Purpose
To identify the normal and injured magnetic resonance imaging appearance of the anterolateral
ligament (ALL).
Methods
A systematic review was performed using PRISMA (Preferred Reporting Items for Systematic
Reviews and Meta-Analyses) guidelines. The PubMed and Cochrane Library electronic
databases were used to search for studies that reported the imaging outcomes of the
appearance of the ALL. Two authors performed the searches in duplicate up to April
30, 2018, and interobserver agreement was calculated. The methodologic quality of
included articles was assessed using an adaptation of the Arrivé methodologic quality
scale for clinical studies of radiologic examinations.
Results
From the original 270 records, a total of 24 studies (κ = 0.94) comprising 2,427 knees
in 2,388 patients (mean age, 33.3 years; 66% male patients; 63% with anterior cruciate
ligament [ACL] injury) were included. The ALL appeared in 51% to 100% of all assessed
knees (71%-100% in ACL-injured knees and 64%-97% in uninjured knees) and was injured
in 11% to 79% of ACL-injured knees. Reliability rates varied considerably (0.04-1.0
for intraobserver and 0.143-1.0 for interobserver agreement), and the entire portion
of the ligament was often not seen. The tibial insertion was seen in 21% to 96% of
cases, followed by the meniscal (range, 0%-100%) and femoral (range, 0%-90%) insertions.
The mean methodologic quality score was 5.1 ± 1.8 out of a possible score of 9.
Conclusions
High variability was found in the identification of normal and injured ALL definition
methods and the respective magnetic resonance imaging findings. Reliability rates
varied considerably, and the entire portion of the ligament was often not seen.
Level of Evidence
Level IV, systematic review of Level II to IV studies.
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Article info
Publication history
Published online: April 15, 2019
Accepted:
October 25,
2018
Received:
June 22,
2018
Footnotes
See commentary on page 1614
The authors report the following potential conflicts of interest or sources of funding: S.Z. is a consultant for Smith & Nephew and DePuy outside of the submitted work. O.R.A. is on the speaker's bureau for ConMed and receives a research grant from AANA, outside of the submitted work. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
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© 2019 by the Arthroscopy Association of North America
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- Regarding “Identification of Normal and Injured Anterolateral Ligaments of the Knee: A Systematic Review of Magnetic Resonance Imaging Studies”ArthroscopyVol. 35Issue 8
- PreviewWe would like to commend the authors of the article “Identification of Normal and Injured Anterolateral Ligaments of the Knee: A Systematic Review of Magnetic Resonance Imaging Studies.”1 We completely agree with the main findings, which were that the literature up until April 2018 (the end date of the literature search) reported high variability in the rates of identification of the anterolateral ligament (ALL), and also the rates of injury in anterior cruciate ligament (ACL)-deficient knees. Andrade et al.
- Full-Text
- Preview
- Editorial Commentary: Magnetic Resonance Imaging of the Knee Anterolateral Ligament: Does It Really Matter?ArthroscopyVol. 35Issue 5
- PreviewGreat interest remains in the structures of the knee anterolateral complex and how they work synergistically with the anterior cruciate ligament to control anterolateral rotatory laxity. Many studies have now used magnetic resonance imaging to assess the degree of damage to the anterolateral ligament. The systematic review described in this commentary rigorously highlights the many deficiencies that exist within our current understanding of the imaging analysis of these structures. Marked variability in the definition of anterolateral ligament injury, significant methodological differences, and the lack of a gold standard reference make it very challenging to translate the findings of these imaging studies into clinical practice.
- Full-Text
- Preview
