Anatomic Study and Reanalysis of the Nomenclature of the Anterolateral Complex of the Knee Focusing on the Distal Iliotibial Band: Identification and Description of the Condylar Strap

Abstract

Background: The capsulo-osseous layer (COL), short lateral ligament, mid–third lateral capsular ligament, lateral capsular ligament, and anterolateral ligament (ALL) are terms that have been used interchangeably to describe what is probably the same structure. This has resulted in confusion regarding the anatomy and function of the anterolateral complex of the knee and its relation to the distal iliotibial band (ITB). Purpose: To characterize the macroscopic anatomy of the anterolateral complex of the knee, in particular the femoral condylar attachment of the distal ITB. We identified a specific and consistent anatomic structure that has not been accurately described previously; it connects the deep surface of the ITB to the condylar area and is distinct from the ALL, COL, and Kaplan fibers. Study Design: Descriptive laboratory study. Methods: Sixteen fresh-frozen human cadaveric knees were used to study the anterolateral complex of the knee. Standardized dissections were performed that included qualitative and quantitative assessments of the anatomy through both anterior (n = 5) and posterior (n = 11) approaches. Results: The femoral condylar attachment of the distal ITB was not reliably identified by anterior dissection but was in all posterior dissections. A distinct anatomic structure, hereafter termed the “condylar strap” (CS), was identified between the femur and the lateral gastrocnemius on one side and the deep surface of the ITB on the other, in all posteriorly dissected specimens. The structure had a mean thickness of 0.88 mm, and its femoral insertion was located between the distal Kaplan fibers and the epicondyle. The proximal femoral attachment of the structure had a mean width of 15.82 mm, and the width of the distal insertion of the structure on the ITB was 13.27 mm. The mean length of the structure was 26.33 mm on its distal border and 21.88 mm on its proximal border. The qualitative evaluation of behavior in internal rotation revealed that this anatomic structure became tensioned and created a tenodesis effect on the ITB. Conclusion: There is a consistent structure that attaches to the deep ITB and the femoral epicondylar area. The orientation of fibers suggests that it may have a role in anterolateral knee stability. Clinical Relevance: This new anatomic description may help surgeons to optimize technical aspects of lateral extra-articular procedures in cases of anterolateral knee laxity.