High prevalence of anterolateral ligament abnormalities on MRI in knees with acute anterior cruciate ligament injuries: a case-control series from the SANTI study group

Ferretti, A., Monaco, E., Redler, A., Argento, G., De Carli, A., Saithna, A. ORCID: 0000-0002-2408-5307, Partezani Helito, P.V. and Partezani Helito, C., 2019. High prevalence of anterolateral ligament abnormalities on MRI in knees with acute anterior cruciate ligament injuries: a case-control series from the SANTI study group. Orthopaedic Journal of Sports Medicine, 7 (6). ISSN 2325-9671

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Abstract

Background:

Broad variation in the reported rate of magnetic resonance imaging (MRI)–detected abnormalities of the anterolateral structures of the anterior cruciate ligament (ACL)–injured knee suggests a lack of reliability that has limited the use of MRI in clinical decision making.

Purpose/Hypothesis:

The aim of this study was to use MRI to determine the prevalence and spectrum of abnormalities of the anterolateral structures in acute ACL-injured knees, using the contralateral uninjured knee as a reference. We hypothesized that MRI evaluation of the acutely injured knee (using the uninjured knee as a reference) would allow reliable identification of abnormalities of the anterolateral structures.

Study Design:

Cohort study (diagnosis); Level of evidence, 3.

Methods:

Patients with acute ACL injury underwent MRI scan of both knees. Images were evaluated by 3 observers. Inter- and intraobserver reliabilities were determined for MRI parameters of anterolateral ligament (ALL) injury by use of the kappa (κ) test. Univariate and multivariate analyses were conducted to test associations between ALL abnormality and associated injuries.

Results:

A total of 34 patients were evaluated. Of these, 30 patients (88.2%) had at least 1 ALL abnormality in the ACL-injured knee (increased signal: n = 27[79.4%]; increased thickness: n = 15[44.1%]; tapering: n = 7[20.6%]; irregularities in the path of the ALL fibers: n = 21[61.7%]). Asymmetries of the genicular vessels were observed in 21 patients (61.7%). ALL abnormality was significantly associated with lateral joint capsular tears (P < .001). No correlation was found between ALL lesions and iliotibial band lesions (P = .49). Inter- and intraobserver reliabilities were very good concerning ALL signal changes and femoral and tibial bone bruises (κ coefficient, 0.81-1).

Conclusion:

MRI evaluation of the ALL was associated with good and very good inter- and intraobserver reliabilities, and it demonstrated abnormalities of the ALL in the majority of acutely ACL-injured knees. The index of suspicion for ALL injury should be elevated by the presence of lesions of the lateral capsule. This suggests that the ALL is part of a wider area of the lateral capsule that is often injured simultaneously in an acute ACL tear.

Item Type: Journal article
Alternative Title: 1.5 Tesla magnetic resonance imaging demonstrates a high prevalence of anterolateral ligament abnormalities in acutely anterior cruciate ligament injured knees: a case-control series comparing against the contralateral uninjured knee from the SANTI study group [working title]
Publication Title: Orthopaedic Journal of Sports Medicine
Creators: Ferretti, A., Monaco, E., Redler, A., Argento, G., De Carli, A., Saithna, A., Partezani Helito, P.V. and Partezani Helito, C.
Publisher: SAGE Publications on behalf of the American Orthopaedic Society for Sports Medicine
Date: 1 June 2019
Volume: 7
Number: 6
ISSN: 2325-9671
Identifiers:
NumberType
10.1177/2325967119852916DOI
Rights: © The Author(s) 2019. This open-access article is published and distributed under the Creative Commons Attribution - NonCommercial - No Derivatives License (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits the noncommercial use, distribution, and reproduction of the article in any medium, provided the original author and source are credited. You may not alter, transform, or build upon this article without the permission of the Author(s). For article reuse guidelines, please visit SAGE’s website at http://www.sagepub.com/journals-permissions.
Divisions: Schools > School of Science and Technology
Depositing User: Jonathan Gallacher
Date Added: 27 Feb 2019 13:55
Last Modified: 16 Jul 2019 13:40
URI: http://irep.ntu.ac.uk/id/eprint/35831

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