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Vasiliadis AV, Chytas D, Giovanoulis V, Troupis T, Noussios G. Anterolateral Ligament Pathological Anatomy and its Associated Injuries: An Infographic. Oman Med J 2024; 39:e643. [PMID: 39015427 PMCID: PMC11247305 DOI: 10.5001/omj.2024.87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 05/06/2024] [Indexed: 07/18/2024] Open
Affiliation(s)
- Angelo V. Vasiliadis
- Department of Orthopaedic Surgery, Sports Trauma Unit, St. Luke's Hospital, Thessaloniki, Greece
- Department of Physical Education and Sports Sciences, Aristotle University of Thessaloniki, Serres, Greece
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, Zografou, Greece
| | - Dimitrios Chytas
- Basic Sciences Laboratory, Department of Physiotherapy, University of Peloponnese, Sparta, Greece
- School of Medicine, European University of Cyprus, Nicosia, Cyprus
| | - Vasileios Giovanoulis
- Department of Orthopedic Surgery, Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France
| | - Theodore Troupis
- Department of Anatomy, School of Medicine, National and Kapodistrian University of Athens, Zografou, Greece
| | - George Noussios
- Department of Physical Education and Sports Sciences, Aristotle University of Thessaloniki, Serres, Greece
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Schwartz J, Rodriguez AN, Banovetz MT, Braaten JA, Larson CM, Wulf CA, Kennedy NI, LaPrade RF. The Functional Integrity of the Anterior Cruciate Ligament Can Be Objectively Assessed With the Use of Stress Radiographs: A Systematic Review. Orthop J Sports Med 2024; 12:23259671241246197. [PMID: 38680218 PMCID: PMC11047241 DOI: 10.1177/23259671241246197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 10/24/2023] [Indexed: 05/01/2024] Open
Abstract
Background Stress radiography is a viable imaging modality that can also be used to assess the integrity of the anterior cruciate ligament (ACL) after primary or secondary injury. Because conventional radiography is relatively easy, affordable, and available worldwide, the diagnostic efficacy of ACL standing, lateral decubitus, and supine stress radiography should be evaluated. Purpose To examine the existing literature regarding the application of stress radiography in evaluating the integrity of the ACL. Study Design Systematic review; Level of evidence, 3. Methods Using the PubMed and MEDLINE databases for relevant articles published between 1980 and the present, a systematic review was conducted to identify evidence related to the radiographic diagnosis or assessment of ACL tears. The literature search was conducted in September 2022. Results Of 495 studies, 16 (1823 patients) were included. Four studies examined standing stress radiography, and 12 investigated lateral decubitus or supine stress radiography. Significant heterogeneity in imaging technique and recorded anterior tibial translation was identified. Anterior tibial translation for ACL-injured knees ranged from 1.2 to 10.6 mm for standing stress radiographs and 2.7 to 11.2 mm for supine stress radiographs, with high sensitivities and specificities for both. Conclusion Stress radiography was a dependable diagnostic method for identifying ACL rupture. Further research is necessary to determine the ideal anatomic landmarks, optimal patient positioning, and appropriate applied stresses to establish a standardized protocol for both assessing ACL tears and evaluating the postoperative integrity of ACL reconstruction using stress radiography.
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Ye Z, Wu X, Chen J, Cho E, Xie G, Dong S, Xu J, Zhao J. Association Between Anterior Tibial Subluxation of Lateral Compartment and High-Grade Knee Laxity in Patients With Anterior Cruciate Ligament Deficiency. Am J Sports Med 2023:3635465231166712. [PMID: 37092733 DOI: 10.1177/03635465231166712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
BACKGROUND High-grade knee laxity and excessive anterior tibial subluxation (ATS) are correlated with poor clinical outcomes in patients with anterior cruciate ligament (ACL) deficiency and share similar risk factors; however, the association between excessive ATS and high-grade knee laxity remains unclear. PURPOSE To identify the association between excessive ATS and high-grade knee laxity in patients with ACL deficiency and determine the possibility that ATS can predict high-grade knee laxity. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS A total of 226 patients who underwent ACL reconstruction between May 2018 and March 2022 were analyzed in the present study; the high-grade group consisted of 113 patients who had a grade 3 result on the preoperative anterior drawer test, Lachman test, or pivot-shift test while under anesthesia, and the low-grade group consisted of 113 matched patients. The ATS values for medial and lateral compartments (ATSMC and ATSLC) were measured on magnetic resonance imaging while patients relaxed the quadriceps in the supine position under no anesthesia. The optimal cutoff values of ATSMC and ATSLC for high-grade knee laxity were determined using receiver operating characteristic curves. Univariate and multivariate logistic regression analyses with stratification were performed to identify the association between excessive ATS and high-grade knee laxity. RESULTS Compared with the low-grade group, the high-grade group had a longer time from injury to surgery; higher rates of medial meniscus posterior horn tear (MMPHT), lateral meniscus posterior horn tear (LMPHT), and anterolateral ligament (ALL) abnormality; and larger lateral tibial slope, ATSMC, and ATSLC. The optimal cutoff value was 2.6 mm (sensitivity, 52.2%; specificity, 76.1%) for ATSMC and 4.5 mm (sensitivity, 67.3%; specificity, 64.6%) for ATSLC in predicting high-grade knee laxity. After adjustment for covariates, ATSLC ≥4.5 mm (odds ratio [OR], 2.94; 95% CI, 1.56-5.55; P = .001), MMPHT (OR, 2.62; 95% CI, 1.35-5.08; P = .004), LMPHT (OR, 2.39; 95% CI, 1.20-4.78; P = .014), and ALL abnormality (OR, 2.09; 95% CI, 1.13-3.89; P = .019) were associated with high-grade knee laxity. The association between excessive ATSLC and high-grade knee laxity was validated in patients with acute ACL injury as well as those with chronic ACL injury. CONCLUSION Excessive ATSLC was associated with high-grade knee laxity in patients who had ACL deficiency, with a predictive cutoff value of 4.5 mm. This study may help surgeons estimate the degree of knee instability more accurately before anesthesia and may facilitate preliminary surgical decision-making, such as appropriate graft choices and consideration of extra-articular augmentation.
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Affiliation(s)
- Zipeng Ye
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiulin Wu
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiebo Chen
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Eunshinae Cho
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guoming Xie
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shikui Dong
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Junjie Xu
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinzhong Zhao
- Department of Sports Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Helito PVP, Helito CP, Rodrigues MB. Anterolateral ligament MRI of the knee in ACL injuries: MRI abnormalities association with instability. Eur Radiol 2023; 33:1456-1464. [PMID: 35976397 DOI: 10.1007/s00330-022-09062-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 06/11/2022] [Accepted: 07/24/2022] [Indexed: 02/03/2023]
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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Affiliation(s)
- Paulo Victor Partezani Helito
- 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. .,Hospital Sírio-Libanês, São Paulo, Brazil. .,Institute of Radiology; Faculty of Medicine, University of São Paulo, São Paulo, Brazil.
| | - Camilo Partezani Helito
- Hospital Sírio-Libanês, São Paulo, Brazil.,Knee Surgery Division, Institute of Orthopedics and Traumatology, Faculty of Medicine, University of São Paulo, Sâo Paulo, Brazil
| | - Marcelo Bordalo Rodrigues
- 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.,Hospital Sírio-Libanês, São Paulo, Brazil.,Institute of Radiology; Faculty of Medicine, University of São Paulo, São Paulo, Brazil
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Anatomy, Biomechanics, and Reconstruction of the Anterolateral Ligament of the Knee Joint. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58060786. [PMID: 35744048 PMCID: PMC9228568 DOI: 10.3390/medicina58060786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/06/2022] [Accepted: 06/09/2022] [Indexed: 11/17/2022]
Abstract
Despite remarkable advances in the clinical outcomes after anterior cruciate ligament reconstructions (ACLRs), residual rotational instability of the knee joint remains a major concern. Since the anterolateral ligament (ALL) on the knee joint has been “rediscovered”, the role of anterolateral structures, including ALL and deep iliotibial band, as secondary stabilizers of anterolateral rotatory instability has gained interest. This interest has led to the resurgence of anterolateral procedures combined with ACLRs to restore rotational stability in patients with anterior cruciate ligament (ACL) deficiencies. However, the difference in concepts between anterolateral ligament reconstructions (ALLRs) as anatomical reconstruction and lateral extra-articular tenodesis (LETs) as non-anatomical reinforcement has been conflicting in present literature. This study aimed to review the anatomy and biomechanics of anterolateral structures, surgical techniques, and the clinical outcomes of anterolateral procedures, including LET and ALLR, in patients with ACL deficiencies.
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The deep lateral femoral notch sign: a reliable diagnostic tool in identifying a concomitant anterior cruciate and anterolateral ligament injury. Knee Surg Sports Traumatol Arthrosc 2021; 29:1968-1976. [PMID: 32974801 DOI: 10.1007/s00167-020-06278-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/10/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The aim of the present study was to investigate the validity and reliability of the deep lateral femoral notch sign (DLFNS) in identifying a concomitant anterior cruciate ligament (ACL)/anterolateral ligament (ALL) rupture and predicting the clinical outcomes following an anatomical single-bundle ACL reconstruction. It was hypothesized that patients with a concomitant ACL/ALL rupture would have an increased DLFNS compared to patients without a concomitant ACL/ALL rupture. METHODS The lateral preoperative radiographs and MRI images of 100 patients with an ACL rupture and 100 control subjects were evaluated for the presence of a DLFNS and ACL/ALL rupture, respectively. The patients were evaluated clinically preoperatively and at a minimum 1 year following the ACL reconstruction. A receiver operator curve (ROC) analysis was performed to define the optimal cut-off value of the DLFNS for identifying a concomitant ACL/ALL injury. The relative risk (RR) was also calculated to determine whether the presence of the DLFNS was a risk factor for residual instability or ACL graft rupture following an ACL reconstruction. RESULTS The prevalence of DLFNS was 52% in the ACL-ruptured patients and 15% in the control group. At a minimum 1-year follow-up, 35% (6/17) of the patients with DLFNS > 1.8 mm complained of persistent instability, and an MRI evaluation demonstrated a graft re-rupture rate of 12% (2/17). In patients with a DLFNS < 1.8 mm, 8% (7/83) reported a residual instability, and the graft rupture rate was 2.4% (2/83). A DLFNS > 1.8 mm demonstrated a sensitivity of 89%, a specificity of 95%, a negative predictive value of 98%, and a positive predictive value of 89% in identifying a concomitant ACL/ALL rupture. Patients with a DLFNS > 1.8 mm had 4.2 times increased risk for residual instability and graft rupture compared to patients with a DLFNS ≤ 1.8 mm. CONCLUSIONS A DLFNS > 1.8 mm could be a clinically relevant diagnostic tool for identifying a concomitant ACL/ALL rupture with high sensitivity and PPV. Patients with a DLFNS > 1.8 mm should be carefully evaluated for clinical and radiological signs of a concomitant ACL/ALL rupture and treated when needed with a combined intra-articular ACL reconstruction and extra-articular tenodesis to avoid a residual rotational instability and ACL graft rupture. LEVEL OF EVIDENCE III.
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Knee laxity, lateral meniscus tear and distal femur morphology influence pivot shift test grade in ACL injury patients. Knee Surg Sports Traumatol Arthrosc 2021; 29:633-640. [PMID: 32303800 DOI: 10.1007/s00167-020-05994-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 04/10/2020] [Indexed: 01/12/2023]
Abstract
PURPOSE Although several factors have been considered to be associated with pivot shift test grade in ACL injured patients, a conclusion regarding which factors contribute to the pivot shift test grade has not been reached. The purpose of this study was to identify factors associated with preoperative pivot shift test grade. METHODS Three hundred and sixty-six consecutive patients who underwent ACL reconstruction in our hospital were enrolled in the study. Patients were divided into two groups on the basis of preoperative pivot shift test grade (Mild: grade 0-3, Severe: grade 4-6). First, 13 independent variables (age, gender, period from injury to surgery, hyperextension, KT measurement, contralateral side pivot shift test grade, medial and lateral tibial slope, lateral condyle length, lateral condyle height, distal femoral condyle offset, medial and lateral meniscus tear) were analyzed by one-way ANOVA and Chi-squared test. Binary Logistic regression was then performed based on the results of univariate analyses (independent variables of p < 0.2 were included). RESULTS Hyperextension, lateral meniscus tear, contralateral side pivot shift test grade, distal femoral condyle offset and KT measurement were identified as risk factors for preoperative pivot shift grade via logistic regression analysis. CONCLUSION The current study revealed that hyperextension, lateral meniscus tear, contralateral side pivot shift test grade, distal femoral condyle offset and anterior instability were associated with preoperative pivot shift grade. Patients with above factors that cannot be modified during surgery may need special consideration when ACL reconstruction is performed, as greater preoperative pivot shift has been proven to be a risk factor for residual pivot shift after ACL reconstruction. LEVEL OF EVIDENCE III.
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Abstract
The femoral attachment of the anterolateral ligament (ALL) of the knee is still under debate, but the tibial attachment is consistently between Gerdy's tubercle and the fibular head. The structure is less identifiable and more variable in younger patients. The ALL likely plays a role in rotational stability, but its impact on anterior stability is less clear. Numerous ALL reconstruction techniques have been described. Biomechanical analysis of these techniques has not shown clear benefits, but this literature is limited by the heterogeneity of techniques, graft choices, and study methodology. Clinical studies of combined anterior cruciate ligament (ACL) and ALL reconstruction are few but promising in lowering the risk of an ACL reinjury. To our knowledge, there are no studies showing the clinical outcomes of combined ACL and ALL reconstruction in pediatric patients, who are at higher risk for ACL graft failure than adults.
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Affiliation(s)
- Ashwin S Madhan
- 1Northwestern University Feinberg School of Medicine, Chicago, Illinois 2Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
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Murgier J, Thomas P, Reina N, Sylvie R, Bérard E, Cavaignac E. Painful Palpation of the Tibial Insertion of the Anterolateral Ligament Is Concordant With Acute Anterolateral Ligament Injury. Orthop J Sports Med 2020; 8:2325967120930200. [PMID: 32637433 PMCID: PMC7322822 DOI: 10.1177/2325967120930200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 03/04/2020] [Indexed: 01/26/2023] Open
Abstract
Background The anterolateral ligament (ALL) has been shown to contribute to the rotational stability of the knee. However, no clinical sign specific to ALL injury has been described. Purpose/Hypothesis The primary aim of this study was to determine the concordance between pain elicited upon ALL palpation and ALL injury diagnosed by ultrasonography (US). The secondary aim was to look for a relationship between ALL injury and high-grade pivot shift. We hypothesized that an ALL lesion can be diagnosed clinically in an acute knee injury by palpating its tibial insertion. Study Design Cohort study (diagnosis); Level of evidence, 2. Methods A total of 130 patients (89 men, 41 women; mean age, 27.2 ± 8.3 years) with an acute, isolated anterior cruciate ligament injury who were scheduled for ligament reconstruction were enrolled in this study. ALL palpation was carried out a mean 8.8 ± 3.2 days after injury. Preoperatively, ALL integrity was evaluated with US, and the pivot shift was determined under general anesthesia. The agreement between pain upon ALL palpation and ALL injury detected on US was determined by calculating the intraclass correlation coefficient (ICC), along with 95% CIs. Results Distal palpation of the ALL tibial insertion elicited pain in 67 (51.5%) patients, and upon US the ALL was found to be damaged in 64 (49.2%) patients. The agreement between pain over the ALL tibial insertion and the ALL being damaged on US was excellent (ICC, 0.801; 95% CI, 0.730-0.855). Moreover, the clinical test had excellent sensitivity (92%; 95% CI, 88%-97%) and specificity (88%; 95% CI, 82%-93%). The agreement between pain at the ALL distal insertion and the pivot shift was good (ICC, 0.654; 95% CI, 0.543-0.742), and ALL palpation had excellent diagnostic accuracy for identifying rotational instability (sensitivity, 88% [95% CI, 82%-93%]; specificity, 97% [95% CI, 94%-100%]). Conclusion Palpation of the ALL tibial insertion highly correlates with ultrasonographic evidence of an ALL injury in the context of an acute knee injury. This simple test should become part of our standard examination when evaluating patients with acute knee injuries.
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Affiliation(s)
- Jérôme Murgier
- Aguiléra Private Clinic, Ramsey Santé, Orthopedic Department, Biarritz, France
| | - Pierre Thomas
- Department of Orthopedic Surgery, Hôpital Pierre Paul Riquet, CHU Toulouse, Rue Jean Dausset, Toulouse, France.,SPS Research, Toulouse, France
| | - Nicolas Reina
- Department of Orthopedic Surgery, Hôpital Pierre Paul Riquet, CHU Toulouse, Rue Jean Dausset, Toulouse, France
| | - Rémi Sylvie
- Department of Orthopedic Surgery, Hôpital Pierre Paul Riquet, CHU Toulouse, Rue Jean Dausset, Toulouse, France
| | - Emilie Bérard
- Department of Epidemiology, Health Economics and Public Health, UMR1027 INSERM-University of Toulouse III, Toulouse University Hospital, Toulouse, France
| | - Etienne Cavaignac
- Department of Orthopedic Surgery, Hôpital Pierre Paul Riquet, CHU Toulouse, Rue Jean Dausset, Toulouse, France.,SPS Research, Toulouse, France
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Shekari I, Shekarchi B, Abbasian M, Minator Sajjadi M, Momeni Moghaddam A, Kazemi SM. Predictive Factors Associated with Anterolateral Ligament Injury in the Patients with Anterior Cruciate Ligament Tear. Indian J Orthop 2020; 54:655-664. [PMID: 32850030 PMCID: PMC7429582 DOI: 10.1007/s43465-020-00159-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 05/27/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND The earlier studies did not assess the associated factors of anterolateral ligament injury, comprehensively. We sought to evaluate the independent predictive factors of anterolateral ligament injury in the patients with anterior cruciate ligament tear. Ultrasound scan has an emerging role in the diagnosis of anterolateral ligament injury. MATERIALS AND METHODS We included 198 patients with anterior cruciate ligament tear in this study. All the patients underwent knee ultrasound scan to diagnose the anterolateral ligament injury. The potential predictive factors of anterolateral ligament injury were compared between the patients with anterolateral ligament injury and the patients with the intact anterolateral ligament. RESULTS In all the patients, the anterolateral ligament was seen in the tibial and femoral portions using the ultrasound scan. One hundred and ten patients (55.6%) had anterolateral ligament injury and the anterolateral ligament was intact in 88 patients (44.4%). The lateral collateral ligament injury was significantly associated with the anterolateral ligament injury (p < 0.001). In addition, the iliotibial band injury had a significant relationship with the anterolateral ligament injury (p = 0.001). An increased lateral tibial slope was significantly associated with the anterolateral ligament injury (p = 0.031). Furthermore, the bone contusion of the lateral femoral condyle had a significant relationship with the anterolateral ligament injury (p = 0.004). CONCLUSION The independent predictors of anterolateral ligament injury included the lateral collateral ligament injury, iliotibial band injury, bone contusion of the lateral femoral condyle, and an increased lateral tibial slope.
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Affiliation(s)
- Iraj Shekari
- grid.411259.a0000 0000 9286 0323Radiology Research Center, AJA University of Medical Sciences, Tehran, Iran
| | - Babak Shekarchi
- grid.411259.a0000 0000 9286 0323Department of Radiology, AJA University of Medical Sciences, Etemadzadeh Street, Fatemi Avenue, Tehran, 1411718541 Iran
| | - Mohammadreza Abbasian
- grid.411600.2Department of Orthopedic Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Amin Momeni Moghaddam
- grid.411600.2Department of Radiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyyed Morteza Kazemi
- grid.411600.2Department of Orthopedic Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Visualization of Concurrent Anterolateral and Anterior Cruciate Ligament Injury on Magnetic Resonance Imaging. Arthroscopy 2020; 36:1086-1091. [PMID: 31926615 DOI: 10.1016/j.arthro.2019.09.039] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 09/18/2019] [Accepted: 09/25/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the ability to visualize the anterolateral ligament (ALL) on magnetic resonance imaging (MRI) and identify ALL injuries in an intact- anterior cruciate ligament (ACL) and torn-ACL cohort. We also aimed to assess inter-rater reliability between 2 radiologists when it comes to the aforementioned assessment. METHODS MRIs that met inclusion and exclusion criteria were placed into a control (ACL-intact) or study (ACL-injured) cohort. MRIs were independently analyzed by 2 radiologists for data points pertaining to demographics, ALL visualization, presence of ALL injury, and concomitant knee abnormalities. Inter-rater reliabilities for visualizing the ALL and identifying ALL injuries were assessed. RESULTS The control and study groups consisted of 116 and 82 MRIs, respectively. Age varied between the 2 groups, but sex distribution was similar. With near-perfect agreement (kappa = 0.92), both radiologists visualized at least part of the ALL in more than 95% of MRIs irrespective of ACL integrity. The mean incidence of ALL injury in the ACL injured group was 53.05% with minimal inter-rater agreement (kappa = 0.38). Segond fractures were noted in a mean 13.95% of MRIs with concomitant ALL and ACL injuries. CONCLUSIONS The ALL was reliably visualized on MRI irrespective of whether the ACL was intact or torn. However, ALL injuries were not reliably diagnosed on MRI in the setting of an ACL tear. Poor interobserver reliability shows the potential for false-positive and -negative interpretation. These findings suggest that, in this study, ALL injuries could not be accurately diagnosed in the presence of an ACL tear using MRI. On the basis of these findings, it is recommended that physicians should not rely on MRI to diagnose an ALL injury in the presence of an ACL injury. LEVEL OF EVIDENCE Level III, retrospective comparative trial.
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The anterolateral ligament of the knee joint: a review of the anatomy, biomechanics, and anterolateral ligament surgery. Knee Surg Relat Res 2019; 31:12. [PMID: 32660576 PMCID: PMC7219606 DOI: 10.1186/s43019-019-0012-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 09/11/2019] [Indexed: 01/26/2023] Open
Abstract
Residual knee instability and low rates of return to previous sport are major concerns after anterior cruciate ligament (ACL) reconstruction. To improve outcomes, surgical methods, such as the anatomical single-bundle technique or the double-bundle technique, were developed. However, these reconstruction techniques failed to adequately overcome these problems, and, therefore, new potential answers continue to be of great interest. Based on recent anatomical and biomechanical studies emphasizing the role of the anterolateral ligament (ALL) in rotational stability, novel surgical methods including ALL reconstruction and anterolateral tenodesis have been introduced with the possibility of resolving residual instability after ACL reconstruction. However, there is still little consensus on many aspects of the ALL, including: several anatomical issues, appropriate indications for ALL surgery, and the optimal surgical method and graft choice for reconstruction surgery. Therefore, further studies are necessary to advance our knowledge of the ALL and its contribution to knee stability.
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Andrade R, Rebelo-Marques A, Bastos R, Zaffagnini S, Seil R, Ayeni OR, Espregueira-Mendes J. Author Reply to "Regarding 'Identification of Normal and Injured Anterolateral Ligaments of the Knee: A Systematic Review of Magnetic Resonance Imaging Studies'". Arthroscopy 2019; 35:2258-2260. [PMID: 31395157 DOI: 10.1016/j.arthro.2019.05.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 05/31/2019] [Indexed: 02/02/2023]
Affiliation(s)
- Renato Andrade
- Clínica do Dragão, Espregueira-Mendes Sports Centre, FIFA Medical Centre of Excellence; Dom Henrique Research Centre; Faculty of Sports, University of Porto, Porto, Portugal
| | - Alexandre Rebelo-Marques
- Clínica do Dragão, Espregueira-Mendes Sports Centre, FIFA Medical Centre of Excellence; Dom Henrique Research Centre, Porto, Portugal; Faculty of Medicine, University of Coimbra; Instituto de Investigação Clínica e Biomédica de Coimbra, Coimbra, Portugal
| | - Ricardo Bastos
- Clínica do Dragão, Espregueira-Mendes Sports Centre, FIFA Medical Centre of Excellence; Dom Henrique Research Centre, Porto, Portugal; Fluminense Federal University, Niteroi, Rio de Janeiro, Brazil
| | - Stefano Zaffagnini
- Rizzoli Orthopaedic Institute, University of Bologna; 2nd Orthopaedic and Traumatology Clinic, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Romain Seil
- Département de l'Appareil Locomoteur, Centre Hospitalier de Luxemburg; Sports Medicine Research Laboratory, Luxembourg Institute of Health, Luxembourg, Luxembourg
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - João Espregueira-Mendes
- School of Medicine, University of Minho, Braga, Portugal; Clínica do Dragão, Espregueira-Mendes Sports Centre, FIFA Medical Centre of Excellence; Dom Henrique Research Centre, Porto, Portugal; ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
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Editorial Commentary: Anterolateral Ligament-Anatomy, Evaluation, and Future Applications to Knee Stability. Arthroscopy 2019; 35:2143-2145. [PMID: 31272634 DOI: 10.1016/j.arthro.2019.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 04/03/2019] [Indexed: 02/02/2023]
Abstract
Magnetic resonance imaging evaluation of anterolateral ligament injury may be reliable for individuals experienced and trained to identify it, but it does not reference a diagnostic gold standard. The structural anatomy and radiographic diagnosis may differ from those of more traditional ligaments, which should influence concepts of reconstruction.
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Helito CP, Helito PVP, Assirati LFB, Longo CH, Bordalo-Rodrigues M, Souza FFD. Magnetic Resonance Imaging Evaluation of the Anterolateral Ligament in Acute Anterior Cruciate Ligament Injuries in an Adolescent Population. Arthroscopy 2019; 35:2136-2142. [PMID: 31272633 DOI: 10.1016/j.arthro.2019.02.034] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 02/15/2019] [Accepted: 02/17/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the frequency of anterolateral ligament (ALL) injuries in acute anterior cruciate ligament (ACL) injuries in adolescent patients using magnetic resonance imaging (MRI) and characterize other potential intra- and extra-articular knee injuries that are associated with ALL injuries. METHODS Patients between 14 and 17 years of age with acute ACL injuries (trauma for <3 weeks before examination) were retrospectively evaluated with MRI over 24 months (January 2016-December 2017). Among this population, ALL was classified as not visible, normal, or injured. Injuries were separated into strains (partial injuries), complete injuries, or Segond fractures. Possible abnormalities of the menisci, collateral ligaments, popliteal tendon, posterior cruciate ligament (PCL), iliotibial tract (ITT), and bone injuries were evaluated. Associations were calculated between ALL injuries and injuries of these other knee structures, as well as age and gender. RESULTS ALL was visible in 171 of the 184 MRI-evaluated knees (92.9%). ALL was considered normal in 68 (39.8%) and damaged in 103 (60.2%) patients. ALL injuries were considered partial in 56 (54.4%) and total in 44 (42.7%) cases. Only 3 (2.9%) cases were Segond fractures. ALL injuries were associated with ITT (P < .0001), lateral meniscus (P = .04), lateral collateral ligament (P = .01), popliteal tendon (P = .001), and medial collateral ligament (P = .009) injuries, in addition to bone contusions in the lateral compartment of the knee (P < .0001). There was no correlation between ALL injuries and medial meniscus (P = .054) or PCL (P = .16) injuries. CONCLUSIONS MRI evaluation showed ALL injuries are present in 60.2% of acute ACL injuries in adolescent patients. These injuries are associated with the medial and lateral collateral ligaments, ITT, lateral meniscus injuries, and bone contusions, but they are not associated with medial meniscus or PCL injuries. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Camilo Partezani Helito
- Hospital Sírio-Libanês, São Paulo, Brazil; Grupo de Joelho, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Paulo Victor Partezani Helito
- Hospital Sírio-Libanês, São Paulo, Brazil; Grupo de Radiologia Musculo-esquelética, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | | | - Marcelo Bordalo-Rodrigues
- Hospital Sírio-Libanês, São Paulo, Brazil; Grupo de Radiologia Musculo-esquelética, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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