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Anterolateral ligament MRI of the knee in ACL injuries: MRI abnormalities association with instability

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

Abstract

Objective

To evaluate anterolateral ligament abnormalities (ALL) at MRI scans and correlate with data from clinical instability tests (Lachman and pivot shift) performed under anesthesia in patients with acute anterior cruciate ligament (ACL) tears. Furthermore, perform multivariate analysis with other variables to isolate the ALL contribution to instability from other abnormalities.

Methods

Retrospective analysis of MRI and instability tests of 95 patients with ACL tears. The ALL was classified as no abnormality, abnormality without discontinuity, and discontinuity. Injuries in other knee ligament structures and menisci were also assessed. Results of instability tests (pivot shift and Lachman) with the patient anesthetized for arthroscopic ACL reconstruction were obtained from the patient database. Statistical analysis was performed using the IBM SPSS 22.

Results

ALL abnormalities and iliotibial band (ITB), lateral (LCL), and medial (MCL) collateral ligament injuries showed a statistically significant correlation with the pivot shift test. The ALL MRI abnormalities were associated with the high-grade pivot shift results (p < 0.0005), with an odds ratio of 55.9 for high degrees of pivot shift in patients with abnormal ALL. The logistic model for all variables analyzed with the results of the pivot shift test demonstrated that the ALL was the only variable with a statistically significant correlation in the model (p < 0.0005).

Conclusion

MRI ALL abnormalities in patients with ACL injuries have a significant association with pivot shift test results in patients under anesthesia. The logistic model for high - grade pivot shift test results demonstrated that ALL abnormalities were the only variable with significant correlation.

Key Points

• Evaluating the anterolateral ligament with MRI in acute anterior cruciate ligament injuries is useful to predict higher grades of pivot shift test in the moment of the arthroscopic reconstruction.

• An abnormal anterolateral ligament presented an odds ratio of 55 for high degrees of pivot shift.

• ALL MRI abnormalities association with knee instability is independent from other internal knee injuries.

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Abbreviations

ACL:

Anterior cruciate ligament

ALL:

Anterolateral ligament

IKDC:

International Knee Documentation Committee

ITB:

Iliotibial band

LCL:

Lateral collateral ligament

LM:

Lateral meniscus

MCL:

Medial collateral ligament

MM:

Medial meniscus

MRI:

Magnetic resonance imaging

OR:

Odds ratio

PCL:

Posterior cruciate ligament

PLC:

Posterolateral corner

References

  1. Tavlo M, Eljaja S, Jensen JT et al (2016) The role of the anterolateral ligament in ACL insufficient and reconstructed knees on rotatory stability: a biomechanical study on human cadavers. Scand J Med Sci Sports 26:960–966. https://doi.org/10.1111/sms.12524

    Article  CAS  Google Scholar 

  2. Monaco E, Maestri B, Labianca L et al (2010) Navigated knee kinematics after tear of the ACL and its secondary restraints: preliminary results. Orthopedics 33:87–93. https://doi.org/10.3928/01477447-20100510-58

    Article  Google Scholar 

  3. Monaco E, Ferretti A, Labianca L et al (2012) Navigated knee kinematics after cutting of the ACL and its secondary restraint. Knee Surg Sports Traumatol Arthrosc 20:870–877. https://doi.org/10.1007/s00167-011-1640-8

    Article  CAS  Google Scholar 

  4. Monaco E, Fabbri M, Mazza D et al (2018) The effect of sequential tearing of the anterior cruciate and anterolateral ligament on anterior translation and the pivot-shift phenomenon: a cadaveric study using navigation. Arthroscopy 34:1009–1014. https://doi.org/10.1016/j.arthro.2017.09.042

    Article  Google Scholar 

  5. Nielsen ET, Stentz-Olesen K, de Raedt S et al (2018) Influence of the anterolateral ligament on knee laxity: a biomechanical cadaveric study measuring knee kinematics in 6 degrees of freedom using dynamic radiostereometric analysis. Orthop J Sport Med 6:1–13. https://doi.org/10.1177/2325967118789699

    Article  Google Scholar 

  6. Ariel de Lima D, Helito CP, Lacerda de Lima L et al (2019) Anatomy of the anterolateral ligament of the knee: a systematic review. Arthroscopy 35:670–681. https://doi.org/10.1016/j.arthro.2018.09.006

    Article  Google Scholar 

  7. Getgood A, Brown C, Lording T et al (2019) The anterolateral complex of the knee: results from the International ALC Consensus Group Meeting. Knee Surg Sports Traumatol Arthrosc 27:166–176. https://doi.org/10.1007/s00167-018-5072-6

    Article  Google Scholar 

  8. Helito CP, Helito PVP, Costa HP et al (2014) MRI evaluation of the anterolateral ligament of the knee: assessment in routine 1.5-T scans. Skeletal Radiol 43:1421–1427. https://doi.org/10.1007/s00256-014-1966-7

    Article  Google Scholar 

  9. Kosy JD, Mandalia VI, Anaspure R (2015) Characterization of the anatomy of the anterolateral ligament of the knee using magnetic resonance imaging. Skeletal Radiol 44:1647–1653. https://doi.org/10.1007/s00256-015-2218-1

    Article  Google Scholar 

  10. Macchi V, Porzionato A, Morra A et al (2016) The anterolateral ligament of the knee: a radiologic and histotopographic study. Surg Radiol Anat 38:341–348. https://doi.org/10.1007/s00276-015-1566-9

    Article  Google Scholar 

  11. Wieser K, Fürnstahl P, Carrillo F et al (2017) Assessment of the isometry of the anterolateral ligament in a 3-dimensional weight-bearing computed tomography simulation. Arthroscopy 33:1016–1023. https://doi.org/10.1016/j.arthro.2016.11.005

    Article  Google Scholar 

  12. Puzzitiello RN, Agarwalla A, Zuke WA et al (2018) Imaging diagnosis of injury to the anterolateral ligament in patients with anterior cruciate ligaments: association of anterolateral ligament injury with other types of knee pathology and grade of pivot-shift examination: a systematic review. Arthroscopy 34:2728–2738. https://doi.org/10.1016/j.arthro.2018.04.025

    Article  Google Scholar 

  13. Helito CP, Helito PVP, Leão RV et al (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. https://doi.org/10.1007/s00167-017-4498-6

    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. https://doi.org/10.1007/s00330-015-4171-8

    Article  Google Scholar 

  15. Lee DW, Lee JH, Kim JN et al (2018) Evaluation of anterolateral ligament injuries and concomitant lesions on magnetic resonance imaging after acute anterior cruciate ligament rupture. Arthroscopy 34:2398–2406. https://doi.org/10.1016/j.arthro.2018.02.048

    Article  Google Scholar 

  16. Yang SG, Zhang H, Wu G et al (2017) Patients with high-grade pivot-shift phenomenon are associated with higher prevalence of anterolateral ligament injury after acute anterior cruciate ligament injuries. Knee Surg Sports Traumatol Arthrosc 25:1111–1116. https://doi.org/10.1007/s00167-017-4492-z

    Article  Google Scholar 

  17. Monaco E, Helito CP, Redler A et al (2019) Correlation between magnetic resonance imaging and surgical exploration of the anterolateral structures of the acute anterior cruciate ligament–injured knee. Am J Sports Med 47:1186–1193. https://doi.org/10.1177/0363546519831686

    Article  Google Scholar 

  18. Sonnery-Cottet B, Daggett M, Fayard JM et al (2017) Anterolateral Ligament Expert Group consensus paper on the management of internal rotation and instability of the anterior cruciate ligament - deficient knee. J Orthop Traumatol 18:91–106. https://doi.org/10.1007/s10195-017-0449-8

    Article  Google Scholar 

  19. Hefti E, Müller W, Jakob RP, Stäubli HU (1993) Evaluation of knee ligament injuries with the IKDC form. Knee Surg Sports Traumatol Arthrosc 1:226–234. https://doi.org/10.1007/BF01560215

    Article  CAS  Google Scholar 

  20. Yang SG, Zhang H, Qian WQ (et al, 2016) Bone contusions after acute noncontact anterior cruciate ligament injury are associated with knee joint laxity, concomitant meniscal lesions, and anterolateral ligament abnormality. Arthroscopy 32:2331–2341. https://doi.org/10.1016/j.arthro.2016.03.015

  21. Helito CP, Helito PVP, Costa HP et al (2017) Assessment of the anterolateral ligament of the knee by magnetic resonance imaging in acute injuries of the anterior cruciate ligament. Arthroscopy 33:140–146. https://doi.org/10.1016/j.arthro.2016.05.009

    Article  Google Scholar 

  22. Devitt BM, O’Sullivan R, Feller JA et al (2017) MRI is not reliable in diagnosing of concomitant anterolateral ligament and anterior cruciate ligament injuries of the knee. Knee Surg Sports Traumatol Arthrosc 25:1345–1351. https://doi.org/10.1007/s00167-017-4538-2

    Article  Google Scholar 

  23. 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. https://doi.org/10.1016/j.jcot.2017.10.004

    Article  Google Scholar 

  24. Marshall T, Oak SR, Subhas N et al (2018) Can the anterolateral ligament be reliably identified in anterior cruciate ligament–intact and anterior cruciate ligament–injured knees on 3-T magnetic resonance imaging? Orthop J Sport Med 6:1–6. https://doi.org/10.1177/2325967118796452

    Article  Google Scholar 

  25. Miyaji N, Hoshino Y, Tanaka T et al (2019) MRI-determined anterolateral capsule injury did not affect the pivot-shift in anterior cruciate ligament-injured knees. Knee Surg, Sport Traumatol Arthrosc 27:3426–3431. https://doi.org/10.1007/s00167-019-05376-8

    Article  Google Scholar 

  26. Young BL, Ruder JA, Trofa DP, Fleischli JE (2020) Visualization of concurrent anterolateral and anterior cruciate ligament injury on magnetic resonance imaging. Arthroscopy 36:1086–1091. https://doi.org/10.1016/j.arthro.2019.09.039

    Article  Google Scholar 

  27. Helito PVP, Bartholomeeusen S, Claes S et al (2020) Magnetic resonance imaging evaluation of the anterolateral ligament and the iliotibial band in acute anterior cruciate ligament injuries associated with Segond fractures. Arthroscopy 36:1679–1686. https://doi.org/10.1016/j.arthro.2020.02.005

    Article  Google Scholar 

  28. Berthold DP, Willinger L, LeVasseur MR et al (2021) High rate of initially overlooked kaplan fiber complex injuries in patients with isolated anterior cruciate ligament injury. Am J Sports Med 49:2117–2124. https://doi.org/10.1177/03635465211015682

    Article  Google Scholar 

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Authors and Affiliations

  1. Musculoskeletal Radiology Department, Institute of Orthopedics and Traumatology, Faculty of Medicine, University of São Paulo, Rua Dr. Ovídio Pires de Campos, 333, Cerqueira Cesar, São Paulo, 05403-010, Brazil

    Paulo Victor Partezani Helito & Marcelo Bordalo Rodrigues

  2. Hospital Sírio-Libanês, São Paulo, Brazil

    Paulo Victor Partezani Helito, Camilo Partezani Helito & Marcelo Bordalo Rodrigues

  3. Institute of Radiology; Faculty of Medicine, University of São Paulo, São Paulo, Brazil

    Paulo Victor Partezani Helito & Marcelo Bordalo Rodrigues

  4. Knee Surgery Division, Institute of Orthopedics and Traumatology, Faculty of Medicine, University of São Paulo, Sâo Paulo, Brazil

    Camilo Partezani Helito

Authors
  1. Paulo Victor Partezani Helito
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Corresponding author

Correspondence to Paulo Victor Partezani Helito.

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Guarantor

The scientific guarantor of this publication is Paulo Victor Partezani Helito (Hospital das Clínicas – FMUSP – São Paulo / SP – Brazil).

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

Márcia Milena Pivatto Serra (Hospital Sírio-Libanês) kindly provided statistical advice for this manuscript.

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Written informed consent was waived by the Institutional Review Board.

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Methodology

• Retrospective

• Cross-sectional study

• Multicenter study

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Helito, P.V.P., Helito, C.P. & Rodrigues, M.B. Anterolateral ligament MRI of the knee in ACL injuries: MRI abnormalities association with instability. Eur Radiol 33, 1456–1464 (2023). https://doi.org/10.1007/s00330-022-09062-1

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