2017 ISAKOS Biennial Congress ePoster #1045

 

Anterolateral Ligament Abnormalities are Associated with Peripheral Ligament and Osseous Injuries but not with Meniscal Lesions in Acute Ruptures of the Anterior Cruciate Ligament

Camilo P. Helito, MD, PhD, Prof, São Paulo, SP BRAZIL
Paulo Helito, MD, São Paulo, SP BRAZIL
Renata Vidal, MD, São Paulo BRAZIL
Marcelo B. Bonadio, MD, São Paulo, SP BRAZIL
José R. Pécora, Prof., São Paulo, SP BRAZIL
Marco K. Demange, MD, PhD, São Paulo, SP BRAZIL
Gilberto L. Camanho, MD, São Paulo, SP BRAZIL
Marcelo Bordalo-Rodrigues, MD, São Paulo BRAZIL

Hospital Sírio Libanês, São Paulo, São Paulo, BRAZIL

FDA Status Cleared

Summary

ALL tears are present in around 40% of patients with an acute ACL injury. Lesions are associated with peripheral ligament tears and osseous injuries, but no correlation was found with meniscal tears. Partial ACL lesions are not correlated with an ALL tear. These findings might suggest a higher trauma energy should be necessary to cause an associated ACL and ALL injury.

Abstract

Introduction

The recent interest in the anterolateral ligament yields a breakthrough for diagnosing and treating problematic rotational knee instability. Identifying and eventually treating this structure lesion could change the clinical approach towards some specific groups of ACL-injured subjects. Few studies have used MRI to identify the ALL, and as it was shown that it is not possible to precisely characterize this ligament in all exams, it is important to identify concomitant lesions that can help in diagnosing abnormalities of this structure.
Thus the present study was performed to determine the frequency of ALL injury in patients with acute ACL rupture and to analyze its associated knee lesions

Materials And Methods

We evaluated 228 patients with acute ACL injuries in MRI. All patients had a history of knee sprain maximum three weeks before the images acquisition. The ALL was classified as non-visualized, injured or normal. Injury of the ALL was considered when proximal or distal bone detachment, discontinuity of its fibers, or irregular contour associated with peri-ligamentous edema was observed. The possible abnormalities of the meniscus, collateral ligaments, popliteus tendon, posterior cruciate ligament and osseous injuries were also evaluated. The association of an ALL injury with these other knee injuries as well as gender and age was calculated. The association between and ACL partial tear and an ALL tear was also evaluated.

Results

Among the 228 knees evaluated, the ALL could not be entirely identified in 61 (26.7%), similar to the literature average. Of the remaining 167, 66 (39.5%) presented an ALL abnormality, divided in 30 (45.4%) proximal lesions, six (9.1%) lesions of both proximal and distal portions and 30 (45.4%) distal lesions. Among the distal lesions, only four (6.1%) were Segond fractures. ALL abnormalities were associated with lesions of the lateral collateral ligament (p=0.004), medial collateral ligament (p=0.011) and popliteus tendon (p=0.005) and had an increasing correlation with bone bruises of the femoral condyle and tibial plateau (no bruise<tibial plateau alone<femoral condyle alone<both) (p=0.008). No correlation was found with medial meniscus (p=0.164), lateral meniscus (p=0.637) and the posterior cruciate ligament (p=0.682) injuries. There was no association between ALL injuries and genders (p=0.553) and older patients were more likely to present an ALL injury (p=0.0384). Partial ACL tears were not associated with ALL abnormalities, while complete tears were (p=0.023)

Conclusion

ALL tears are present in around 40% of patients with an acute ACL injury. Segond fractures are only the minority of the ALL abnormalities and should not be the only associated factor with these injuries. These lesions are associated with peripheral ligament tears and have an increasing correlation with osseous injuries, but no correlation was found with meniscal tears. Partial ACL lesions are not correlated with an ALL tear, but complete lesions are. These findings might suggest a higher trauma energy should be necessary to cause an associated ACL and ALL injury.