Skip to main content

Advertisement

SpringerLink
Log in

The magnetic resonance imaging appearance of the anterolateral ligament of the knee in association with anterior cruciate rupture

  • Published:
Skeletal Radiology Aims and scope Submit manuscript

Abstract

Objective

The magnetic resonance imaging (MRI) appearance of the anterolateral ligament (ALL) has been described. However, the appearance of this structure and injury, in the presence of anterior cruciate ligament (ACL) injury, is less well defined. We studied the incidence of injury to the ALL and the pattern of this injury on MRI.

Materials and methods

Following Institutional Review Board approval, a retrospective study of 375 consecutive MRI studies was performed. Cases were identified from a prospective database of ACL reconstruction patients. Following exclusions, 280 MRIs (277 patients; 197 males: 80 females; mean age 30.2 years, range, 16–54) were evaluated. Injury was defined as full thickness, partial thickness, or an avulsion fracture. Each study was independently assessed by two consultant musculoskeletal radiologists.

Results

Injury to the ALL was identified (by at least one observer) in only 10.7% of cases (2.50% full thickness, 7.50% partial thickness, and 0.71% avulsion fracture). There was an almost perfect level of interobserver agreement for both the identification of an injury (κ = 0.854) and grading of injury (κ = 0.858). The MRI incidence of ALL injury was significantly greater within 6 weeks of the knee injury (18.5 vs. 8.37%; p < 0.05).

Conclusions

ALL injury was identified in only one-tenth of cases of ACL rupture. MRI changes can be reliably identified with strong agreement between observers. ALL injury is found more frequently on MRI within 6 weeks of the knee injury (compared to scans performed after this time period) suggesting that some injuries may resolve or become less visible.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Vincent JP, Magnussen RA, Gezmez F, et al. The anterolateral ligament of the human knee: an anatomic and histologic study. Knee Surg Sports Traumatol Arthrosc. 2012;20:147–52.

    Article  PubMed  Google Scholar 

  2. Claes S, Vereecke E, Maes M, et al. Anatomy of the anterolateral ligament of the knee. J Anat. 2013;223:321–8.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Helito CP, Demange MK, Bonadio MB, et al. Anatomy and histology of the knee anterolateral ligament. Orthop J Sports Med. 2013;1:1–5.

    Google Scholar 

  4. Caterine S, Litchfield R, Johnson M, et al. A cadaveric study of the anterolateral ligament: re-introducing the lateral capsular ligament. Knee Surg Sports Traumatol Arthrosc. 2015;23:3186–95.

    Article  PubMed  Google Scholar 

  5. Stijak L, Bumbasirevic M, Radonjic V, et al. Anatomical description of the anterolateral ligament of the knee. Knee Surg Sports Traumatol Arthrosc. 2016;24:2083–8.

    Article  PubMed  Google Scholar 

  6. Monaco E, Ferretti A, Labianca L, et al. Navigated knee kinematics after cutting of the ACL and its secondary restraint. Knee Surg Sports Traumatol Arthrosc. 2012;20:870–7.

    Article  CAS  PubMed  Google Scholar 

  7. Guenther D, Rahnemai-Azar AA, Bell KM, et al. The anterolateral capsule of the knee behaves as a sheet of fibrous tissue. Am J Sports Med. 2016.

  8. Kernkamp WA, Li G, Van de Velde SK. The anterolateral ligament: a closed chapter? Ann Transl Med. 2016;4(Suppl 1):S37.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Tanaka M, Vyas D, Moloney G, et al. What does it take to have high-grade pivot shift? Knee Surg Sports Traumatol Arthrosc. 2012;20:737–42.

    Article  CAS  PubMed  Google Scholar 

  10. Monaco E, Maestri B, Conteduca F, Mazza D, Iorio C, Ferretti A. Extra-articular ACL reconstruction and pivot shift—in vivo dynamic evaluation with navigation. Am J Sports Med. 2014;42:1669–74.

    Article  PubMed  Google Scholar 

  11. Wroble RR, Grood ES, Cummings JS, Henderson JM, Noyes FR. The role of the lateral extraarticular restraints in the anterior cruciate ligament-deficient knee. Am J Sports Med. 1993;21:257–62.

    Article  CAS  PubMed  Google Scholar 

  12. Musahl V, Rahnemai-Azar AA, Costello J, et al. The influence of meniscal and anterolateral capsular injury on knee laxity in patients with anterior cruciate ligament injuries. Am J Sports Med. 2016;44:3126–31.

    Article  PubMed  Google Scholar 

  13. Van Dyck P, De Smet E, Lambrecht V, et al. The anterolateral ligament of the knee: what the radiologist needs to know. Semin Musculoskelet Radiol. 2016;20:26–32.

    Article  PubMed  Google Scholar 

  14. Helito CP, Helito PV, Costa HP, et al. MRI evaluation of the anterolateral ligament of the knee: assessment in routine 1.5-T scans. Skelet Radiol. 2014;43:1421–7.

    Article  Google Scholar 

  15. Kosy JD, Mandalia VI, Anaspure R. Characterisation of the anterolateral ligament of the knee using magnetic resonance imaging. Skelet Radiol. 2015;44:1647–53.

    Article  Google Scholar 

  16. Claes S, Bartholomeeusen S, Bellemans J. High prevalence of anterolateral ligament abnormalities in magnetic resonance images of anterior cruciate ligament-injured knees. Acta Orthop Belg. 2014;80:45–9.

    PubMed  Google Scholar 

  17. Wodicka R, Jose J, Baraga MG, et al. MRI evaluation of the anterolateral ligament of the knee in the setting of ACL rupture. Orthop J Sports Med. 2014;2(Suppl 2):1.

    Google Scholar 

  18. Helito CP, Helito PV, Costa HP, et al. Assessment of the anterolateral ligament of the knee by magnetic resonance imaging in acute injuries of the anterior cruciate ligament. Arthroscopy. 2016;33:140–6.

    Article  PubMed  Google Scholar 

  19. Hartigan DE, Carroll KW, Kosarek FJ, et al. Visibility of anterolateral ligament tears in anterior cruciate ligament-deficient knees with standard 1.5 Tesla magnetic resonance imaging. Arthroscopy. 2016;32:2061–5.

    Article  PubMed  Google Scholar 

  20. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159–74.

    Article  CAS  PubMed  Google Scholar 

  21. Van Dyck P, Clockaerts S, Vanhoenacker FM, et al. Anterolateral ligament abnormalities in patients with acute anterior cruciate ligament rupture are associated with lateral meniscal and osseous injuries. Eur Radiol. 2016;26:3383–91.

    Article  PubMed  Google Scholar 

  22. Taneja AK, Miranda FC, Braga CA, et al. MRI features of the anterolateral ligament of the knee. Skelet Radiol. 2015;44:403–10.

    Article  Google Scholar 

  23. Porrino Jr J, Maloney E, Richardson M, et al. The anterolateral ligament of the knee: MRI appearance, association with the Segond fracture, and historical perspective. AJR Am J Roentgenol. 2015;204:367–73.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospital, Barrack Road, Exeter, EX2 5DW, UK

    Jonathan D. Kosy, Peter J. Schranz, Anish Patel, Rahul Anaspure & Vipul I. Mandalia

Authors
  1. Jonathan D. Kosy
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Peter J. Schranz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Anish Patel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rahul Anaspure
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Vipul I. Mandalia
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jonathan D. Kosy.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

This article does not contain patient data.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kosy, J.D., Schranz, P.J., Patel, A. et al. The magnetic resonance imaging appearance of the anterolateral ligament of the knee in association with anterior cruciate rupture. Skeletal Radiol 46, 1193–1200 (2017). https://doi.org/10.1007/s00256-017-2657-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00256-017-2657-y

Keywords

Search

Navigation