Article

Since the recent descriptions of the anterolateral ligament (ALL),
the role played by the anterolateral peripheral structures in the rotational
control of the knee is again being debated. The objective of this study was to
identify the structures during internal tibial rotation and then to define their
anatomical characteristics. We hypothesized that internal rotation would tighten
several anatomical formations, both superficial and deep, with the ALL one part
of these structures. METHODS: Nine fresh-frozen cadaver knee
specimens were studied. The anterolateral structures tightened were identified
from superficial to deep at 30 degrees of flexion. Each was selectively
dissected, identifying its insertions and orientations, and measuring its size.
The length variations of the ALL during internal tibial rotation were measured by
applying a 30-N force using a dynamometric torque wrench at the tibiofibular
mortise. RESULTS: The superficial structures tightened were the iliotibial tract
and the Kaplan fibers. In internal tibial rotation, the Kaplan fibers held the
iliotibial tract against the lateral epicondyle, allowing it to play the role of
a stabilizing ligament. The Kaplan fibers were 73.11+/-19.09mm long (range,
63-82mm) and at their femoral insertion they were 12.1+/-1.61mm wide (range,
10-15mm). The deep structures tightened covered a triangular area including the
ALL and the anterolateral capsule. The ALL was 39.11+/-3.4mm long (range,
35-46mm) in neutral rotation and 49.88+/-5.3mm long (range, 42-58mm) in internal
rotation (p<0.005). Its femoral insertion area was narrow at 5.27+/-1.06mm
(range, 3.5-7mm) and was mainly proximal and posterior at the lateral epicondyle.
Its tibial insertion zone was wide, with a clearly differentiated anterior limit
but a posterior limit confused with the joint capsule. In the vertical plane,
this insertion was located 6.44+/-2.37mm (range, 2-9) below the joint space.
DISCUSSION: This study demonstrates two distinct anterolateral tissue planes
tightened during internal rotation of the tibia: a superficial plane represented
by the iliotibial tract and the Kaplan fibers, which acts as a ligament
structure, and a deep plane represented by a triangular capsular ligament complex
within which the ALL and the anterolateral capsule are recruited. LEVEL OF
EVIDENCE: Descriptive cadaver study IV.
CI - Copyright (c) 2015 Elsevier Masson SAS. All rights reserved.

Langue : FRANCAIS