Researcher discovers a new knee ligament: Anterolateral Ligament (ALL), impact to ACL

S

Say Chi Sin Lo

G.O.A.T.
Scientists have discovered a previously unknown ligament, called anterolateral ligament (ALL) within the knee and they postulate it could affect ACL repairs. The ALL is present in 97% of all human knees, and it could contribute to the instability of reconstructured knee experienced by many patients. Supposedly, because this ligament has not been identified, injuries to this ALL are left un-attended and compromises the stability of the knee post-ACL reconstruction.

Here's a link in simple English:
http://www.sciencedaily.com/releases/2013/11/131105081352.htm

Here's the publication, awesome read:
http://www.ncbi.nlm.nih.gov/pubmed/23906341
 
Cindysphinx

Cindysphinx

G.O.A.T.
Um . . . How could there possibly be anything inside normal human bodies that is visible to the naked eye that no one happened to notice until now?
 
ollinger

ollinger

G.O.A.T.
^^ both articles cited by the OP indicate that the structure was refered to by a French surgeon in 1879, and then apparently ignored as rudimentary. What's new is not its existence but rather an awareness of what it does. Things like that happen in medical science from time to time.
 
S

Say Chi Sin Lo

G.O.A.T.
ollinger said:
^^ both articles cited by the OP indicate that the structure was refered to by a French surgeon in 1879, and then apparently ignored as rudimentary. What's new is not its existence but rather an awareness of what it does. Things like that happen in medical science from time to time.
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My take away was that the French surgeon speculated that, there had to be another ligament to fulfill x/y/z function of the knee. (not sure if the surgeon knew it was there at all)

Recently, scientists have gathered enough evidence to call that piece of tissue as its own ligament.

I did research for a few years fresh out of college, and yeah, this stuff happens from time to time, if not all the time.
 
S

Say Chi Sin Lo

G.O.A.T.
Cindysphinx said:
Because I have never once looked inside a human body. Those things are disgusting.
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So basically, you haven't even made an attempt and certainly can't do better than those scientists right? If you can't do better, then don't criticize.

I hate it when I would go to a conference on genomic instability and maintenance, then the invited anesthesiologist starts talking just to talk.
 
Vlad_C

Vlad_C

Semi-Pro
Say Chi Sin Lo said:
So basically, you haven't even made an attempt and certainly can't do better than those scientists right? If you can't do better, then don't criticize.

I hate it when I would go to a conference on genomic instability and maintenance, then the invited anesthesiologist starts talking just to talk.
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Are you saying we should give it a try??? :shock:
The last thing we need is for TW posters to start carving up corpses...
The General Pro Player Discussion section of the forums is already a horror show in itself, populated mostly by brainless zombies.

And come on man, lighten up. Unless you have some history with Cindysphinx that the rest of us don't know about, I'd say you're overreacting a bit.
I mean, that was my first reaction as well when I first read about it: the human body has been around for a long time, you'd think that by now they would have catalogued all the bits and pieces inside it.
It is certainly surprising that something like this has been overlooked for so long.
 
Cindysphinx

Cindysphinx

G.O.A.T.
Vlad_C said:
Are you saying we should give it a try??? :shock:
The last thing we need is for TW posters to start carving up corpses...
The General Pro Player Discussion section of the forums is already a horror show in itself, populated mostly by brainless zombies.
Click to expand...

Hey, don't knock it.

Clearly, the so-called experts have no idea how to do a proper autopsy.

If you want something done right, do it yourself! :)
 
S

Say Chi Sin Lo

G.O.A.T.
Vlad_C said:
Are you saying we should give it a try??? :shock:
The last thing we need is for TW posters to start carving up corpses...
The General Pro Player Discussion section of the forums is already a horror show in itself, populated mostly by brainless zombies.

And come on man, lighten up. Unless you have some history with Cindysphinx that the rest of us don't know about, I'd say you're overreacting a bit.
I mean, that was my first reaction as well when I first read about it: the human body has been around for a long time, you'd think that by now they would have catalogued all the bits and pieces inside it.
It is certainly surprising that something like this has been overlooked for so long.
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No, I don't have a former history with Cindysphinx. As a former researcher, I used to and still hate people who criticize others when they can't do better. You can't publish anything without definitive proof. You can't just say "oh look, there's a new tissue here that no one noticed it before..." You have to be able to provide definitive proof such as function and how this new piece of tissue differentiates from another.

That's my approach in life, if you can't do better, keep your mouth shut. Otherwise, use constructive criticism, heard of that before?
 
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S

sureshs

Bionic Poster
The first question that occurred to me (without reading the articles) was how come something was still undiscovered in the human body. Then I read ollinger's explanation and understood what had happened. I see Cindy's reaction as pretty normal and nothing to get riled up about.
 
M

maleyoyo

Professional
Cindysphinx said:
Um . . . How could there possibly be anything inside normal human bodies that is visible to the naked eye that no one happened to notice until now?
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Unlike yourself I have made an attempt to look for that darn ligament, so I guess I’m qualified to pose the question:

“Um . . . How could there possibly be anything inside normal human bodies that is visible to the naked eye that no one happened to notice until now?”
 
Cindysphinx

Cindysphinx

G.O.A.T.
Say Chi Sin Lo said:
No, I don't have a former history with Cindysphinx. As a former researcher, I used to and still hate people who criticize others when they can't do better.

. . . .

That's my approach in life, if you can't do better, keep your mouth shut. Otherwise, use constructive criticism, heard of that before?
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Let me suggest that the standard you are applying is somewhat flawed.

Are you saying that if you saw a doctor who committed malpractice by amputating the wrong leg you wouldn't criticize and would "keep your mouth shut" because you couldn't have done a better amputation yourself?

It sounds like you are an educated professional. It is not an acceptable posture for a professional to defend his or her work with, "Well, if you can't do it better yourself, keep your mouth shut."
 
S

Say Chi Sin Lo

G.O.A.T.
Cindysphinx said:
Let me suggest that the standard you are applying is somewhat flawed.

Are you saying that if you saw a doctor who committed malpractice by amputating the wrong leg you wouldn't criticize and would "keep your mouth shut" because you couldn't have done a better amputation yourself?

It sounds like you are an educated professional. It is not an acceptable posture for a professional to defend his or her work with, "Well, if you can't do it better yourself, keep your mouth shut."
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Alright, wrong doing is one thing, but has the researchers done wrong by NOT discovering it earlier? How's that for a flawed standard? And therefore, they should get heat for not discovering and publishing it earlier?

It's not acceptable for a professional to defend his or her work with such thinking, but it's also common courtesy to keep your mouth shut if you don't know the subject well enough to have meaningful conversation about the subject. My background is in cell and molecular biology, I don't know anything about human anatomy, let alone the anatomy of the knee. So I'd keep my mouth shut versus running my mouth and say something along the lines of: "ppsssssh, a ligament that's been in "plain sight" and NOW you distinguishes it?!"
 
S

Say Chi Sin Lo

G.O.A.T.
And if you still think they should have discovered/published this sooner. Provide the methods necessary in which would have aided the process.
 
R

RogueFLIP

Professional
When performing cadaver dissection and autopsies, there's usually a certain protocol to follow. Certain cuts in specific directions in different planes.

Back in the '90s some people deviated from normal protocol and wound up discovering a new muscle:

https://en.wikipedia.org/wiki/Sphenomandibularis


The knee doesn't even come close to looking like the picture in the first link. There's so much soft tissue/fascia surrounding the area, that standard dissection could have easily overlooked the ligament, and you'd just think it was part of some other structure like the lateral collateral ligament or the IT band.

These docs were looking into the knee anatomy specifically for their purposes so of course they are going to scrutinize each structure and function very carefully.

So like Ollinger alluded to, the "ligament" was always there, but no one really cared to try to classify it as a separate and distinct ligament. Until now.

Thanks OP.
 
Cindysphinx

Cindysphinx

G.O.A.T.
So the question is "How could this structure have been overlooked for centuries?"

And the answer is "Because it was, that's why."

I mean, before we had standard dissection protocol, I imagine we had . . . Nothing that was standard. So even if today's protocol might skirt this structure, how come nobody for centuries saw this and said, "good heavens. What's this and what does it do?"

It boggles the mind.
 
Cindysphinx

Cindysphinx

G.O.A.T.
Say Chi Sin Lo said:
Alright, wrong doing is one thing, but has the researchers done wrong by NOT discovering it earlier? How's that for a flawed standard? And therefore, they should get heat for not discovering and publishing it earlier?

It's not acceptable for a professional to defend his or her work with such thinking, but it's also common courtesy to keep your mouth shut if you don't know the subject well enough to have meaningful conversation about the subject. My background is in cell and molecular biology, I don't know anything about human anatomy, let alone the anatomy of the knee. So I'd keep my mouth shut versus running my mouth and say something along the lines of: "ppsssssh, a ligament that's been in "plain sight" and NOW you distinguishes it?!"
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You're a scientist, and you don't have any more intellectual curiosity than that? You aren't the least perplexed about why generations of your fellow scientists missed identifying the existence of this structure and its purpose? I thought important characteristics of a scientist were to challenge the status quo, ask questions, test assumptions.

Rogue's reference to that jaw muscle that was found recently helps explain it, but there seems to be some debate about whether that was truly a new discovery. I guess if the standard dissection protocol can overlook something for centuries, maybe the protocol is the problem or could be improved.
 
S

Say Chi Sin Lo

G.O.A.T.
It's not about curiosity, but rather the way one asks questions. I'd question their science, not "what took you so long?"

Your question had nothing to do with the science itself. If anything, your question had more to do with their work ethics. Since it apparently "took so long and in plain sight."
 
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Cindysphinx

Cindysphinx

G.O.A.T.
Here's a pic of the new ligament:

anterolateral-ligament-MAIN-2689378.jpg


It seems a valid question to ask, "What took you so long?" I mean, it is not small, it is not hidden, it is not subsumed to anything else that has been identified.

Regarding this idea that a person asking, "What the hell went wrong?" must themselves be an expert . . . come one.

When a plane crashes, I think everyone who is not an aeronautical engineer is quite entitled to ask, "What the hell went wrong?" They need not explain or even understand the science, and they need no experience in the field.

Answering the question "What the hell happened?" *is* the job of the experts in that field.

I mean, maybe the problem is that anatomy is a dull field, and no one cares to hunt around in cadavers to see if anything was missed. As I understand it, the scientists who discovered this new ligament examined the knees of 42 cadavers.

Maybe that's just not the kind of work that wins the Nobel Prize.

It does make me wonder about surgeons, though. How is it that surgeons have been performing reconstructions, repairs, amputations, open surgeries, arthroscopies and imaging and still no one figured this out?
 
Raul_SJ

Raul_SJ

G.O.A.T.
Article says all but one of the 41 cadavers examined had the Anterolateral Ligament... Why didn't that one have it?
 
S

sureshs

Bionic Poster
Raul_SJ said:
Article says all but one of the 41 cadavers examined had the Anterolateral Ligament... Why didn't that one have it?
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Genetics? Some thing during early development of issues in the womb? Why are some unfortunate people born without some body parts?
 
Raul_SJ

Raul_SJ

G.O.A.T.
Cindysphinx said:
Here's a pic of the new ligament:


It seems a valid question to ask, "What took you so long?" I mean, it is not small, it is not hidden, it is not subsumed to anything else that has been identified.
Click to expand...

I suspect that researchers already knew of the existence of this ligament since it was already mentioned in an 1879 article.

Prior to this study, if one had shown that pic of that cadaver (with the ligament clearly visible to the naked eye) to scientists, would they have been surprised?

I am thinking that it is a case where the physical existence of the ligament was already acknowledged but they were simply searching for an anatomical description and purpose of the structure.

If not, I would agree that it was a major oversight.
 
R

RogueFLIP

Professional
Cindysphinx said:
Here's a pic of the new ligament:

anterolateral-ligament-MAIN-2689378.jpg


It seems a valid question to ask, "What took you so long?" I mean, it is not small, it is not hidden, it is not subsumed to anything else that has been identified.
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Quite the contrary, as you can see how the origin of the ALL coincides with the LCL. The article states as I have said before that it shares some fibers with other structures....it's highly probable that as Raul SJ stated that it was probably considered part of something else (my guess the LCL) until someone actually proved otherwise.

There's probably still plenty of structures in the body and brain that well, scientists have identified, but aren't 100% of its exact function.

Cindysphinx said:
It does make me wonder about surgeons, though. How is it that surgeons have been performing reconstructions, repairs, amputations, open surgeries, arthroscopies and imaging and still no one figured this out?
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Bc as you said, they're performing repairs and surgeries....there's not necessarily questioning each tissue they find and what it does. Otherwise they'd be researchers and probably not making as much $$ :twisted:
 
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