505-532
- The innervation of the ankle joint. An anatomical and histological study in the cat.Cells Tissues Organs. 1967; 68: 321-333
- Topography of mechanoreceptors in the shoulder joint region—A computer-aided 3D reconstruction in the laboratory mouse.Anat Rec. 1997; 248: 433-441
- Mechanoreceptor endings in human thoracic and lumbar facet joints.Spine. 1998; 23: 168-173
- Proprioception of the cruciate ligaments: Receptor mapping in an animal model.Arch Orthop Trauma Surg. 1998; 118: 159-163
- Histomorphometric analysis of innervation of the anterior cruciate ligament in osteoarthritis.J Orthop Res. 1995; 13: 78-82
- The innervation of the human meniscus.Clin Orthop Relat Res. 1992; : 232-236
- An immunohistochemical study of mechanoreceptors in lumbar spine intervertebral discs.J Clin Neurosci. 2010; 17: 742-745
- Immunohistochemical analysis of wrist ligament innervation in relation to their structural composition.J Hand Surg Am. 2007; 32: 30-36
- Mechanoreceptors found in a posterior cruciate ligament from a well-functioning total knee arthroplasty retrieval.J Arthroplasty. 2011; 26 (504.e9-504.e12)
- Histologic analysis of neural elements in the human sacroiliac joint.Spine. 2002; 27: 1202-1207
- Nerve distribution in hemangiomas depends on the proliferative state of the microvasculature.J Surg Res. 2000; 93: 144-148
- Tyrosine hydroxylase- and nitric oxide synthase-immunoreactive nerve fibers in mitral valve of young adult and aged Fischer 344 rats.J Auton Nerv Syst. 1996; 58: 35-43
- The pattern of distribution of PGP 9.5 and TNF-alpha immunoreactive sensory nerve fibers in the labrum and synovium of the human hip joint.Neurosci Lett. 2009; 450: 18-22
- Nerve distribution to the human knee joint: Anatomical and immunohistochemical study.Int Orthop. 2000; 24: 1-4
- The anterolateral ligament: An anatomic study on sex-based differences.Orthop J Sport Med. 2017; 5
- The anterolateral ligament: A cadaveric study in fetuses.Clin Anat. 2017; 30: 625-634
- The infra-meniscal fibers of the anterolateral ligament are stronger and stiffer than the supra-meniscal fibers despite similar histological characteristics.Knee Surg Sport Traumatol Arthrosc. 2017; 25: 1078-1085
- Correlation of magnetic resonance imaging with knee anterolateral ligament anatomy: A cadaveric study.Orthop J Sport Med. 2015; 3 (2325967115621024)
- The anterolateral ligament: An anatomic, radiographic, and biomechanical analysis.Am J Sports Med. 2015; 43: 1606-1615
- Length changes of the anterolateral ligament during passive knee motion: A human cadaveric study.Am J Sports Med. 2015; (0363546515594373)
- Anatomical study on the anterolateral ligament of the knee.Rev Bras Ortop. 2013; 48: 368-373
- Study of the anterolateral ligament of the knee in formalin-embedded cadavers.Acta Ortop Bras. 2017; 25: 89-92
- Anatomic and histological investigation of the anterolateral capsular complex in the fetal knee.Am J Sports Med. 2017; 45: 1383-1387
- Why do authors differ with regard to the femoral and meniscal anatomic parameters of the knee anterolateral ligament? Dissection by layers and a description of its superficial and deep layers.Orthop J Sport Med. 2016; 4 (2325967116675604)
- Anatomic description of the anterolateral ligament of the knee.Knee Surg Sport Traumatol Arthrosc. 2016; 24: 2083-2088
- The anterolateral ligament of the knee: Unwrapping the enigma. Anatomical study and comparison to previous reports.J Orthop Traumatol. 2016; 17: 303-308
- Anatomic dissection of the anterolateral ligament (ALL) in paired fresh-frozen cadaveric knee joints.Arch Orthop Trauma Surg. 2017; 137: 249-255
- Anterolateral ligament of the knee shows variable anatomy in pediatric specimens.Clin Orthop Relat Res. 2017; 475: 1583-1591
- Solving the mystery of the antero lateral ligament.J Clin Diagnostic Res. 2017; 11: AC01-AC04
- The anterolateral ligament: Anatomic implications for its reconstruction.Knee. 2017; 24: 1083-1089
- Femoral origin of the anterolateral ligament: an anatomic analysis.Arthroscopy. 2016; 32: 835-841
- A sensory role for the cruciate ligaments.Clin Orthop Relat Res. 1991; 268: 161-178
- The mechanoreceptor innervation of the human fibular collateral ligament.J Anat. 1989; 162: 1-7
- Innervation of nociceptors in the menisci of the knee joint: An immunohistochemical study.Arch Orthop Trauma Surg. 2000; 120: 201-204
- Mechanical sensitivity of group III and IV afferents from posterior articular nerve in normal and inflamed cat knee.J Neurophysiol. 1986; 55: 635-643
- The ultrastructure of sensory nerve endings in the human knee joint capsule.Anat Embryol (Berl). 1985; 172: 265-275
- Sensory-motor control of ligaments and associated neuromuscular disorders.J Electromyogr Kinesiol. 2006; 16: 549-567
- Mechanics of the passive knee joint. Part 1: The role of the tibial articular surfaces in guiding the passive motion.Proc Inst Mech Eng Part H J Eng Med. 2006; 220: 813-822
- Mechanics of the passive knee joint. Part 2: Interaction between the ligaments and the articular surfaces in guiding the joint motion.Proc Inst Mech Eng H. 2007; 221: 821-832
- Immunohistochemical mapping of sensory nerve endings in the human triangular fibrocartilage complex.Clin Orthop Relat Res. 2015; 473: 3245-3253
Article info
Publication history
Accepted:
May 10,
2019
Received:
December 13,
2018
Footnotes
The authors report that they have no conflicts of interest in the authorship and publication of this article. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
See commentary on page 2929
Identification
Copyright
© 2019 by the Arthroscopy Association of North America
ScienceDirect
Access this article on ScienceDirectLinked Article
- Editorial Commentary: Knee Anterolateral Ligament Mechanoreceptors: The First Step From Peripheral to Central Nervous SystemArthroscopyVol. 35Issue 10
- PreviewThe mechanoreceptors around the knee are of interest, including those mechanoreceptors related to the anterolateral ligament. Histopathologic evaluations of mechanoreceptors are the first steps in understanding the exact sensorimotor system of the extremities. Many studies have shown these mechanoreceptors, but more electrophysiologic studies are needed to make sense of the reported phenomena.
- Full-Text
- Preview
