The anterolateral bundle of the ACL is the larger, dominant bundle, taut in flexion, running from the anterolateral femoral origin to the anterolateral tibial insertion. It is the primary restraint against anterior tibial translation in flexion.
The dominant ACL bundle — primary restraint against anterior tibial translation at 30-90 degrees of flexion, contributing to rotational stability during pivoting activities. Standard single-bundle ACL reconstruction primarily reconstructs this bundle.
Single-bundle ACL reconstruction targets the AL bundle, positioning the tibial tunnel at the AM bundle centre and the femoral tunnel at the AL bundle centre. The Lachman test and anterior drawer assess AL bundle integrity. Pivot shift testing assesses the combination of AL bundle and anterolateral complex function.
Anterolateral bundle rupture with intact PM bundle producing Lachman-positive anterior laxity but intact extension stability, managed by selective ALB reconstruction or total ACL reconstruction.
Conventional ACL reconstruction placing the graft in the anterolateral bundle position to restore the primary anterior stability restraint.
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