Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 25, Issue 4, pp 1140–1148 | Cite as

Anterolateral ligament abnormalities are associated with peripheral ligament and osseous injuries in acute ruptures of the anterior cruciate ligament

  • Camilo Partezani HelitoEmail author
  • Paulo Victor Partezani Helito
  • Renata Vidal Leão
  • Marco Kawamura Demange
  • Marcelo Bordalo-Rodrigues



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



Anterolateral ligament MRI Anterior cruciate ligament Diagnosis Collateral ligaments Meniscus Osseous contusions Anterolateral capsule Iliotibial band 



Anterior cruciate ligament


Anterolateral ligament


Medial collateral ligament


Lateral collateral ligament


Posterior cruciate ligament


Popliteus tendo


Magnetic resonance imaging


Iliotibial band


Author contributions

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.

Ethical approval

The study was approved by the ethics committee of the institution (CEPesq) and the protocol number for this approval was 442.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2017

Authors and Affiliations

  • Camilo Partezani Helito
    • 1
    • 2
    Email author
  • Paulo Victor Partezani Helito
    • 1
    • 3
  • Renata Vidal Leão
    • 1
  • Marco Kawamura Demange
    • 2
  • Marcelo Bordalo-Rodrigues
    • 1
    • 3
  1. 1.Hospital Sírio-LibanêsSão PauloBrazil
  2. 2.Knee Surgery Division, Faculty of Medicine, Institute of Orthopedics and TraumatologyUniversity of São PauloSão PauloBrazil
  3. 3.Musculoskeletal Radiology Department, Faculty of Medicine, Institute of Orthopedics and TraumatologyUniversity of São PauloSão PauloBrazil

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