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# Anterolateral ligament (ALL)

The anterolateral ligament (ALL) is a thin band on the outer side of the knee that helps control twisting.

Official name: Anterolateral ligament of knee

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## What it is

A thin band on the outer side of the knee, running from near the outer bump of the [femur](https://durgical.com/en/anatomy/femur/) to the tibia, between Gerdy's tubercle and the head of the [fibula](https://durgical.com/en/anatomy/fibula/).

## What it does

Helps control the inward rotation of the shin bone, together with the ACL.

## Key points

- The Segond fracture, a small avulsion of the lateral tibial rim, happens at the attachment of the anterolateral structures and almost always means an ACL tear
- Described as a fibrous band by Segond in the 19th century and brought back to attention in 2013; whether it is a distinct ligament is still debated
- Lateral extra-articular procedures are added to ACL reconstruction in high-risk cases to reduce re-tears

## Key facts

**Attaches**
Near lateral femoral epicondyle to anterolateral tibia between Gerdy tubercle and fibular head; attaches to lateral meniscus

**Function**
Helps control internal rotation of tibia (varies: not found in all knees; status still debated)

**Tight in**
Knee flexion with internal rotation of tibia

## Relations

**Course**
From near the lateral femoral epicondyle (texts differ on whether just in front of or behind the LCL origin), it runs forward and down to the anterolateral [tibia](https://durgical.com/en/anatomy/tibia/)

**Superficial**
[IT band](https://durgical.com/en/anatomy/iliotibial-tract/) (iliotibial band)

**Deep**
Anterolateral [joint capsule](https://durgical.com/en/anatomy/articular-capsule-of-knee-joint/) and the body of the [lateral meniscus](https://durgical.com/en/anatomy/lateral-meniscus/), to which it sends fibres

**Behind**
LCL

## How to find it

It cannot be felt. In dissection it is shown by flexing the knee to about 30–60° and turning the tibia inward: a thin band tightens from just behind and above the lateral femoral epicondyle to the tibia midway between Gerdy's tubercle and the fibular head.

## Examination

- Pivot shift: a high-grade, explosive shift suggests that the anterolateral structures are injured as well as the ACL

## On imaging

Coronal MRI may show it as a thin band near the LCL, often only in part. On the AP knee X-ray, a Segond fracture is a small elliptical flake just below the lateral tibial plateau; a reverse Segond fracture on the medial side goes with PCL and [medial meniscus](https://durgical.com/en/anatomy/medial-meniscus/) injuries.

## Common problems

- Can be injured together with the ACL in twisting injuries.

## How it is diagnosed

Often seen on MRI in ACL injuries; its role is still being studied.

## Treatment

- Some surgeons add a lateral reinforcement (anterolateral ligament reconstruction or a lateral tenodesis) to an ACL reconstruction in selected patients.

## Clinical notes

- ALL reconstruction or lateral extra-articular tenodesis is considered with ACL reconstruction in young pivoting athletes, a high-grade pivot shift or a revision
- A Segond fracture on X-ray calls for MRI to look for ACL and meniscus tears

## Anatomical variants

- It is not found as a distinct band in every knee; dissection studies report it in widely different proportions, and its femoral attachment is described in slightly different places

## Test yourself

Think of the answer, then tap the question to see it.

## What does a Segond fracture almost always indicate?

An ACL tear; it is a small avulsion of the lateral tibial rim at the attachment of the anterolateral structures.

## What are the attachments and function of the anterolateral ligament (ALL)?

From near the lateral femoral epicondyle to the anterolateral tibia between Gerdy's tubercle and the fibular head; it helps control tibial internal rotation.

## When is an ALL reconstruction or lateral extra-articular tenodesis added to ACL reconstruction?

In high-risk cases: young pivoting athletes, a high-grade pivot shift or a revision, to reduce re-tears.

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Educational information, not medical advice. For any symptom, see a health professional.

## Its names

**Official Spanish (DeCS)**
Ligamento anterolateral de la rodilla

**English (TA2)**
Anterolateral ligament of knee

**Also called**
ALL

## Related

- [LCL](https://durgical.com/en/anatomy/fibular-collateral-ligament/)
- [ACL](https://durgical.com/en/anatomy/anterior-cruciate-ligament/)
- [Femur](https://durgical.com/en/anatomy/femur/)
- [Tibia](https://durgical.com/en/anatomy/tibia/)

Sources: [Anatomy, Bony Pelvis and Lower Limb, Knee](https://www.ncbi.nlm.nih.gov/books/NBK500017/).

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Representative model, for educational purposes only.

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License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/anatomy/anterolateral-ligament-of-knee/