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A lthough ACL reconstruction has been successfully performed for the last three decades, only about 60% of patients return to their preinjury levels of activity [9]. Young athletes who return to sports too early or have incorrectly placed graft tunnels have an increased risk of reinjury. Recently, researchers have been exploring the biomechanical role of the anterolateral ligament (ALL), a secondary ligament of the knee that plays a role in rotatory stability. The Segond fracture, frequently observed on plain radiographs in an acute ACL injury, is believed to be a sign of ALL involvement as well [3, 6, 7]. In the current study, Kent III and colleagues investigated ALL function and found that not all ACL-deficient knees benefit from an ALL reconstruction. Their study, similar to a study published earlier this year [2], demonstrated that the clinical function of the ALL varies in different knees in relation to the ACL. While Drews and colleagues [2] show that the ALL plays a role in supporting the ACL to a minor degree, the current study indicates that ALL has function in some cadaveric knees, and as such, supports reconstruction in selected cases. These findings suggest that surgical decisions, such as joint position and tension at which lateral extraarticular grafts are fixed, should be customized for each patient. Based on the current knowledge, extraarticular grafts may only be needed in revision surgeries.

CORR Insights®: High Interspecimen Variability in Engagement of the Anterolateral Ligament: An In Vitro Cadaveric Study