The anterolateral ligament was re-described in 2013 by Claes and colleagues as a distinct ligamentous structure at the anterolateral knee, running from the lateral femoral condyle to the anterolateral tibia between Gerdy's tubercle and the fibular head. It restrains the internal tibial rotation that produces the pivot shift. Combined ACL and ALL tears help explain the high-grade pivot shift seen in some ACL disruptions, and 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) |
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| Insertion | Anterolateral tibia between the Gerdy's tubercle and the fibular head |
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Helps restrain internal rotation of the tibia, contributing to anterolateral rotatory stability of the knee.
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.
Small avulsion fracture of the lateral tibial rim at the ALL and lateral capsular attachment, a marker of ACL rupture.
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