Anterolateral ligament abnormalities are associated with peripheral ligament and osseous injuries in acute ruptures of the anterior cruciate ligament
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Few studies have used MRI to identify the ALL. As it was shown that it is not possible to precisely characterize this ligament in all examination, it is important to identify concomitant lesions that can help in diagnosing ALL abnormalities. It is important to characterise this injury due to its association with anterolateral knee instability. Thus, the present study was performed to determine the frequency of ALL injuries in patients with acute ACL rupture and to analyse its associated knee lesions.
Patients with acute ACL injuries were evaluated by MRI. Among this population, the ALL was classified as non-visualised, injured or normal. The possible abnormalities of the meniscus, collateral ligaments, popliteus tendon, posterior cruciate ligament, Iliotibial band (ITB), anterolateral capsule and osseus injuries were evaluated. The association of an ALL injury with these other knee structures as well as sex and age was calculated.
Among the 228 knees evaluated, the ALL could not be entirely identified in 61 (26.7%). Of the remaining 167, 66 (39.5%) presented an ALL abnormality and only four (6.1%) were Segond fractures. ALL abnormalities were associated with lesions of the lateral collateral ligament, medial collateral ligament, popliteus tendon, ITB, anterolateral capsule and osseous contusions of the femoral condyle and tibial plateau. No correlation was found with medial meniscus, lateral meniscus and posterior cruciate ligament injuries. There was no association between ALL injuries and gender, and older patients were more likely to present an ALL injury.
ALL injuries are present in approximately 40% of ACL injuries, and a minority of these are Segond fractures. These injuries are associated with peripheral ligament injuries, anterolateral structures lesions and bone contusions, but there is no association with meniscal injuries. Surgeons must be aware of these associations to consider an ALL lesion even if it is not completely clear in imaging evaluation, especially if a high degree of anterolateral instability is present on physical examination.
Level of evidence
KeywordsAnterolateral ligament MRI Anterior cruciate ligament Diagnosis Collateral ligaments Meniscus Osseous contusions Anterolateral capsule Iliotibial band
Anterior cruciate ligament
Medial collateral ligament
Lateral collateral ligament
Posterior cruciate ligament
Magnetic resonance imaging
CPH designed the study, analysed the data and wrote the manuscript. PVPH designed the study, analysed the data and wrote the manuscript. RVL analysed the data and wrote the manuscript. MKD supervised the study. MBR analysed the data and supervised the study.
Compliance with ethical standards
Conflict of interest
The authors report no conflict of interest in relation to this study.
The study had no funding.
The study was approved by the ethics committee of the institution (CEPesq) and the protocol number for this approval was 442.
Informed consent was obtained from all individual participants included in the study.
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