MRI evaluation of anterolateral ligament tears in knee injury with anterior cruciate ligament rupture

Abstract

Introduction:To evaluate the incidence of anterolateral ligament (ALL) tear in acute knee injury and its association with anterior cruciate ligament tear (ACL). Methods: Forty patients with isolated early ACL tears were prospectively reviewed under 3T-MRI evaluation to identify ALL tears. This was correlated with trauma mechanisms and degree of knee instability. Patients less than 18, or more than 50 years of age, and those with posterolateral corner injury or LCL instability were excluded, which left 31 patients (30 males: 1 female; mean age: 28.6 years) for the final evaluation. Results: The ALL was visualized completely on the MRI in all 31 patients. ALL had mid substance tear in 19 knees (61.3%), proximal femoral attachment in eight knees (25.8%), at the tibial end in 6 knees (19.3%) and was seen torn at both proximal and distal ends in five knees (16.1%). Clinical correlation revealed higher number of giving way episodes, more functional loss of activities and higher grades of pivot shift test in cases with ALL tear along with ACL tear as compared with patients who had ACL deficiency without concomitant ALL tear (p value <0.05). Conclusion: The ALL can be identified in all cases with 3T-MRI. Tears are clearly seen and may be classified according to location. We found no correlation of ALL tears with injury mechanism; however ACL deficient knees with concomitant ALL tear on MRI had more functional impairment and instability. Level of evidence: II b.KEY WORDS: anterolateral ligament (ALL), knee injury, ACL deficient knee, 3T MRI, knee instability.

MRI Evaluation of Anterolateral Ligament of the Knee: A Cross-Sectional Study in Malaysia

“…Despite detailed delineation of the ALL, MRI evaluation of the ALL remains challenging because of the anatomical variations and the fine thickness of this structure [ 6 , 24 ]. Aside from the high-resolution MR evaluation using a 3-T scanner, hitherto only one study demonstrates the identification of ALL in all the knee MR images [ 16 , 22 ]. Limited understanding of the detailed anatomy of the ALL, in addition to lower resolution and indecorous axis, may have contributed to the lower detection rate of the ALL [ 16 ].…”

“…Aside from the high-resolution MR evaluation using a 3-T scanner, hitherto only one study demonstrates the identification of ALL in all the knee MR images [ 16 , 22 ]. Limited understanding of the detailed anatomy of the ALL, in addition to lower resolution and indecorous axis, may have contributed to the lower detection rate of the ALL [ 16 ]. Since most of the centers in Malaysia are performing MR imaging with 1.5-T scanners, the data from this study might serve as a guide for other centers to emulate.…”

“…Previous studies in the identification of ALL with magnetic resonance imaging (MRI) revealed a mixed result. By utilizing a 3-Tesla (T) MRI, Hooda et al managed to identify ALL in all 31 patients [16]. On the other hand, studies using 1.5T MRI show a large discrepancy, with reports showing full visualization of ALL ranging from 11% to 100%, possibly due to anatomical variations and the fine thickness of this structure [17][18][19][20][21][22].…”

Clasificación cuantitativa de la maniobra de pivot-shift

“…El grado de sensibilidad de la misma, para detectar lesión del LCA es de 86.5% y tiene una especificidad de 95.2%. 3,4,5,6,7,8,9,10 Existen algunos cuestionarios que permiten valorar de forma subjetiva la estabilidad de la rodilla, entre los que se incluyen:…”

Role of Mri in Evaluation of Anterior Cruciate Ligament Tear

“…It is due to its high resolution ability to the soft tissues of the body and the capability of three dimensional imaging approach and specific protocols which are more sensitive to soft tissue injuries, in addition to precise diagnosis the injury it is also beneficial for the physicians and surgeons to decide the optimal treatment approaches. To achieve the higher sensitivity and specificity higher magnetic field strength is recommended so the magnetic strength of three tesla seems to be the better choice of modality to minimize the chances of uncertainties in the diagnosis of ligamentous injuries (10) . Commonly the anterior cruciate ligaments are evaluated on oblique sagittal MRIs with T2 weighted imaging technique.…”