Anatomy and Function of the Anterolateral Capsule Structures

Abstract

verall goal when treating athletes with high-grade rotatory knee laxity is to restore normal kinematics and joint function in order to facilitate a safe return to sports. Isolated ACL ies do not require additional extra-articular tenodesis procedures. However, the current iture is unclear with regard to the more complex situation of chronic ACL tears, combined injuries, athletes with generalized joint hyperlaxity, and revision surgery. The structures of the anterolateral capsule have held multiple names throughout history. To date, while there is no consensus in terms of the anatomy and biomechanical function of the anterolateral ligament, some researchers have proposed surgical treatment for anterolateral capsular injuries. Histologically, the organization of the anterolateral capsular structures is not as reproducible as the lateral collateral ligament. Moreover, an anterolateral ligament has not been observed during human fetal dissection. Nonetheless, studies have shown that the anterolateral capsule is an important restraint to anterior tibial loads and internal rotation torque in the ACLdeficient knee. This leads to the assumption that, in the majority of cases, capsular injuries appear secondary to chronic ACL tears. The role of additional procedures in addressing capsular injuries, such as extra-articular tenodesis or lateral plasty, requires definition based on the severity of the injury. The standardized pivot-shift test allows the determination of rotatory knee laxity and can be quantified using different customized tools. Treatment algorithms should be established based on each individual patient's anatomy.