If you are diagnosed with an ALL tear, it means the anterolateral ligament (ALL) in your knee has torn. This is a relatively common injury on track and field, in the gym, and on rambling paths – and it is best treated sooner rather than later.
Read on and find out more about ALL tears and how we treat them at Sports Med London.
The ALL And The ALC
The ALL is part of the AnteroLateral Complex (ALC), which is on the front and side of the knee. The ligament runs from the side of the thighbone to the side of the shinbone. Other major parts of the ALC are the Kaplan’s fibres and the joint capsule components. The complex helps control your knee’s inward rotational stability.
How The ALL Tears
ALL tears usually happen when the knee is injured by twisting or turning, and they often happen at the same time as an anterior cruciate ligament (ACL) tear. In a rotational injury, the ALL and/or another part of the ALC may tear.
Rotational injuries can happen when you change direction or stop suddenly, you fall on a flexed knee, or you overextend your knee.
The injury may also cause the ligaments to pull bits of bone off the site at which they are attached, which is known as a Segond fracture. If you have a Segond fracture, it will need to be repaired at the same time as the ALL and ACL, or it could lead to the procedure failing.
ALL Tears At Sports Med London
At Sports Med London, we usually repair ALL tears when repairing ACL tears. We do this in one of two ways:
Lateral Extra-articular Tenodesis (LET) – The surgeon cuts a strip of the tight broad band that connects the thighbone and shin bone. He uses that strip to reconstruct the ALL and ACL.
Free Graft or Ribbon/Tape – Another way of reconstructing the ALL is for the surgeon to graft a hamstring tendon from yourself or from a donor. The surgeon also has the option of using special ribbon or tape. Whether the surgeon uses a tendon or tape, he will attach it to the thighbone and shinbone.
The surgery used for ALL tears is known as keyhole surgery, as it is performed through small incisions. When finished, the surgeon will used absorbable stitches to close the wounds before covering them with a dressing.
Surgery is only part of the treatment for ALL tears. While recovering, a physiotherapist will visit you to give you a series of exercises to help strengthen your ALC. Keep reading for a more detailed explanation of ALL tears.
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.