The anterolateral ligament was re-described in 2012 by Claes et al as a distinct ligamentous structure at the anterolateral knee, providing the restraint against the internal tibial rotation that produces the pivot shift. Combined ACL + ALL tears explain the high-grade pivot shift seen in complete ACL disruptions. ALL reconstruction alongside ACL reconstruction reduces pivot shift recurrence in high-grade rotational instability.
| Origin | Lateral femoral condyle (just posterior and proximal to the LCL) |
|---|---|
| Insertion | Anterolateral tibia between the Gerdy's tubercle and the fibular head |
| Actions | Restrains internal tibial rotation (pivot shift); secondary restraint to anterior tibial translation; the anatomical basis for the anterolateral knee instability seen with ACL injuries |
|---|
ALL reconstruction using a gracilis or ITB graft from the lateral femoral condyle to the anterolateral tibia is performed alongside ACL reconstruction for patients with high-grade pivot shift, hyperlaxity, or previous ACL re-rupture. The modification has reduced re-rupture rates in randomised trials. The Lemaire and ITB tenodesis procedures are earlier techniques targeting the same anatomical territory.
High-grade pivot shift from combined ACL and ALL disruption managed with combined ACL and ALL reconstruction to reduce re-rupture and rotational instability.
