Identification of the Anterolateral Ligament on Magnetic Resonance Imaging

Patel, Karan A.; Chhabra, Anikar; Goodwin, Jill; Hartigan, David E.

doi:10.1016/j.eats.2016.09.015

Cited by 23 publications

(18 citation statements)

References 15 publications

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“…This could indicate that patient-specific treatment should be considered to a greater extent than is currently the case, especially in light of the distinctness and variations of the ALL position between patients. 9,14,34 Noninvasive methods such as ultrasound 44 and magnetic resonance imaging 19,46,61 may be used for the preoperative evaluation and diagnosis of anterolateral structures such as the ALL.…”

Section: Discussionmentioning

confidence: 99%

Influence of the Anterolateral Ligament on Knee Laxity: A Biomechanical Cadaveric Study Measuring Knee Kinematics in 6 Degrees of Freedom Using Dynamic Radiostereometric Analysis

Nielsen

Stentz-Olesen

Raedt

et al. 2018

Orthopaedic Journal of Sports Medicine

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Background:An anterior cruciate ligament (ACL) rupture often occurs during rotational trauma to the knee and may be associated with damage to extracapsular knee rotation–stabilizing structures such as the anterolateral ligament (ALL).Purpose:To investigate ex vivo knee laxity in 6 degrees of freedom with and without ALL reconstruction as a supplement to ACL reconstruction.Study Design:Controlled laboratory study.Methods:Cadaveric knees (N = 8) were analyzed using dynamic radiostereometry during a controlled pivotlike dynamic movement simulated by motorized knee flexion (0° to 60°) with 4-N·m internal rotation torque. We tested the cadaveric specimens in 5 successive ligament situations: intact, ACL lesion, ACL + ALL lesion, ACL reconstruction, and ACL + ALL reconstruction. Anatomic single-bundle reconstruction methods were used for both the ACL and the ALL, with a bone-tendon quadriceps autograft and gracilis tendon autograft, respectively. Three-dimensional kinematics and articular surface interactions were used to determine knee laxity.Results:For the entire knee flexion motion, an ACL + ALL lesion increased the mean knee laxity (P < .005) for internal rotation (2.54°), anterior translation (1.68 mm), and varus rotation (0.53°). Augmented ALL reconstruction reduced knee laxity for anterior translation (P = .003) and varus rotation (P = .047) compared with ACL + ALL–deficient knees. Knees with ACL + ALL lesions had more internal rotation (P < .001) and anterior translation (P < .045) at knee flexion angles below 40° and 30°, respectively, compared with healthy knees. Combined ACL + ALL reconstruction did not completely restore native kinematics/laxity at flexion angles below 10° for anterior translation and below 20° for internal rotation (P < .035). ACL + ALL reconstruction was not found to overconstrain the knee joint.Conclusion:Augmented ALL reconstruction with ACL reconstruction in a cadaveric setting reduces internal rotation, varus rotation, and anterior translation knee laxity similar to knee kinematics with intact ligaments, except at knee flexion angles between 0° and 20°.Clinical Relevance:Patients with ACL injuries can potentially achieve better results with augmented ALL reconstruction along with ACL reconstruction than with stand-alone ACL reconstruction. Furthermore, dynamic radiostereometry provides the opportunity to examine clinical patients and compare the recontructed knee with the contralateral knee in 6 degrees of freedom.

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Section: Discussionmentioning

confidence: 99%

Influence of the Anterolateral Ligament on Knee Laxity: A Biomechanical Cadaveric Study Measuring Knee Kinematics in 6 Degrees of Freedom Using Dynamic Radiostereometric Analysis

Nielsen

Stentz-Olesen

Raedt

et al. 2018

Orthopaedic Journal of Sports Medicine

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“…2,27 A mixed lesion includes both above and below the meniscal portion of the ALL. 4,12,40 A complete ALL rupture was further subcategorized as having an avulsion of the bony insertion, which is referred to as a “Segond fracture.” 6,20 The degree of bone contusions was defined as grade 0 = none, grade 1 = minimal (just beneath the subchondral bone), grade 2 = moderate (beneath the subchondral bone but not extending beyond the physeal scar), and grade 3 = severe (extending beyond the physeal scar). 47 Compared with its preoperative appearance, the healing status of the ALL was classified as “good” (taut, linear, and low-signal intensity), “partial” (wavy, irregular contour, attenuated, or thickened), “scar formation” (discontinuous but with increased signal intensity), or “nonvisualized.” Poor healing included partial healing, scar formation, and nonvisualization of the ALL.…”

Section: Methodsmentioning

confidence: 99%

Evaluation of Anterolateral Ligament Healing After Anatomic Anterior Cruciate Ligament Reconstruction

Lee

Kim

et al. 2020

Am J Sports Med

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Background: Few studies have reported the healing process of anterolateral ligament (ALL) injuries. Purpose/Hypothesis: This study investigated the healing status of ALL injuries after primary anterior cruciate ligament (ACL) reconstruction (ACLR). Additionally, we investigated the association between the healing status of ALL injuries and associated lesions such as osseous lesions and meniscal tears occurring at the time of an ACL rupture. We hypothesized that acute ALL injuries show a high rate (more than two-thirds) of healing at the 1-year follow-up after ACLR and that concomitant lesions observed at the time of an ACL rupture affect the healing status of the ALL. Study Design: Case-control study; Level of evidence, 3. Methods: We retrospectively investigated patients with ALL injuries who underwent primary ACLR between March 2015 and February 2017. Using magnetic resonance imaging (MRI), we evaluated the features of ALL injuries and concomitant lesions, and MRI was performed at the 1-year follow-up to assess the healing status of the ALL. We investigated the association between the healing status of the ALL and concomitant lesions observed at the time of an ACL rupture. A subjective assessment was performed using the Lysholm score, International Knee Documentation Committee subjective score, and Tegner activity scale. Objective tests included an isokinetic strength assessment and functional performance testing. Results: With respect to the severity of ALL injuries, of 54 patients, a complete rupture occurred in 16 (29.6%) of the 54 patients and a partial rupture in 38 (70%). A significant association was observed between the severity of ALL injuries and bone contusions (lateral tibial plateau and medial tibial plateau [MTP]) and meniscus ramp lesions (Fisher exact test: P = .023, .012, and .023, respectively). Good and partial healing of the ALL occurred in 16 (29.6%) and 23 (42.6%) of 54 patients, respectively. Scar formation occurred in 12 (22.2%), and nonvisualization of the ALL was observed in 3 (5.6%) of 54 patients. Poor healing of the ALL was associated with preoperative MTP bone contusions and a high-grade pivot shift. Multivariate analysis showed that an MTP bone contusion was an independent risk factor associated with poor healing of the ALL. Among the functional tests performed, significant differences were observed between the good and poor healing groups with respect to the carioca test ( P = .039). The good healing group (n = 16) showed a negative pivot shift at the last follow-up, whereas 5 (13.2%) of the patients from the poor healing group (n = 38) showed a positive pivot shift, including 2 (5.3%) with a high-grade pivot shift. Conclusion: Approximately 70% of acute ALL injuries showed poor healing at the 1-year follow-up. Poor healing of ALL injuries was significantly associated with preoperative MTP bone contusions and a high-grade pivot shift. Therefore, a careful assessment of posteromedial bone contusions at the time of an ACL rupture is warranted, particularly in patients with a high-grade pivot shift.

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“…A standardized process for identification of the ALL was used. 30 The ALL was defined as the low signal band originating from the region of the lateral epicondyle of the femur, crossing the proximal surface of the lateral collateral ligament, and reaching the middle third of the lateral tibial plateau. Evaluators graded ALLs according to the MRI classification described by Muramatsu et al 27 (grade A, ALL visualized as a continuous, clearly defined, low-signal band; grade B, ALL exhibited warping, thinning, or iso-signal changes; grade C, absence of clear continuity of ALL).…”

Section: Imaging Evaluationmentioning

confidence: 99%

The Anterolateral Ligament Has Limited Intrinsic Healing Potential: A Serial, 3-Dimensional–Magnetic Resonance Imaging Study of Anterior Cruciate Ligament–Injured Knees From the SANTI Study Group

et al. 2021

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Background: Recent imaging studies demonstrate that the anterolateral ligament (ALL) is frequently injured at the time of anterior cruciate ligament (ACL) rupture. The intrinsic healing potential of these injuries after ACL reconstruction (ACLR) has not been defined. Purpose/Hypothesis: The primary objective was to evaluate the rate and duration of the healing process of injured ALLs after ACLR using serial 3-dimensional magnetic resonance imaging (3D-MRI). The secondary objective was to investigate whether any patient, injury, or surgical factors influenced the healing rate. The hypothesis was that serial imaging would demonstrate that the ALL has limited healing potential. Study Design: Case series; Level of evidence, 4. Methods: Patients enrolled in the study underwent 3D-MRI (slice thickness 0.5 mm) preoperatively and at 1, 6, 12, and 24 months after ACLR. Three observers determined the grade of ALL injury according to the Muramatsu classification. Inter- and intraobserver reliabilities were calculated. The rates of injury and time points for healing were determined. Full healing was defined as a change from a preoperative Muramatsu grade of B or C (indicating partial or complete injury) to grade A (normal). Multivariate analysis was used to investigate the association of aforementioned factors with the risk of incomplete healing. Results: A total of 44 patients were enrolled in the study. Of them, 71.2% had an ALL injury on preoperative imaging. Overall, full healing of ALL injuries occurred at a rate of 3.2%, 15.2%, and 30.3% at 1, 6, and 12 months, respectively. There were no changes in the Muramatsu grade in any patient beyond 12 months postoperatively. None of the complete lesions demonstrated full healing, but the proportion of patients with a grade C injury decreased from 13.6% preoperatively to 4.5% at 12 months due to an improvement to grade B in 4 of 6 patients (66%). Inter- and intraobserver reliabilities of the classification system were almost perfect at 0.81-0.94 and 0.95-1.00, respectively. None of the potential risk factors investigated were predictive of an increased risk of nonhealing. Conclusion: ALL injuries occurred in the majority of ACL-injured knees. They had limited intrinsic healing potential, with only 30.3% healing by 12 months after ACLR. The process of healing took >6 months in half of the patients in whom it occurred. No new cases of full healing occurred beyond 12 months postoperatively. No significant risk factors for failure of full healing to occur were identified, but it is likely that this aspect of the study was underpowered.

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Identification of the Anterolateral Ligament on Magnetic Resonance Imaging

Cited by 23 publications

References 15 publications

Influence of the Anterolateral Ligament on Knee Laxity: A Biomechanical Cadaveric Study Measuring Knee Kinematics in 6 Degrees of Freedom Using Dynamic Radiostereometric Analysis

Influence of the Anterolateral Ligament on Knee Laxity: A Biomechanical Cadaveric Study Measuring Knee Kinematics in 6 Degrees of Freedom Using Dynamic Radiostereometric Analysis

Evaluation of Anterolateral Ligament Healing After Anatomic Anterior Cruciate Ligament Reconstruction

The Anterolateral Ligament Has Limited Intrinsic Healing Potential: A Serial, 3-Dimensional–Magnetic Resonance Imaging Study of Anterior Cruciate Ligament–Injured Knees From the SANTI Study Group

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