New knee ligament

Simon Spooner · Nov 6, 2013

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This showed up in my facebook feed:
http://www.iflscience.com/health-and-medicine/new-human-body-part-discovered
Paper is here:
http://onlinelibrary.wiley.com/doi/...ionid=696761CCEA5A638685056926D39B7BBF.f03t02

mike weber · Nov 6, 2013

Crazy Aug 2013 shows how much we still have to learn

blinda · Nov 6, 2013

Liked the comment;

It is just a ligament of their imagination
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There you were thinking you had only ruptured your ACL, eh?

Simon Spooner · Nov 6, 2013

No, according to the MRI I had a total rupture of ACL, partial of PCL and a meniscal tear. I suspect the rest of the PCL "went" about a couple of months later when I was surfing since I felt it "pop" and had to drag myself onto the beach in "kin agony. Rugby is great.

blinda · Nov 6, 2013

Simon Spooner said: ↑

No, according to the MRI I had a total rupture of ACL, partial of PCL and a meniscal tear. I suspect the rest of the PCL "went" about a couple of months later when I was surfing since I felt it "pop" and had to drag myself onto the beach in "kin agony. Rugby is great.
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Ah, sorry. Forgot about the post injury PCL "popping". Looks like you can add ALL to the list now. Great indeed.

Simon Spooner · Nov 6, 2013

Knees are crap joints.

blinda · Nov 6, 2013

...But rugby is still great.

Kevin Kirby · Nov 6, 2013

blinda said: ↑

...But rugby is still great...
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....for orthopedic surgeons...;)

blinda · Nov 6, 2013

Kevin Kirby said: ↑

....for orthopedic surgeons...;)
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Touché :drinks

Simon Spooner · Nov 6, 2013

Kevin Kirby said: ↑

....for orthopedic surgeons...;)
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Nah, I'm waiting until I need surgery. At the moment my knee doesn't bother me, if I don't bother it. I actually played a game of rugby twelve months ago (my last game ever) with my knee held together with gaffer tape. I hadn't planned on playing but the boys were short of numbers so I loaned a pair of size 9 boots (I'm an 11) and played on the wing (out of the way). Ball came to me in first couple of minutes and I stepped off my dodgy knee only to find that someone had replaced my leg with some form of jelly. Start of the second half it got better: on a seriously muddy pitch the whole of the cleat plate from my right boot (my dodgy side) fell off and at this point I moved back to my preferred position of blindside flanker.... How we laughed in the bar latter (not). Great game, miss it daily.

blinda · Nov 6, 2013

"And the hardest part
Was letting go, not taking part
Was the hardest part"

http://www.youtube.com/watch?v=bnjwG23ay2s

Craig Payne · Nov 7, 2013

duh! Its no new ligament. Twiiter and facebook etc are all over this; the media fell for the press release - ITS NOT NEW. It been documented for over a century.

here is an abstract from Jan last yr talking about it:

Knee Surg Sports Traumatol Arthrosc. 2012 Jan;20(1):147-52. doi: 10.1007/s00167-011-1580-3. Epub 2011 Jun 30.
The anterolateral ligament of the human knee: an anatomic and histologic study.
Vincent JP, Magnussen RA, Gezmez F, Uguen A, Jacobi M, Weppe F, Al-Saati MF, Lustig S, Demey G, Servien E, Neyret P.
Source
Centre Hospitalier Universitaire Brest, Brest, France.
Abstract
PURPOSE:
The functional anatomy of the knee is frequently studied but remains incompletely understood. Numerous authors have described a structure in the lateral knee connecting the lateral femoral condyle with the lateral meniscus and tibial plateau. The goal of this study is to define the incidence, anatomy, and histology of this structure, the anterolateral ligament.
METHODS:
The incidence of the ligament was determined in 30 consecutive patients undergoing total knee arthroplasty (TKA) for medial compartment osteoarthritis. The anatomy and histology were evaluated using 10 cadaveric knees.
RESULTS:
The anterolateral ligament was noted to be present in all 40 knees. In all cases, it was noted to take origin near or on the popliteus tendon insertion and insert into the lateral meniscus and tibial plateau 5 mm distal to the articular surface and posterior to Gerdy's Tubercle. The average width of the relatively flat structure was 8.2 ± 1.5 mm, and the average length was 34.1 ± 3.4 mm. Histologic analysis revealed a discreet structure with a fibrous core surrounded by synovium. Fibers blended with the popliteus at its origin and with the lateral meniscus as it passed distally.
CONCLUSIONS:
The anterolateral ligament may play a role in preventing anterior tibial translation. The role, if any, of this structure in meniscal stability and the pathology of meniscal tears remain unclear.
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Amazing how much hype that this generated.

Craig Payne · Nov 7, 2013

This funny. The press release that the gullible media lapped up had this headline: "Surgeons describe new ligament in the human knee "

In the abstract of the research, the very first sentence says "In 1879, the French surgeon Segond described the existence of a ‘pearly, resistant, fibrous band’ at the anterolateral aspect of the human knee, attached to the eponymous Segond fracture" ... it been described since 1879. Nothing new!

Craig Payne · Nov 7, 2013

..and the ligament has its own wikipedia page!

Anterolateral ligament

Ligament on the lateral aspect of the human knee

The anterolateral ligament (ALL) is a ligament on the lateral aspect of the human knee, anterior to the fibular collateral ligament.^[1]
Perhaps the earliest account of the ALL was written by French surgeon Paul Segond in 1879, in which he described a ligamentous structure between the lateral femur and tibia.^[2]^[3]
Claes and Bellemans (2013) found that the ALL originates at the lateral epicondyle of the femur, and inserts at the anterolateral aspect of the proximal tibia.^[1] However, Vincent et al. (2012) reported the origin to be the lateral femoral condyle.^[4]

^ ^a ^b Claes, S.; Vereecke, E.; Maes, M.; Victor, J.; Verdonk, P.; Bellemans, J. (Oct 2013). "Anatomy of the anterolateral ligament of the knee". J Anat. 223 (4): 321–8. doi:10.1111/joa.12087. PMC 3791125. PMID 23906341.

^ Segond P (1879) Recherches cliniques et expérimentales sur les épanchements sanguins du genou par entorse. Progrès Médical (Paris) (accessible from [1] Archived 2012-12-31 at the Wayback Machine), 1-85.

^ Recherches cliniques et expérimentales sur les épanchements sanguins du genou par entorse, par Paul Segond. 1879. Retrieved November 6, 2013.

^ Vincent, J. P.; Magnussen, R. A.; Gezmez, F.; et al. (January 2012). "The anterolateral ligament of the human knee: An anatomic and histologic study". Knee Surg Sports Traumatol Arthrosc. 20 (1): 147–52. doi:10.1007/s00167-011-1580-3. PMID 21717216.

Read More

histona5 · Jan 13, 2014

http://blog.podored.es/lo-siento-no-se-ha-descubierto-un-nuevo-ligamento-en-la-rodilla/

toughspiders · Jan 14, 2014

Simon Spooner said: ↑

Knees are crap joints.
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I totally hear you!

Sicknote · Jan 21, 2014

Simon Spooner said: ↑

Knees are crap joints.
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They are when you treat them like crap.

NewsBot · Jan 3, 2015

The Biomechanical Function of the Anterolateral Ligament of the Knee
Erin M. Parsons, MS, Albert O. Gee, MD, Charles Spiekerman, PhD and Peter R. Cavanagh, PhD, DSc
Am J Sports Med January 2, 2015

Background: Recent anatomic investigations of the lateral structures of the knee have identified a new ligament, called the anterolateral ligament (ALL). To date, the anterolateral ligament has not been biomechanically tested to determine its function.
Hypothesis: The ALL of the knee will resist internal rotation at high angles of flexion but will not resist anterior drawer forces.
Study Design: Controlled laboratory study.
Methods: Eleven cadaveric knees were subjected to 134 N of anterior drawer at flexion angles between 0° and 90° and separately to 5 N·m of internal rotation at the same flexion angles. The in situ forces of the ALL, anterior cruciate ligament (ACL), and lateral collateral ligament (LCL) were determined by the principle of superposition.
Results: The contribution of the ALL during internal rotation increased significantly with increasing flexion, whereas that of the ACL decreased significantly. At knee flexion angles greater than 30°, the contribution of the ALL exceeded that of the ACL. During anterior drawer, the forces in the ALL were significantly less than the forces in the ACL at all flexion angles (P < .001). The forces in the LCL were significantly less than those in either the ACL or the ALL at all flexion angles for both anterior drawer and internal rotation (P < .001).
Conclusion: The ALL is an important stabilizer of internal rotation at flexion angles greater than 35°; however, it is minimally loaded during anterior drawer at all flexion angles. The ACL is the primary resister during anterior drawer at all flexion angles and during internal rotation at flexion angles less than 35°.
Clinical Relevance: Damage to the ALL of the knee could result in knee instability at high angles of flexion. It is possible that a positive pivot-shift sign may be observed in some patients with an intact ACL but with damage to the ALL. This work may have implications for extra-articular reconstruction in patients with chronic anterolateral instability.
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NewsBot · Apr 18, 2015

The Anterolateral Ligament
An Anatomic, Radiographic, and Biomechanical Analysis
Mitchell I. Kennedy et al
Am J Sports Med April 17, 2015

Background: Recent publications have described significant variability in the femoral attachment and overall anatomy of the anterolateral ligament (ALL). Additionally, there is a paucity of data describing its structural properties.
Purpose: Quantitative data characterizing the anatomic and radiographic locations and the structural properties of the ALL may be used to guide graft selection and placement and to facilitate the future development of an evidence-based approach to ALL reconstructions.
Study Design: Descriptive laboratory study.
Methods: Identification of the ALL was performed by a combined outside-in and inside-out anatomic dissection of 15 nonpaired fresh-frozen cadaveric knees. Quantitative anatomic relationships were calculated using a 3-dimensional coordinate measuring device. Measurements on anteroposterior (AP) and lateral radiographs were obtained by use of a picture archiving and communications system program. Structural properties were characterized during a single pull-to-failure test using a tensile testing machine. All anatomic, radiographic, and biomechanical measurements were reported as mean values and 95% CIs.
Results: The ALL was identified as a thickening of the lateral capsule coming under tension with an applied internal rotation at 30° of flexion. Its femoral attachment was located 4.7 mm (95% CI, 3.5-5.9 mm) posterior and proximal to the fibular collateral ligament attachment and coursed anterodistally to its anterolateral tibial attachment approximately midway between the center of the Gerdy tubercle and the anterior margin of the fibular head; the tibial attachment was located 24.7 mm (95% CI, 23.3-26.2 mm) and 26.1 mm (95% CI, 23.9-28.3 mm) from each structure, respectively. On the AP radiographic view, the ALL originated on the femur 22.3 mm (95% CI, 20.7-23.9 mm) proximal to the joint line and inserted on the tibia 13.1 mm (95% CI, 12.3-13.9 mm) distal to the lateral tibial plateau. On the lateral view, the femoral attachment was 8.4 mm (95% CI, 6.8-10.0 mm) posterior and proximal to the lateral epicondyle. The tibial attachment was 19.0 mm (95% CI, 17.1-20.9 mm) posterior and superior to the center of the Gerdy tubercle. The mean maximum load was 175 N (95% CI, 139-211 N) and the stiffness was 20 N/mm (95% CI, 16-25 N/mm). Failure occurred by 4 distinct mechanisms: ligamentous tear at the femoral (n = 4) or tibial (n = 1) attachment, midsubstance tear (n = 4), and bony avulsion of the tibial attachment (Segond fracture; n = 6).
Conclusion: Defined ALL attachment locations can be reproducibly identified with intraoperative landmarks or radiographs. The biomechanical analysis suggests that most traditional soft tissue grafts are sufficient for ALL reconstruction.
Clinical Relevance: The ALL was consistently found in all knees. Segond fractures appear to occur primarily from the avulsion of the ALL.
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NewsBot · Sep 19, 2017

The Anterolateral Ligament Does Exist
An Anatomic Description
Stefano Zaffagnini et al
Clinics in Sports Medicine; Article in Press

The debate around the existence, anatomy, and role of the so-called anterolateral ligament of the knee represents one of the main sources of recent controversy among orthopedic surgeons. In the modern era of sports medicine, several content experts have contributed to the understanding of the anatomy of the anterolateral aspect of the knee. This article analyzes the historical, phylogenetic, anatomic, arthroscopic, and radiological evidence regarding the anterolateral ligament. The existence of the anterolateral ligament as a distinct ligamentous structure and its exact anatomic features are still matters of controversy and ongoing study.
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Anterolateral ligament

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