Credit: LiveScience.com
You would think we’d have mapped the entire human body by now. Given the number of medical students going through cadaver anatomy classes around the world we should have everything pretty set. So it was with a bit of surprise that physicians in Belgium uncovered a new knee ligament.
The Anterolateral ligament or ALL has a point of origin on the lateral side of the femur and a point of insertion on the tibia. It sits near enough to the ACL that when an ACL tear occurs an ALL injury can happen as well.
This was what led the knee surgeons in Belgium to suspect another ligament existed. They noted that no matter how healthy a repaired ACL looked, some patients would still have problems such as buckling post-surgery.
They began to dissect 41 cadavers and discovered the ALL in 40 of them. But they were far from the first, back in 1879 a French surgeon, Paul Segond discovered the “pearly, resistant fibrous band” and thought it might assist joint stabilization. For some reason, no one ever followed up on his hunch and the ALL remained hidden to anatomists.
Physicians are still learning
One of our Sermo physicians noted that anatomical discoveries do crop up from time to time. “This does happen. It wasn’t until the 1970s that a medical student named Nikolai Bogduk informed the neurosurgeons at Johns Hopkins that the nerves they were cutting for back pain didn’t exist. He took his argument to the chief of the department, Donlin Long. They did dissections and Bogduk was proven correct. That’s how RF neurotomy of the medial branches was born.
Impact for patients
What’s interesting is that physicians now have another culprit to look for when injury occurs. The Belgian surgeons are already working on surgical approaches to repair this ligament when damage happens. They have also gone back to prior surgeries to look for ALL damage along with ACL injuries, and have found a strong correlation when recovery was less than expected.
The impact for patients could be huge. A pro-athlete may be able to return to high-level play, and regular Joe and Jane patients could return to their usual daily activities with less long-term complications. What do you think? Are you surprised it took this long to discover this ligament? As a physician will you integrate this knowledge into your practice? If you’re an M.D. or a D.O. we’ll be discussing this more inside Sermo, please join us.
Source for John Hopkins/back surgery. N Bogduk; Donlin M Long. The anatomy of the so-called “articular nerves” and their relationship to facet denervation in the treatment of low-back pain. Journal of Neurosurgery 1979;51(2):172-7.
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