Knee surgeons from the University Hospitals Leuven in Belgium have surprised the medical profession by declaring that they have discovered a new knee ligament. The findings published in The Journal of Anatomy should advance professional understanding of how the knee works and clear up some of the mysteries surrounding failed knee surgeries.
The surgeons who found this new knee ligament, named Antero Lateral Ligament (ALL), were the Orthopedic surgeons Dr. Steven Claes and Dr. Johann Bellemans.
The knee is a complex and often fragile body part consisting of bones, cartilage, fluids, ligaments and tendons. A perfectly healthy knee will have all its parts moving together smoothly but if the knee is abruptly injured it can tear, rupture and fracture. Unfortunately millions of people every year experience knee injuries which results in millions of knee exams, scans and operations.
Given the frequency of knee problems it was assumed that the internal structure of the knee was well understood, however after dissecting more than 40 human corpse knee joints the surgeons identified the ALL.
In 1879 Paul Segond, a French surgeon had first speculated that as well as the four structural knee ligaments known then - the anterior cruciate, medial collateral, posterior cruciate and lateral collateral, there must be others that exist in the knee which provides its stability. At the time he wrote that he had found a “pearly, resistant fibrous band” which originated at the outside, front portion of the thighbone and continued to the shinbone.
However he didn’t name the pearly band and with time it had simply been ignored and forgotten until a few years ago when Dr. Claes and his colleagues decided to find out whether it really existed. Their interest was ignited by a recurring problem that appeared in some of their patients who had received reconstructive surgery for ACL injuries. The problem was that although the repaired knees would initially appear to be healed and healthy, the joint would trouble people as they moved.
“We thought, something is still not right” in that knee, stated Dr. Claes, who was thinking that perhaps additional, untended knee injuries could be causing it and if so, whether they were occurring in uncharted knee parts. “I know it probably sounds crazy to say that we thought there might be this new ligament,” he said.
Eventually Dr. Claes became convinced that this tissue must exist. Due to its position at the front of the knee, it would be vulnerable to tearing when an ACL was injured. However unlike torn ACL’s, this new tissue’s injuries would not receive any treatment which would potentially lead to knee instability and buckling.
Once they started dissecting the donated knees they found a narrow band of tissue, which is clearly separate from the iliotibial band and neatly linking the femur and the tibia.
Researchers stated “We think that it’s quite likely many people who tear an ACL also tear an ALL,” and that lingering injury in this unnoticed ligament could leave joints unstable.
At the moment this possibility remains a open question although Dr. Claes and his colleagues have re-examined scans of some of the knees that they had operated on to repair ACL injuries and have discovered ALL tears in many of them.
At the moment many things about the ligament remain unknown. “We still have a lot of work to do,” said Dr. Claes. He and his colleagues have begun preparations for surgical procedures to treat the ALL tears and they will presenting their findings at Orthopedic surgery conventions as and when they discover them.
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