MRI visibility of the anterolateral ligament and the deep structures of the iliotibial tract

Abstract Purpose To determine the accuracy of detection, injury rate and inter- and intrarater reproducibility in visualizing lesions to the anterolateral ligament (ALL) and the deep portion of the iliotibial tract (dITT) in anterior cruciate ligament (ACL) deficient knees. Methods Ninety-one consecutive patients, out of those 25 children (age 14.3 ± 3.5 years), with diagnosed ACL tears were included. Two musculoskeletal radiologists retrospectively reviewed MRI data focusing on accuracy of detection and potential injuries to the ALL or dITT. Lesion were diagnosed in case of discontinued fibers in combination with intra- or peri-ligamentous edema and graded as intact, partial or complete tears. Cohen’s Kappa and 95% confidence intervals (95% CI) were determined for inter- and intrarater reliability measures. Results The ALL and dITT were visible in 52 (78.8%) and 56 (84.8%) of adult-and 25 (100%) and 19 (76.0%) of pediatric patients, respectively. The ALL was injured in 45 (58.5%; partial: 36.4%, compleate: 22.1%) patients. Partial and comleate tears, where visualized in 21 (40.4%) and 16 (30.8%) adult- and seven (28.0%) and one (4%) peditric patients. A total of 16 (21.3%; partial: 13.3%, compleate: 8.0%) dITT injuries were identified. Partal and complete lesions were seen in seven (12.5%) and five (8.9%) adult- and three (15.8%) and one (5.3%) pediatric patients. Combined injuries were visualized in nine (12.7%) patients. Inter-observer (0.91–0.95) and intra-observer (0.93–0.95) reproducibility was high. Conclusion In ACL injured knees, tears of the ALL are observed more frequently compared to lesions to the deep iliotibial tract. Combined injuries of both structures are rare. Clinically, the preoperative visualization of potentially injured structures of the anterolateral knee is crucial and is important for a more personalized preoperative planning and tailored anatomical reconstruction. The clinical implication of injuries to the anterolateral complex of the knee needs further investigation. Level of evidence II.

Download Full-text

The anterolateral ligament and the deep structures of the iliotibial tract: MRI visibility in the paediatric patient

Injury ◽

10.1016/j.injury.2018.10.040 ◽

2019 ◽

Vol 50 (2) ◽

pp. 602-606 ◽

Cited By ~ 2

Author(s):

M.C. Liebensteiner ◽

B. Henninger ◽

C. Kittl ◽

R. Attal ◽

J.M. Giesinger ◽

...

Keyword(s):

Paediatric Patient ◽

Anterolateral Ligament ◽

Iliotibial Tract

Download Full-text

Diagnostic findings caused by cutting of the iliotibial tract and anterolateral ligament in an ACL intact knee using a standardized and automated clinical knee examination

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-017-4499-5 ◽

2017 ◽

Vol 25 (4) ◽

pp. 1161-1169 ◽

Cited By ~ 3

Author(s):

Timothy Lording ◽

Shaun K. Stinton ◽

Philippe Neyret ◽

Thomas P. Branch

Keyword(s):

Anterolateral Ligament ◽

Iliotibial Tract ◽

Intact Knee

Download Full-text

Anatomical Consideration of the Anterolateral Ligament of the Knee

BioMed Research International ◽

10.1155/2019/5740473 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6 ◽

Cited By ~ 2

Author(s):

Ho-Jung Cho ◽

Dai-Soon Kwak

Keyword(s):

Tibial Plateau ◽

Anterolateral Ligament ◽

Lateral Part ◽

Anterior Border ◽

Capsular Ligament ◽

Morphological Variations ◽

Iliotibial Tract ◽

Prevalence Difference ◽

Korean Adult ◽

Length Width

Many researchers have studied the structures of the anterolateral part of the knee. Several researchers have investigated the existence of the anterolateral ligament (ALL) and its frequency has been inconsistently reported. Therefore, we assessed whether the ALL is the anatomical true ligament and studied the morphological variations of this structure. Sixty-four Korean adult cadavers (120 knees, mean age: 79.1 years) were used for this study. The lateral part of the knee joint was carefully dissected with internal rotation of the tibia. We checked the existence and morphological features and measured the dimensions (length, width, and thickness) of the ALL. The ALL was clearly distinguished from the capsulo-osseous layer of the iliotibial tract and runs obliquely from the lateral femoral epicondyle to the tibial plateau. The ALL was found in 42.5% of the samples, and 15 cadavers had ALLs in both knees. There was no prevalence difference between females and males. Most of the anterior border of the ALL was blended with the knee capsule. Therefore, we concluded that this structure is a local thickening of the capsule in the anterolateral region of the knee, where it possibly developed against some external physical stress. Therefore, the ALLs in this present study can be defined as a capsular ligament of the knee and, as per the nomenclature of the capsular ligament, can be also called the ‘anterolateral (capsular) ligament’.

Download Full-text

The anterolateral ligament (ALL) of the knee—Part of the iliotibial tract or a truly separate structure?

Annals of Anatomy - Anatomischer Anzeiger ◽

10.1016/j.aanat.2017.02.010 ◽

2017 ◽

Vol 212 ◽

pp. 1-3 ◽

Cited By ~ 7

Author(s):

Matthias Brockmeyer ◽

Denis Höfer ◽

Katja Schäfer ◽

Romain Seil ◽

Kurt Becker ◽

...

Keyword(s):

Anterolateral Ligament ◽

Iliotibial Tract

Download Full-text

STUDY OF THE ANTEROLATERAL LIGAMENT OF THE KNEE IN FORMALIN-EMBEDDED CADAVERS

Acta Ortopédica Brasileira ◽

10.1590/1413-785220172502162204 ◽

2017 ◽

Vol 25 (2) ◽

pp. 89-92 ◽

Cited By ~ 8

Author(s):

Paloma Batista Almeida Fardin ◽

Juliana Hott de Fúcio Lizardo ◽

Josemberg da Silva Baptista

Keyword(s):

Knee Joint ◽

Cross Sections ◽

Subcutaneous Tissue ◽

Biceps Tendon ◽

Joint Capsule ◽

Anterolateral Ligament ◽

Patellar Ligament ◽

Collateral Ligament ◽

Level Of Evidence ◽

Iliotibial Tract

ABSTRACT Objective: To verify the incidence and characterize morphologically the anterolateral ligament of the knee (ALL) in cadaveric samples of the collection of the Laboratory of Anatomy of the Department of Morphology of the Universidade Federal do Espírito Santo. Methods: Dissections and cross sections were performed for mesoscopic analysis of the anterolateral region of 15 knees preserved in 4% formalin solution in order to identify the ALL. Results: After dissection of the skin and subcutaneous tissue of the knee anterolateral region, it was possible to identify the iliotibial tract (ITT), the patellar ligament and the femoral biceps tendon. The ITT was removed from the Gerdy tubercle and the following structures were visualized: knee joint capsule, fibular collateral ligament and popliteal tendon. However, the ALL was not identified in any of the samples. Conclusions: The ALL could not be identified in any of the specimens studied, either through dissection or mesoscopic analysis. Level of Evidence III, Diagnosis Studies - Investigation of an Exam for Diagnosis.

Download Full-text

Combined Anterior Cruciate Ligament Repair and Anterolateral Ligament Reconstruction With a Single-Strand Gracilis Graft

Arthroscopy Techniques ◽

10.1016/j.eats.2021.01.041 ◽

2021 ◽

Author(s):

Jean-Marie Fayard ◽

Alexandre Penet ◽

Paul-Henri Bauwens ◽

Mathieu Thaunat

Keyword(s):

Anterior Cruciate Ligament ◽

Ligament Reconstruction ◽

Cruciate Ligament ◽

Anterolateral Ligament ◽

Single Strand ◽

Ligament Repair ◽

Anterolateral Ligament Reconstruction ◽

Anterior Cruciate Ligament Repair ◽

Anterior Cruciate

Download Full-text

Graft Preparation for Combined ACL and ALL Reconstruction With a Single Femoral Tunnel

Video Journal of Sports Medicine ◽

10.1177/26350254211004597 ◽

2021 ◽

Vol 1 (3) ◽

pp. 263502542110045

Author(s):

Camilo Partezani Helito ◽

Tales Mollica Guimarães ◽

Marcel Faraco Sobrado

Keyword(s):

Anterior Cruciate Ligament ◽

High Risk ◽

Cruciate Ligament ◽

Anterolateral Ligament ◽

Anatomical Landmarks ◽

High Risk Patients ◽

Risk Patients ◽

Anterior Cruciate ◽

Semitendinosus Graft ◽

Lemaire Procedure

Background: Combined reconstruction of the anterolateral ligament (ALL) and anterior cruciate ligament (ACL) has shown excellent results. It could potentially reduce graft failure and improve outcomes in high-risk patients. There are several surgical techniques described. Hamstrings are the most frequently used graft for ALL reconstruction. The distal portion of the iliotibial band is used for the modified Lemaire procedure. Indications: Anterior cruciate ligament reconstructions associated with the following risk factors: pivoting sports, high-demand athletes, high-grade pivot-shift, chronic ACL injury, lateral femoral condyle notch, Segond fractures, young patients (<20 years), ACL revision, generalized hyperlaxity, and Lachman >7 mm. Technique Description: Semitendinosus and gracilis tendons are harvested and their extremities are prepared with continuous suture. The semitendinosus graft is folded in 3 parts leaving the ends of the graft internalized. The triple semitendinosus will be the main component of the ACL and the single gracilis will be used for both ACL and ALL. Anterolateral ligament anatomical landmarks are proximal and posterior to the lateral epicondyle in the femur, and in the mid distance from the fibular head and the Gerdy tubercle in the tibia. The ALL is fixed in knee extension with interference screws. This video also includes a brief demonstration of graft preparation for the modified Lemaire procedure. Results: Results from our group using this technique have shown excellent clinical outcomes, minimal complications, and low failure rates in high-risk populations. This graft preparation shows excellent diameter and length for combined ACL and ALL reconstruction. Conclusion: This technique is easy to perform, with minimal complications, and should be considered in high-risk patients undergoing ACL reconstruction.

Download Full-text