Abstract
PurposeWe aimed to identify the anterolateral ligament (ALL) tears in anterior cruciate ligament (ACL)-deficient knees using standard 1.5-Tesla magnetic resonance imaging (MRI).MethodsWe included all patients who underwent primary ACL reconstruction at our center between 2012 and 2015. Exclusion criteria included patients with multiple ligament injuries, lateral collateral ligament, posterolateral corner, and infections, and patients who underwent MRI more than 2 months after their injury. All patients (n = 148) had ACL tears that were subsequently arthroscopically reconstructed. The magnetic resonance (MR) images of the injured knees performed within 2 months of injury were reviewed by a musculoskeletal radiologist and an orthopedic surgeon. The patients were divided into two groups. The first group of patients had MRI performed within 1 month of injury. The second group of patients had MRI performed 1–2 months after the index injury. Both assessors were blinded and the MR mages were read separately to assess the presence of ALL, presence of a tear and the location of the tear. Based on their readings, interobserver agreement (kappa statistic (K)), sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were compared.ResultsThe ALL was identified in 100% of the patients. However, there was a discrepancy of up to 15% in the identification of tear of the ALL. In the first group in which MRI scans were performed within 1 month of injury, the ALL tear was identified by the radiologist in 92% of patients and by the surgeon in 90% of patients (Κ = 0.86). In the second group in which MRI scans were performed within 1–2 months of the injury, the ALL tear was identified by the radiologist in 78% of patients and by the surgeon in 93% of patients (K = 0.62).ConclusionThe ALL can be accurately identified on MRI, but the presence and location of ALL tear and its location cannot be reliably identified on MRI. The accuracy in identification and characterization of a tear was affected by the interval between the time of injury and the time when the MRI was performed.Level of evidenceDiagnostic, level IIIb, retrospective.
Highlights
Claes et al described the presence of the anterolateral ligament (ALL) consistently seen in the lateral side of the knee
Identification of the ALL The ALL was identified on the magnetic resonance imaging (MRI) images in all patients across the two groups
The strengths of our study are the following: (1) all MRI examinations in our study were performed using the same standard sequence using the 1.5 Tesla MRI machine at our center; (2) all magnetic resonance (MR) images were read by two specialists; (3) we stratified our cohort based on the time interval between the index injury and the acquisition of MRI; and (4) we studies a larger sample of patients than most of the other studies published on this topic
Summary
Claes et al described the presence of the anterolateral ligament (ALL) consistently seen in the lateral side of the knee. Macchi et al and Helito et al described the visibility of the three segments of the intact ALL in the uninjured knee, but did not examine knees with ALL tears [7, 8]. Other studies have evaluated agreement between musculoskeletal (MSK) radiologists or between MSK radiologists and orthopedic surgeons, with regards to the ALL, ALL tears, and the location of ALL tears seen on MRI. Taneja reported good agreement (kappa (K) = 0.70) between two MSK radiologists in identifying the presence of the ALL as a structure [9]. Kizilgovz reported good agreement (K = 0.784–1) for the visibility of the various parts of the ALL [10]
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