Anterolateral ligament injury has a synergic impact on the anterolateral rotatory laxity in acute anterior cruciate ligament-injured knees

  • Yong-Beom Park
  • Han-Jun Lee
  • Du-Hyun Ro
  • Geun Young Lee
  • Sujin Kim
  • Seong Hwan KimEmail author



To investigate the prevalence of the anterolateral ligament (ALL) injuries and its role in rotatory laxity in acute anterior cruciate ligament (ACL)-injured knees.


Two-hundred and ninety-six consecutive patients with acute ACL injuries were evaluated retrospectively, excluding those with other ligament injury and undetectable path of ALL in MRI. Patients were divided into two groups based on the degree of ACL injury in arthroscopy (complete versus partial group). Logistic regression and discriminant analysis were performed to assess the risk of pivot shift test.


A total of 169 patients were included (128 with complete and 41 with partial ACL rupture). Overall, 106/169 (62.7%) of ALL injuries were characterized, 87/128 (67.9%) in complete group, and 19/41 (46.3%) in partial group. The incidence of pivot shift was 120/128 (93.8%) and 14/41 (34.1%) in the complete and partial groups, respectively. The odds ratio in the pivot shift of combined ALL injury was found as 3.8 (95% CI 1.8–8.4) with the overall ACL injury, but higher as 17.1 (95% CI 3.1–96.4) with partial group. Higher grade of pivot shift showed a greater incidence of injury of ALL. Degree of ACL injury and ALL injury allowed 87.0% of correct classification of subsequent anterolateral rotatory laxity.


Injury to the ALL could have a synergetic effect on anterolateral rotatory laxity in acute ACL-injured knee, however, its effect might be minor in case of complete tear. Careful assessment about combined ALL injury should be considered, especially in knees with high-grade pivot shift in acute ACL-injured knees.

Level of evidence

Retrospective prognostic study, Level IV.


Knee Anterior cruciate ligament Anterolateral ligament Pivot shift Acute anterior cruciate ligament injury 



There is no funding source.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the Institutional Review Boards of Chung-Ang University Hospital (No.:1706-001-16071) and was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki.


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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019

Authors and Affiliations

  1. 1.Department of Orthopedic SurgeryChung-Ang University Hospital, Chung-Ang University College of MedicineSeoulSouth Korea
  2. 2.Department of RadiologyChung-Ang University Hospital, Chung-Ang University College of MedicineSeoulSouth Korea
  3. 3.Department of Orthopedic SurgerySeoul National University Hospital, Seoul National University College of MedicineSeoulSouth Korea
  4. 4.Orthopedic DepartmentCentre Hospitalier de VersaillesLe ChesnayFrance

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