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The anterolateral complex in anterior cruciate ligament deficient knees demonstrate sonographic abnormalities on high-resolution sonography

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The presence of anterolateral ligament of the knee is still controversial, and some physicians prefer to call this structure anterolateral complex (ALC) to infer plural nature of structures involved. The purpose of this study was to describe the scanning techniques and to classify various sonographic appearances of the tibial-side ALC of the knee in subjects with anterior cruciate ligament (ACL) injury. It was hypothesized that sonographic abnormity of the ALC would be associated with ACL injury history.

Methods

Patients with a history of unilateral ACL injury were prospectively recruited, and the ALC was sonographically evaluated. During the evaluation, the lateral femoral epicondyle was visualized in anatomic transverse view first. At this location, the ALC was typically most conspicuous between the short head of the biceps femoris muscle and the posterior and deep aspect of the iliotibial band superficial to the origin of the lateral collateral ligament. The ALC was followed distally to the broad insertion centralizing to the area posterior to Gerdy’s tubercle. The appearance of the distal insertion of the ALC was classified based both on echogenicity and on the presence of a Segond fracture as follows: Grade 0: isoechoic to the rest of the ALC, Grade 1: hypoechoic, Grade 2: anechoic, and Grade 3: Segond fracture. The uninjured side was similarly scanned for comparison.

Results

A total of 28 patients (13 men; mean age 22.1 ± 8.1 years old with range: 12–44; mean body mass index 25.0 with range: 18.9–39.2) were included in this study. The average time from injury to sonograhpic evaluation was 4 months (range: 2 days to 1 year). Of 28 ACL-deficient knees, 19 were (68%) graded as Grade 0 in the distal insertion of the ALC, 7 (25%) as Grade 1, 1 (3.5%) as Grade 2, and 1 (3.5%) as Grade 3. Contralateral knees showed 25 knees (89%) with Grade 0 and 3 knees (11%) with Grade 1.

Conclusion

ACL injury history was associated with a higher incidence of sonographic abnormalities within the distal insertion of the anterolateral complex.

Level of evidence

III.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, USA

    Masahito Yoshida, Elmar Herbst, Macio Albers, Volker Musahl, Freddie H. Fu & Kentaro Onishi

  2. Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Science, Nagoya, Japan

    Masahito Yoshida

  3. Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany

    Elmar Herbst

  4. Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Fifth Avenue LSK BuildingSuite 201, Pittsburgh, PA, 15213, USA

    Kentaro Onishi

Authors
  1. Masahito Yoshida
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  2. Elmar Herbst
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  4. Volker Musahl
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Correspondence to Kentaro Onishi.

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Yoshida, M., Herbst, E., Albers, M. et al. The anterolateral complex in anterior cruciate ligament deficient knees demonstrate sonographic abnormalities on high-resolution sonography. Knee Surg Sports Traumatol Arthrosc 25, 1024–1029 (2017). https://doi.org/10.1007/s00167-017-4512-z

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  • DOI: https://doi.org/10.1007/s00167-017-4512-z

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