Ultrasound-Guided Percutaneous Reconstruction of the Anterolateral Ligament: Surgical Technique and Case Report

The first noted description of the anterolateral ligament (ALL) is often attributed to Dr. Paul Segond (1879). Segond described a "fibrous, pearly band showing extreme amounts of tension during forced internal rotation" that was responsible for an avulsion at the lateral aspect of the proximal tibia. In 2013, Dr. Steven Claes confirmed the presence of the ALL as the band of tissue detailed by Segond. Recent biomechanical studies have shown that the ALL is a vital stabilizer during internal rotation of the knee. Its contribution to stability during rotational kinematics has been proven to exceed that of the anterior cruciate ligament (ACL). Using the concept of the wheel and axle biomechanical formulas, the ACL endures 6 times greater forces during internal rotation in an ALL-deficient knee. With the recent anatomic and biomechanical findings, the necessity of a technique for reconstruction of the ALL has become increasingly important. The novel use of ultrasound intraoperatively allows for the exact anatomic reconstruction of the lost ligament by identifying the exact anatomic location of both the origin and insertion of the ALL. This article describes a technique for an ultrasound-guided percutaneous reconstruction of the ALL and a case report on one of our patients who required the reconstruction of his ALL.