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



1 Department of Anatomy, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India

2 Department of Orthopaedics, Pondicherry Institute of Medical Sciences, Puducherry, India


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