Summary: In anterior cruciate ligament (ACL) injured knees, tears of the anterolateral ligemant (ALL) are observed more frequently compared to lesions to the deep iliotibial tract (Kaplan fiber complex) while combined injuries of both structures are rare.

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 pediatrics, 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: Level II

Key Words: Anterolateral Ligament, ALL, Iliotibial tract, Iliotibial band Kaplan Fibers, Anterior cruciate ligament rupture, ACL, MRI, Anterolateral knee complex, Knee, Intrarater reliability, Interrater reliability

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Injuries To The Anterolateral Ligament Are Observed More Frequently Compared To Lesions To The Deep Iliotibial Tract (Kaplan Fibers) In Anterior Cruciate Ligamant Deficient Knees Using Magnet Resonance Imaging (Mri)

Injuries To The Anterolateral Ligament Are Observed More Frequently Compared To Lesions To The Deep Iliotibial Tract (Kaplan Fibers) In Anterior Cruciate Ligamant Deficient Knees Using Magnet Resonance Imaging (Mri)

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Injuries To The Anterolateral Ligament Are Observed More Frequently Compared To Lesions To The Deep Iliotibial Tract (Kaplan Fibers) In Anterior Cruciate Ligamant Deficient Knees Using Magnet Resonance Imaging (Mri)

Injuries To The Anterolateral Ligament Are Observed More Frequently Compared To Lesions To The Deep Iliotibial Tract (Kaplan Fibers) In Anterior Cruciate Ligamant Deficient Knees Using Magnet Resonance Imaging (Mri)

Purpose

Methods

Results

Conclusion