Anterolateral ligament of the knee: anatomical evidence, prevalence, insertions, and surgical implications. Narrative review

Abstract

Introduction: Anterior cruciate ligament reconstruction may be associated with residual anterolateral rotator laxity, which has renewed interest in the structures of the anterolateral compartment of the knee, including the anterolateral ligament (LAL). Objective: To critically synthesize the anatomical evidence on the existence, prevalence, morphometry, and insertions of LAL, as well as its surgical implications. Methods: A narrative review guided by SANRA was structured, with a search in the 2016–2026 window and complementary recovery by snowballing of previous seminal works. Priority was given to cadaveric, histological, imaging, biomechanical studies and reviews that addressed the existence, prevalence, insertions, or anatomical characterization of LAL. Results: The included studies show a consistent anatomical tracing when LAL is identified, with femoral origin in the vicinity of the lateral epicondyle, tibial insertion between Gerdy's tubercle and the head of the fibula, and almost constant attachment to the lateral meniscus. However, prevalence varies markedly between primary studies, from complete absence to universal identification, while pooled syntheses report intermediate-high estimates and geographic gradient. Conclusions: The LAL can be considered a topographically consistent structure, but of variable presence and nature still discussed. The evidence included allows us to better answer about existence, prevalence, and insertions than about morphometry or direct surgical benefit.