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. 2018 Oct-Dec;9(4):312-316.
doi: 10.1016/j.jcot.2017.10.004. Epub 2017 Oct 7.

Anterolateral ligament injuries on magnetic resonance imaging and pivot-shift testing for rotational laxity

Carlos M Barrera  1 , Azael Arizpe  2 , Ross Wodicka  3 , Bryson P Lesniak  4 , Michael G Baraga  2 , Lee Kaplan  2 , Jean Jose  5
Affiliations

Anterolateral ligament injuries on magnetic resonance imaging and pivot-shift testing for rotational laxity

Carlos M Barrera et al. J Clin Orthop Trauma. 2018 Oct-Dec.

Abstract

Maintaining anterolateral rotational stability of the knee requires a complex set of structures, most notably the anterior cruciate ligament. However, lateral knee structures such as the anterolateral ligament (ALL) also play an important role. There has been controversy over the role the ALL plays in an ACL deficient knee to maintain rotational stability. In this study, we examined ACL deficient knees with and without intact ALLs, for rotatory laxity using a pivot shift examination. This was graded using International Knee Document Committee (IKDC) criteria. MRI was used to view the ALL and its status. We found no statistically significant difference in rotational stability of ACL deficient knees, with or without intact ALLs. We did however find a statistically significant association between injury to the ALL and other concomitant lateral structures such as the lateral collateral ligament, biceps femoris tendon, and iliotibial band. This supports that the ALL works in concert with the other lateral structures in the knee and the ACL, to provide rotational stability. This suggests that as an isolated structure, the ALL's contribution to clinical rotational stability is not significant, even in the presence of an ACL tear.

Keywords: Anterolateral ligament; Anterolateral rotational stability; Knee MRI; Pivot shift.

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Figures

Fig. 1
Fig. 1
Axial proton density MR image just below the level of the lateral femoral epicondyle demonstrates the location of the ALL (straight arrow) relative to its neighboring structures, including the popliteus tendon (curved arrow). Both the ALL and fibular collateral ligament (lateral collateral ligament complex) are closely associated at the femoral attachment, and together are part of the deepest layer (III), separate from the iliotibial band (layer I) and lateral patellar retinaculum (layer II).
Fig. 2
Fig. 2
A and B − Coronal PD FS images showing proximal tear of the ALL (arrows).
See this image and copyright information in PMC

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