Skip to main content
SpringerLink
Log in

Prevalence of anterolateral ligament injuries and lateral meniscus tear on MR imaging in patients with both-bundle tear vs. selective bundle incomplete tear of the anterior cruciate ligament

  • Musculoskeletal
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

We investigated the prevalence of anterolateral ligament (ALL) injury and lateral meniscus (LM) tear in cases with both-bundle tear and selective bundle incomplete tear of the anterior cruciate ligament (ACL).

Methods

A total of 174 cases of magnetic resonance (MR) images that had an ACL tear and underwent arthroscopic ACL reconstruction were retrospectively reviewed. ACL injury was classified into both bundle, anteromedial bundle, and posterolateral bundle (PL) on arthroscopic finding. The ALL was divided into three portions: femoral, meniscal, and tibial. ALL injury was scored into three groups: grade 0 is intact; grade 1 is stranding and edema surrounds the expected location of the ALL; grade 2 is clear discontinuity of the ALL consistent with rupture. Traumatic LM tear was also assessed on MR images.

Results

The total prevalence of ALL injury was 36.2% (reader 1) and 42.0% (reader 2). ALL injury was statistically related to the selective bundle tear (p = 0.002 and 0.004, readers 1 and 2). PL bundle tear was significantly correlated with the ALL injury (p value < 0.001, readers 1 and 2, both). The location and grade of ALL injury were not significantly correlated with the type of ACL injury. LM tear was not significantly related to the types of ACL tear (p = 0.208 and 0.907, readers 1 and 2) and ALL injury (p value = 0.096 and 0.383, readers 1 and 2).

Conclusions

ALL injury was significantly related to the PL bundle tear of the ACL. LM tear was not significantly correlated with the types of ACL injury and ALL injury.

Key Points

• Anterolateral ligament (ALL) injury was significantly related to the posterolateral bundle (PL) tear of the anterior cruciate ligament (ACL).

• Lateral meniscus (LM) tear was not significantly correlated with the types of ACL injury and ALL injury.

• Clinicians and radiologists should be aware of these relationships and scrutinize ALL injury in cases with PL bundle tears, even with an incomplete ACL injury.

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
Fig. 5
Fig. 6

Similar content being viewed by others

Abbreviations

ACL:

Anterior cruciate ligament

ALL:

Anterolateral ligament

LM:

Lateral meniscus

MR:

Magnetic resonance

PL:

Posterolateral bundle

References

  1. Vieira EL, Vieira EA, da Silva RT, Berlfein PA, Abdalla RJ, Cohen M (2007) An anatomic study of the iliotibial tract. Arthroscopy 23:269–274

    Article  Google Scholar 

  2. Helito CP, Demange MK, Helito PV et al (2015) Evaluation of the anterolateral ligament of the knee by means of magnetic resonance examination. Rev Bras Ortop 50:214–219

    Article  Google Scholar 

  3. Helito CP, Miyahara HS, Bonadio MB et al (2013) Anatomical study on the anterolateral ligament of the knee. Rev Bras Ortop 48:368–373

    Article  Google Scholar 

  4. CP Helito MK Demange MB Bonadio et al (2013) Anatomy and histology of the knee anterolateral ligament. Orthop J Sports Med 1:2325967113513546

  5. Vincent JP, Magnussen RA, Gezmez F et al (2012) The anterolateral ligament of the human knee: an anatomic and histologic study. Knee Surg Sports Traumatol Arthrosc 20:147–152

    Article  Google Scholar 

  6. Van der Watt L, Khan M, Rothrauff BB et al (2015) The structure and function of the anterolateral ligament of the knee: a systematic review. Arthroscopy 31:569-582.e563

    Article  Google Scholar 

  7. Parsons EM, Gee AO, Spiekerman C, Cavanagh PR (2015) The biomechanical function of the anterolateral ligament of the knee. Am J Sports Med 43:669–674

    Article  Google Scholar 

  8. Terry GC, Norwood LA, Hughston JC, Caldwell KM (1993) How iliotibial tract injuries of the knee combine with acute anterior cruciate ligament tears to influence abnormal anterior tibial displacement. Am J Sports Med 21:55–60

    Article  CAS  Google Scholar 

  9. Lintin L, Chowdhury R, Yoong P et al (2020) The anterolateral ligament in acute knee trauma: patterns of injury on MR imaging. Skeletal Radiol 49:1765–1772

    Article  Google Scholar 

  10. Claes S, Bartholomeeusen S, Bellemans J (2014) High prevalence of anterolateral ligament abnormalities in magnetic resonance images of anterior cruciate ligament-injured knees. Acta Orthop Belg 80:45–49

    PubMed  Google Scholar 

  11. Kennedy MI, Claes S, Fuso FA et al (2015) The Anterolateral Ligament: An Anatomic, Radiographic, and Biomechanical Analysis. Am J Sports Med 43:1606–1615

    Article  Google Scholar 

  12. Claes S, Vereecke E, Maes M, Victor J, Verdonk P, Bellemans J (2013) Anatomy of the anterolateral ligament of the knee. J Anat 223:321–328

    Article  Google Scholar 

  13. Lording T, Corbo G, Bryant D, Burkhart TA, Getgood A (2017) Rotational laxity control by the anterolateral ligament and the lateral meniscus is dependent on knee flexion angle: a cadaveric biomechanical study. Clin Orthop Relat Res 475:2401–2408

    Article  Google Scholar 

  14. Van Dyck P, Clockaerts S, Vanhoenacker FM et al (2016) Anterolateral ligament abnormalities in patients with acute anterior cruciate ligament rupture are associated with lateral meniscal and osseous injuries. Eur Radiol 26:3383–3391

    Article  Google Scholar 

  15. Shybut TB, Vega CE, Haddad J et al (2015) Effect of lateral meniscal root tear on the stability of the anterior cruciate ligament-deficient knee. Am J Sports Med 43:905–911

    Article  Google Scholar 

  16. Hagino T, Ochiai S, Senga S et al (2015) Meniscal tears associated with anterior cruciate ligament injury. Arch Orthop Trauma Surg 135:1701–1706

    Article  Google Scholar 

  17. Kilcoyne KG, Dickens JF, Haniuk E, Cameron KL, Owens BD (2012) Epidemiology of meniscal injury associated with ACL tears in young athletes. Orthopedics 35:208–212

    Article  Google Scholar 

  18. Bellabarba C, Bush-Joseph CA, Bach BR Jr (1997) Patterns of meniscal injury in the anterior cruciate-deficient knee: a review of the literature. Am J Orthop (Belle Mead NJ) 26:18–23

    CAS  Google Scholar 

  19. Forkel P, Reuter S, Sprenker F et al (2015) Different patterns of lateral meniscus root tears in ACL injuries: application of a differentiated classification system. Knee Surg Sports Traumatol Arthrosc 23:112–118

    Article  Google Scholar 

  20. Hansford BG, Yablon CM (2017) Multiligamentous injury of the knee: MRI diagnosis and injury patterns. Semin Musculoskelet Radiol 21:63–74

    Article  Google Scholar 

  21. Lee JE, Park HJ, Lee SY, Ahn JH, Park JH, Park JY (2017) Evaluation of selective bundle injury to the anterior cruciate ligament: T2-weighted fast spin-echo 3-T MRI with reformatted 3D oblique isotropic (VISTA) versus 2D technique. AJR Am J Roentgenol 209:W308-w316

    Article  Google Scholar 

  22. Zantop T, Herbort M, Raschke MJ, Fu FH, Petersen W (2007) The role of the anteromedial and posterolateral bundles of the anterior cruciate ligament in anterior tibial translation and internal rotation. Am J Sports Med 35:223–227

    Article  Google Scholar 

  23. Gabriel MT, Wong EK, Woo SL, Yagi M, Debski RE (2004) Distribution of in situ forces in the anterior cruciate ligament in response to rotatory loads. J Orthop Res 22:85–89

    Article  Google Scholar 

  24. Park JH, Park HJ, Lee SY et al (2020) Intra-articular and meniscal pathology according to anterior cruciate ligament injury pattern: both-bundle tear or selective bundle tear. Acta Radiol 61:644–650

    Article  Google Scholar 

  25. Lee DW, Kim JG, Kim HT, Cho SI (2020) Evaluation of anterolateral ligament healing after anatomic anterior cruciate ligament reconstruction. Am J Sports Med 48:1078–1087

    Article  Google Scholar 

  26. De Smet AA, Nathan DH, Graf BK, Haaland BA, Fine JP (2008) Clinical and MRI findings associated with false-positive knee MR diagnoses of medial meniscal tears. AJR Am J Roentgenol 191:93–99

    Article  Google Scholar 

  27. Newman AP, Daniels AU, Burks RT (1993) Principles and decision making in meniscal surgery. Arthroscopy 9:33–51

    Article  CAS  Google Scholar 

  28. Viera AJ, Garrett JM (2005) Understanding interobserver agreement: the kappa statistic. Fam Med 37:360–363

    PubMed  Google Scholar 

  29. Porrino J Jr, Maloney E, Richardson M, Mulcahy H, Ha A, Chew FS (2015) The anterolateral ligament of the knee: MRI appearance, association with the Segond fracture, and historical perspective. AJR Am J Roentgenol 204:367–373

    Article  Google Scholar 

  30. Barrera CM, Arizpe A, Wodicka R et al (2018) Anterolateral ligament injuries on magnetic resonance imaging and pivot-shift testing for rotational laxity. J Clin Orthop Trauma 9:312–316

    Article  Google Scholar 

  31. Helito CP, Helito PVP, Leão RV, Demange MK, Bordalo-Rodrigues M (2017) Anterolateral ligament abnormalities are associated with peripheral ligament and osseous injuries in acute ruptures of the anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc 25:1140–1148

    Article  Google Scholar 

  32. Yoo YS, Song SY, Yang CJ, Ha JM, Kim YS, Seo YJ (2016) A comparison between clinical results of selective bundle and double bundle anterior cruciate ligament reconstruction. Yonsei Med J 57:1199–1208

    Article  Google Scholar 

  33. Zantop T, Brucker PU, Vidal A, Zelle BA, Fu FH (2007) Intraarticular rupture pattern of the ACL. Clin Orthop Relat Res 454:48–53

    Article  Google Scholar 

  34. Ahn JH, Koh IJ, McGarry MH et al (2020) Knee laxity in anterolateral complex injuries versus lateral meniscus posterior horn injuries in anterior cruciate ligament deficient knees: A cadaveric study. Knee 27:363–374

    Article  Google Scholar 

  35. Saithna A, Thaunat M, Delaloye JR, Ouanezar H, Fayard JM, Sonnery-Cottet B (2018) Combined ACL and anterolateral ligament reconstruction. JBJS Essent Surg Tech 8:e2

  36. Lau BC, Rames J, Belay E, Riboh JC, Amendola A, Lassiter T (2019) Anterolateral complex reconstruction augmentation of anterior cruciate ligament reconstruction: biomechanics, indications, techniques, and clinical outcomes. JBJS Rev 7:e5

  37. Feucht MJ, Bigdon S, Bode G et al (2015) Associated tears of the lateral meniscus in anterior cruciate ligament injuries: risk factors for different tear patterns. J Orthop Surg Res 10:34

    Article  Google Scholar 

  38. Tandogan RN, Taşer O, Kayaalp A et al (2004) Analysis of meniscal and chondral lesions accompanying anterior cruciate ligament tears: relationship with age, time from injury, and level of sport. Knee Surg Sports Traumatol Arthrosc 12:262–270

    Article  Google Scholar 

  39. Duran S, Gunaydin E, Aksahin E, Dasar U, Bicimoglu A, Sakman B (2019) Evaluation of the anterolateral ligament of the knee by magnetic resonance imaging in patients with chronic anterior cruciate ligament rupture. J Clin Orthop Trauma 10:706–709

    Article  Google Scholar 

Download references

Funding

The authors state that this work has not received any funding.

Author information

Authors and Affiliations

  1. Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, #108 Pyung-dong, Jongno-gu, Seoul, 03181, Republic of Korea

    Ji Na Kim, Hee Jin Park, Myung Sub Kim, So Yeon Won & Minchul Kim

  2. Department of Orthopaedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea

    Jai Hyung Park & Eugene Kim

  3. Department of Radiology, Inje University Ilsan Paik Hospital, Goyang, Gyeonggido, Republic of Korea

    Ji Yeon Park

Authors
  1. Ji Na Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hee Jin Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Myung Sub Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. So Yeon Won
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Minchul Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jai Hyung Park
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Eugene Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ji Yeon Park
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hee Jin Park.

Ethics declarations

Guarantor

The scientific guarantor of this publication is Hee Jin Park.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise. We consulted Myung Sub Kim who is an expert in statistics.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• diagnostic or prognostic study

• performed at one institution

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kim, J.N., Park, H.J., Kim, M.S. et al. Prevalence of anterolateral ligament injuries and lateral meniscus tear on MR imaging in patients with both-bundle tear vs. selective bundle incomplete tear of the anterior cruciate ligament. Eur Radiol 32, 3954–3962 (2022). https://doi.org/10.1007/s00330-021-08472-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-021-08472-x

Keywords

Search

Navigation