What Is the Anatomic Footprint of the Anterolateral Ligament of the Knee? A Race- and Sex-based MRI Analysis

For patients with ALL injuries of the knee or revision surgeries where the native footprint cannot be identified, 3D MRI reconstruction technology enables precise 3D reconstruction of the ALL footprint using anatomic landmarks from the healthy side. This provides surgeons with effective preoperative planning guidance, intraoperative navigation support, and postoperative clinical function assessment. The established relationship between ligament sagittal angles and footprint positioning assists in real-time intraoperative evaluation of tunnel placement and postoperative accuracy verification. Additionally, our data revealed that the distance between the ALL footprint and LCL footprint was shorter in the White group compared with the Chinese group. Based on this anatomic variation, it is recommended to set the upper limit of ALL femoral tunnel diameter at 8 mm for the Chinese group and 7 mm for the White group. Further biomechanical studies are required to precisely define the safety threshold for graft diameter, ensuring graft stability while minimizing the risk of iatrogenic LCL injury.