THAT'S ALL A right knee dissection shows the anterolateral ligament, or ALL.
University Hospitals Leuven

A debate is simmering among orthopedic surgeons over whether a newly developed ligament repair helps to stabilize injured knees, whether it has no effect at all, and also whether the ligament at issue actually exists.

Orthopedic surgeons Steven Claes, MD, and Johan Bellemans, MD, PhD, of University Hospitals Leuven in Belgium published a description of the anterolateral ligament (ALL), a previously undefined structure located along the outside of the knee that connects the femur to the anterolateral tibia, in the October 2013 issue of the Journal of Anatomy.

Their article suggested that injuries to the ligament, if sustained at the same time as injuries to the anterior cruciate ligament (ACL), may go overlooked and may compromise the long-term stability of otherwise successful ACL repairs. The doctors worked with medical manufacturer Arthrex to develop and market a repair procedure for the ALL, which has gained popularity among sports medicine practitioners.

But there's still dispute among orthopods about many aspects of ALL repair, as reported in the New York Times on July 25. Given the lack of long-term studies on patients who've undergone the procedure, some physicians are skeptical about the surgery's effectiveness, not to mention the ligament's role in knee function.

Others argue that the ALL is not actually a separate feature of knee anatomy. (Professional jealousy may play a part here.) And the Times points out that Arthrex did not conduct clinical trials on the risks and benefits of using its technology to repair the ALL, but that the procedure is an off-label use of its FDA-approved devices.

"The procedure's adoption offers a window into how an untested treatment can quickly make its way from the pages of an obscure publication to the operating room," notes the Times.

David Bernard