The tale of two or three ligaments…

Most people have heard of the dreaded ACL (Anterior Cruciate Ligament) tear. It used to be a career ending injury, but now thanks to modern technology and the advance of sports medicine in most cases it is only a 6-9 month road block and athletes can sometimes comeback even stronger. There are 4 major ligaments the comprise the knee joint; ACL, PCL, MCL, & LCL. The ACL prevents anterior translation of the tibia helps with rotational stability of the knee.

Over recent years there has been an emerging debate on what is the best way to reconstruct the torn ligament. The patient has three main choices; hamstring autograft, patella tendon autograft, or a cadaver graft. Each have their own pros and cons. For the sake of this post I am going to eliminate the cadaver ligament as it is mainly only chosen as for patients over 40 as a second or third choice. The pros and cons of the hamstring and patella grafts are relative to each and patient and there is just a difference of a couple of percentage points in regards to the re-rupture rate between the hamstring and patella tendon grafts. This blog post also is not to debate if the hamstring is better than the patella. It is about the “discovery” of a new-found knee ligament.

In 2013 an article in the Journal of Anatomy (1) made comments and brought to light the potential impact of a widely unknown ligament called the Anterolateral ligament. At first the media portrayed that this was a new discovery but this ligament has indeed been documented since the 19th century.

(http://www.sydneyknee.com.au/wp-content/themes/ypo-theme/images/anterolateral-ligament-knee.jpg)

The ligament is on the outside part of the knee, tanish in color.

Another article came out a couple of weeks ago in Bottom Line (2) alerting consumers to orthopedic surgeons who have started repairing the anterolateral ligament along with the reconstruction of the ACL. This is alarming and should be definitely be brought up with your surgeon if you are having ACL surgery. It is alarming because there is no evidence that supports it is beneficial to the patient to repair the anterolateral ligament. Research is on going and it will be interesting what conclusions they will find and if it’ll have any benefit in eventually repairing it along with the ACL ligament. This is also a controversial surgery because there is no info on how to exactly perform the surgery! Make sure you are talking with your surgeon to get all the details possible and do your own research to make sure you make an educated decision in regards to the reconstruction of your ACL. My best advice is just to have an open and honest conversation with your doctor.

1.Claes, S., Vereecke, E., Maes, M., Victor, J., Verdonk, P., & Bellemans, J. (2013). Anatomy of the anterolateral ligament of the knee. Journal of anatomy, 223(4), 321-328.

2. Bottom Line Link