What is the ALL?
The AnteroLateral Complex (ALC) is located on the anterior (front) and lateral part of the knee at the same level as the knee joint. This complex consists mainly the of the anterolateral ligament, the joint capsule components and the Kalpan’s fibers (between the femur and the Ilio-tibial band (ITB)) and contributes to controlling the rotational stability of the knee.
What causes an ALL Injury?
During a rotational injury of the knee, the ALC is frequently injured. This may result in a capsular bony avulsion (pull off) of the ALC, also called a “Segond fracture”, and is almost always associated with an ACL tear. This causes increased rotational instability and when present, if not addressed at the time of the ACL reconstruction, is associated with poorer outcomes and increased risk of failure.
How is an ALL injury treated?
The anterolateral ligament (ALL) runs from the lateral (outer) side of the femur (thighbone) to the lateral aspect of the tibia (shinbone). It is involved in controlling internal (inward) rotation of the tibia. Reconstructing the anterolateral complex may be performed by using a strip of the Ilio-tibial band (ITB) which is the tight broad band on the outer surface of the leg and runs from the upper thigh to the upper tibia and fixing it to the femur. This is called a Lateral Extra-articular Tenodesis (LET).
Alternatively, the native anterolateral ligament (ALL) may be reconstructed using a free graft (often a hamstring tendon) either from the same patient (autograft) or from a donor (allograft) and fixing it to the femur and tibia. Sometimes special tape or ribbon may be used instead. ALL surgery is performed using small incisions. Very often and ALL reconstruction is performed at the same time as an ACL reconstruction/repair.
The wound is closed with absorbable sutures and a dressing is applied.
As surgical techniques have improved significantly over the last decade, complications are reduced and recovery much quicker than in the past.
Following ALL reconstruction, a rehabilitation program with physiotherapy is started to help you to ultimately return to sport and a wider range of activities.