Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 25, Issue 4, pp 1345–1351 | Cite as

MRI is not reliable in diagnosing of concomitant anterolateral ligament and anterior cruciate ligament injuries of the knee

  • Brian M. Devitt
  • Richard O’Sullivan
  • Julian A. Feller
  • Nicholas Lash
  • Tabitha J. Porter
  • Kate E. Webster
  • Timothy S. Whitehead
Knee

Abstract

Purpose

There has been a renewed interest in the anterolateral structures of the knee, including description of the anterolateral ligament (ALL) as a distinct structure. Recognizing injury to the ALL is challenging, particularly given the subjective nature of physical examination. Consequently, focus has turned to magnetic resonance imaging (MRI) to reach a preoperative diagnosis of this region. The aim of this study was to examine the ability of 3-Tesla (3T) MRI to identify the ALL in ACL-injured patients compared to a matched control group of ACL-intact patients. The hypothesis was that the ALL would be more difficult to identify in ACL-injured patients compared to ACL-intact patients.

Methods

A prospective case control study was performed comparing 3T MRI scans of 63-patients with an ACL rupture with a control group of 64-patients without ACL injury. An experienced musculoskeletal radiologist and an orthopaedic surgeon evaluated the scans performed using standard knee protocols. The ALL was considered in three regions for analysis: femoral, meniscal, and tibial. The status of the ALL was determined as visualized or non-visualized, and the integrity was assessed as intact, attenuated, or focal discontinuity.

Results

The detection rate of at least a portion of the ALL was 41/64 (64%) in the control group and 45/63 (72%) in the ACL-injured cohort, respectively. The entire length of the ALL could only be identified in 15/64 (23%) of the control group and 13/63 (21%) of the ACL-injured cases. In both groups, the visibility of the ALL was poorest at the femoral region and greatest at the tibial regions. The ALL, when visualized, was deemed to be intact in 55/63 (87%) of cases. Although the inter-observer reliability was excellent for detection of the ALL in the control group (κ = 0.86), this decreased to only moderate reliability in the ACL-injured group (κ = 0.52).

Conclusion

This study demonstrates that MRI alone should not be relied upon to make a diagnosis of ALL injury in the setting of concomitant ACL injury due to the inability to accurately visualize this structure consistently in its entirety. To make a diagnosis of ALL injury or anterolateral instability of the knee and clinical correlation remains essential.

Level of evidence

Case–control study, Level III.

Keywords

Anterolateral ligament Knee Magnetic resonance imaging Anterior cruciate ligament Injury 

References

  1. 1.
    Atkinson PJ, Cooper TG, Anseth S, Walter NE, Kargus R, Haut RC (2008) Association of knee bone bruise frequency with time postinjury and type of soft tissue injury. Orthopedics 31(5):440CrossRefPubMedGoogle Scholar
  2. 2.
    Campos JC, Chung CB, Lektrakul N, Pedowitz R, Trudell D, Yu J, Resnick D (2001) Pathogenesis of the Segond fracture: anatomic and MR imaging evidence of an iliotibial tract or anterior oblique band avulsion. Radiology 219(2):381–386CrossRefPubMedGoogle Scholar
  3. 3.
    Caterine S, Litchfield R, Johnson M, Chronik B, Getgood A (2015) A cadaveric study of the anterolateral ligament: re-introducing the lateral capsular ligament. Knee Surg Sports Traumatol Arthrosc 23(11):3186–3195CrossRefPubMedGoogle Scholar
  4. 4.
    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(1):45–49PubMedGoogle Scholar
  5. 5.
    Claes S, Luyckx T, Vereecke E, Bellemans J (2014) The Segond fracture: a bony injury of the anterolateral ligament of the knee. Arthroscopy 30(11):1475–1482CrossRefPubMedGoogle Scholar
  6. 6.
    Claes S, Vereecke E, Maes M, Victor J, Verdonk P, Bellemans J (2013) Anatomy of the anterolateral ligament of the knee. J Anat 223(4):321–328CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Coquart B, Le Corroller T, Laurent PE, Ollivier M, Pradel V, Champsaur P, Guenoun D (2016) Anterolateral ligament of the knee: myth or reality? Surg Radiol Anat 38(8):955–962CrossRefPubMedGoogle Scholar
  8. 8.
    Dietz GW, Wilcox DM, Montgomery JB (1986) Segond tibial condyle fracture: lateral capsular ligament avulsion. Radiology 159(2):467–469CrossRefPubMedGoogle Scholar
  9. 9.
    Dodds AL, Halewood C, Gupte CM, Williams A, Amis AA (2014) The anterolateral ligament: anatomy, length changes and association with the Segond fracture. Bone Joint J 96-B(3):325–331CrossRefPubMedGoogle Scholar
  10. 10.
    Duchman KR, Westermann RW, Spindler KP, Reinke EK, Huston LJ, Amendola A, MOON Knee Group, Wolf BR (2015) The fate of meniscus tears left in situ at the time of anterior cruciate ligament reconstruction: a 6-year follow-up study from the MOON cohort. Am J Sports Med 43(11):2688–2695CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Galway HR, MacIntosh DL (1980) The lateral pivot shift: a symptom and sign of anterior cruciate ligament insufficiency. Clin Orthop Relat Res 147:45–50Google Scholar
  12. 12.
    Helito CP, Demange MK, Bonadio MB, Tirico LE, Gobbi RG, Pecora JR, Camanho GL (2013) Anatomy and histology of the knee anterolateral ligament. Orthop J Sports Med 1(7):2325967113513546CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Helito CP, Demange MK, Helito PV, Costa HP, Bonadio MB, Pecora JR, Rodrigues MB, Camanho GL (2015) Evaluation of the anterolateral ligament of the knee by means of magnetic resonance examination. Rev Bras Ortop 50(2):214–219CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Helito CP, Nakamichi YD, Gobbi RG, Bonadio MB, Natalino RJ, Pecora JR, Cardoso TP, Camanho GL, Demange MK (2016) Why Do authors differ with regard to the femoral and meniscal anatomic parameters of the knee anterolateral ligament? Dissection by layers and a description of its superficial and deep layers. Orthop J Sports Med 4(12):2325967116675604CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Helito CP, Helito PV, Costa HP, Bordalo-Rodrigues M, Pecora JR, Camanho GL, Demange MK (2014) MRI evaluation of the anterolateral ligament of the knee: assessment in routine 1.5-T scans. Skelet Radiol 43(10):1421–1427CrossRefGoogle Scholar
  16. 16.
    Hughston JC, Andrews JR, Cross MJ, Moschi A (1976) Classification of knee ligament instabilities. Part II. The lateral compartment. J Bone Joint Surg Am 58(2):173–179CrossRefPubMedGoogle Scholar
  17. 17.
    Karanicolas PJ, Bhandari M, Kreder H, Moroni A, Richardson M, Walter SD, Norman GR, Guyatt GH, Collaboration for Outcome Assessment in Surgical Trials (COAST) Musculoskeletal Group (2009) Evaluating agreement: conducting a reliability study. J Bone Joint Surg Am 91(Suppl. 3):99–106CrossRefPubMedGoogle Scholar
  18. 18.
    Kennedy MI, Claes S, Fuso FA, Williams BT, Goldsmith MT, Turnbull TL, Wijdicks CA, LaPrade RF (2015) The anterolateral ligament: an anatomic, radiographic, and biomechanical analysis. Am J Sports Med 43(7):1606–1615CrossRefPubMedGoogle Scholar
  19. 19.
    Kittl C, Halewood C, Stephen JM, Gupte CM, Weiler A, Williams A, Amis AA (2015) Length change patterns in the lateral extra-articular structures of the knee and related reconstructions. Am J Sports Med 43(2):354–362CrossRefPubMedGoogle Scholar
  20. 20.
    Kosy JD, Mandalia VI, Anaspure R (2015) Characterization of the anatomy of the anterolateral ligament of the knee using magnetic resonance imaging. Skelet Radiol 44(11):1647–1653CrossRefGoogle Scholar
  21. 21.
    Kosy JD, Soni A, Venkatesh R, Mandalia VI (2016) The anterolateral ligament of the knee: unwrapping the enigma. Anatomical study and comparison to previous reports. J Orthop Traumatol 17(4):303–308CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33(1):159–174CrossRefPubMedGoogle Scholar
  23. 23.
    Leitze Z, Losee RE, Jokl P, Johnson TR, Feagin JA (2005) Implications of the pivot shift in the ACL-deficient knee. Clin Orthop Relat Res 436:229–236CrossRefGoogle Scholar
  24. 24.
    Musahl V, Rahnemai-Azar AA, Costello J, Arner JW, Fu FH, Hoshino Y, Lopomo N, Samuelsson K, Irrgang JJ (2016) The influence of meniscal and anterolateral capsular injury on knee laxity in patients with anterior cruciate ligament injuries. Am J Sports Med 44(12):3126–3131CrossRefPubMedGoogle Scholar
  25. 25.
    Okazaki K, Miura H, Matsuda S, Yasunaga T, Nakashima H, Konishi K, Iwamoto Y, Hashizume M (2007) Assessment of anterolateral rotatory instability in the anterior cruciate ligament-deficient knee using an open magnetic resonance imaging system. Am J Sports Med 35(7):1091–1097CrossRefPubMedGoogle Scholar
  26. 26.
    Parsons EM, Gee AO, Spiekerman C, Cavanagh PR (2015) The biomechanical function of the anterolateral ligament of the knee. Am J Sports Med 43(3):669–674CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    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(2):367–373CrossRefPubMedGoogle Scholar
  28. 28.
    Stijak L, Bumbasirevic M, Radonjic V, Kadija M, Puskas L, Milovanovic D, Filipovic B (2016) Anatomic description of the anterolateral ligament of the knee. Knee Surg Sports Traumatol Arthrosc 24(7):2083–2088CrossRefPubMedGoogle Scholar
  29. 29.
    Taneja AK, Miranda FC, Braga CA, Gill CM, Hartmann LG, Santos DC, Rosemberg LA (2015) MRI features of the anterolateral ligament of the knee. Skelet Radiol 44(3):403–410CrossRefGoogle Scholar
  30. 30.
    Vincent JP, Magnussen RA, Gezmez F, Uguen A, Jacobi M, Weppe F, Al-Saati MF, Lustig S, Demey G, Servien E, Neyret P (2012) The anterolateral ligament of the human knee: an anatomic and histologic study. Knee Surg Sports Traumatol Arthrosc 20(1):147–152CrossRefPubMedGoogle Scholar
  31. 31.
    Waite JC, Beard DJ, Dodd CA, Murray DW, Gill HS (2005) In vivo kinematics of the ACL-deficient limb during running and cutting. Knee Surg Sports Traumatol Arthrosc 13(5):377–384CrossRefPubMedGoogle Scholar

Copyright information

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

Authors and Affiliations

  • Brian M. Devitt
    • 1
  • Richard O’Sullivan
    • 2
  • Julian A. Feller
    • 1
  • Nicholas Lash
    • 1
  • Tabitha J. Porter
    • 1
  • Kate E. Webster
    • 3
  • Timothy S. Whitehead
    • 1
  1. 1.Orthosport VictoriaMelbourneAustralia
  2. 2.Bridge Road ImagingMelbourneAustralia
  3. 3.School of Allied HealthLa Trobe UniversityMelbourneAustralia

Personalised recommendations