The anterolateral ligament of the knee is a discrete capsulo-ligamentous structure running from the lateral femoral epicondyle to the anterolateral tibia between Gerdy's tubercle and the fibular head, providing anterolateral rotational stability.
Primary restraint against anterolateral tibial rotation (the pivot shift), limits internal tibial rotation, and supplements the ACL in controlling the pivot shift phenomenon. The ALL is taut in knee extension and early flexion.
The ALL was anatomically described in 2013 and has become a focus of knee surgery — combined ACL and ALL reconstruction (lateral extra-articular tenodesis) reduces the residual pivot shift after isolated ACL reconstruction in high-risk patients. The Segond fracture is an ALL avulsion.
Combined ACL and ALL reconstruction using iliotibial band strip tenodesis from Gerdy's tubercle to the lateral epicondyle, reducing residual pivot shift in athletes with ACL insufficiency.
Lateral tibial rim avulsion fracture pathognomonic for ACL injury, now recognised as the bony avulsion of the anterolateral ligament from the tibia.
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