MRI is Not Reliable in Diagnosing of Concomitant Anterolateral Ligament and Anterior Cruciate Ligament Injuries of the Knee

Overview

Journal Knee Surg Sports Traumatol Arthrosc

Publisher Wiley

Specialties Emergency Medicine
General Surgery
Orthopedics

Date 2017 Apr 14

PMID 28405740

Citations 12

Authors

Brian M Devitt

Richard OSullivan

Julian A Feller

Nicholas Lash

Tabitha J Porter

Kate E Webster

Timothy S Whitehead

Affiliations

Soon will be listed here.

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.

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References

Atkinson P, Cooper T, Anseth S, Walter N, Kargus R, Haut R . Association of knee bone bruise frequency with time postinjury and type of soft tissue injury. Orthopedics. 2009; 31(5):440. DOI: 10.3928/01477447-20080501-01. View

Stijak L, Bumbasirevic M, Radonjic V, Kadija M, Puskas L, Milovanovic D . Anatomic description of the anterolateral ligament of the knee. Knee Surg Sports Traumatol Arthrosc. 2014; 24(7):2083-8. DOI: 10.1007/s00167-014-3422-6. View

Porrino Jr J, Maloney E, Richardson M, Mulcahy H, Ha A, Chew F . The anterolateral ligament of the knee: MRI appearance, association with the Segond fracture, and historical perspective. AJR Am J Roentgenol. 2015; 204(2):367-73. DOI: 10.2214/AJR.14.12693. View

Caterine S, Litchfield R, Johnson M, Chronik B, Getgood A . A cadaveric study of the anterolateral ligament: re-introducing the lateral capsular ligament. Knee Surg Sports Traumatol Arthrosc. 2014; 23(11):3186-95. DOI: 10.1007/s00167-014-3117-z. View

Taneja A, Miranda F, Braga C, Gill C, Hartmann L, Santos D . MRI features of the anterolateral ligament of the knee. Skeletal Radiol. 2014; 44(3):403-10. DOI: 10.1007/s00256-014-2052-x. View

Dodds A, Halewood C, Gupte C, Williams A, Amis A . The anterolateral ligament: Anatomy, length changes and association with the Segond fracture. Bone Joint J. 2014; 96-B(3):325-31. DOI: 10.1302/0301-620X.96B3.33033. View

Kennedy M, Claes S, Fuso F, Williams B, Goldsmith M, Turnbull T . The Anterolateral Ligament: An Anatomic, Radiographic, and Biomechanical Analysis. Am J Sports Med. 2015; 43(7):1606-15. DOI: 10.1177/0363546515578253. View

Claes S, Luyckx T, Vereecke E, Bellemans J . The Segond fracture: a bony injury of the anterolateral ligament of the knee. Arthroscopy. 2014; 30(11):1475-82. DOI: 10.1016/j.arthro.2014.05.039. View

HUGHSTON J, Andrews J, Cross M, Moschi A . Classification of knee ligament instabilities. Part II. The lateral compartment. J Bone Joint Surg Am. 1976; 58(2):173-9. View

10.

Kosy J, Mandalia V, Anaspure R . Characterization of the anatomy of the anterolateral ligament of the knee using magnetic resonance imaging. Skeletal Radiol. 2015; 44(11):1647-53. DOI: 10.1007/s00256-015-2218-1. View

11.

Leitze Z, Losee R, Jokl P, Johnson T, Feagin J . Implications of the pivot shift in the ACL-deficient knee. Clin Orthop Relat Res. 2005; (436):229-36. DOI: 10.1097/01.blo.0000160026.14363.22. View

12.

Dietz G, Wilcox D, Montgomery J . Segond tibial condyle fracture: lateral capsular ligament avulsion. Radiology. 1986; 159(2):467-9. DOI: 10.1148/radiology.159.2.3961179. View

13.

Kittl C, Halewood C, Stephen J, Gupte C, Weiler A, Williams A . Length change patterns in the lateral extra-articular structures of the knee and related reconstructions. Am J Sports Med. 2014; 43(2):354-62. DOI: 10.1177/0363546514560993. View

14.

Helito C, Partezani Helito P, Costa H, Bordalo-Rodrigues M, Pecora J, Camanho G . MRI evaluation of the anterolateral ligament of the knee: assessment in routine 1.5-T scans. Skeletal Radiol. 2014; 43(10):1421-7. DOI: 10.1007/s00256-014-1966-7. View

15.

Okazaki K, Miura H, Matsuda S, Yasunaga T, Nakashima H, Konishi K . Assessment of anterolateral rotatory instability in the anterior cruciate ligament-deficient knee using an open magnetic resonance imaging system. Am J Sports Med. 2007; 35(7):1091-7. DOI: 10.1177/0363546507299530. View

16.

Duchman K, Westermann R, Spindler K, Reinke E, Huston L, Amendola A . 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. 2015; 43(11):2688-95. PMC: 4869979. DOI: 10.1177/0363546515604622. View

17.

Kosy J, Soni A, Venkatesh R, Mandalia V . The anterolateral ligament of the knee: unwrapping the enigma. Anatomical study and comparison to previous reports. J Orthop Traumatol. 2016; 17(4):303-308. PMC: 5071230. DOI: 10.1007/s10195-016-0392-0. View

18.

Helito C, Demange M, Partezani Helito P, Costa H, Bonadio M, Pecora J . Evaluation of the anterolateral ligament of the knee by means of magnetic resonance examination. Rev Bras Ortop. 2015; 50(2):214-9. PMC: 4519625. DOI: 10.1016/j.rboe.2015.03.009. View

19.

Helito C, Demange M, Bonadio M, Tirico L, Gobbi R, Pecora J . Anatomy and Histology of the Knee Anterolateral Ligament. Orthop J Sports Med. 2015; 1(7):2325967113513546. PMC: 4555517. DOI: 10.1177/2325967113513546. View

20.

Waite J, Beard D, Dodd C, Murray D, Gill H . In vivo kinematics of the ACL-deficient limb during running and cutting. Knee Surg Sports Traumatol Arthrosc. 2005; 13(5):377-84. DOI: 10.1007/s00167-004-0569-6. View