Three-dimensional Magnetic Resonance Imaging of the Anterolateral Ligament of the Knee: An Evaluation of Intact and Anterior Cruciate Ligament-Deficient Knees From the Scientific Anterior Cruciate Ligament Network International (SANTI) Study Group

Arthroscopy. 2018 Jul;34(7):2207-2217. doi: 10.1016/j.arthro.2018.02.014. Epub 2018 May 2.


Purpose: To determine the visualization rate of the anterolateral ligament (ALL) in uninjured and anterior cruciate ligament (ACL)-deficient knees using 3-dimensional (3D) magnetic resonance imaging (MRI) and to characterize the spectrum of ALL injury observed in ACL-deficient knees, as well as determine the interobserver and intraobserver reliability of a 3D MRI classification of ALL injury.

Methods: A total of 100 knees (60 ACL deficient and 40 uninjured) underwent 3D MRI. The ALL was evaluated by 2 blinded orthopaedic surgeons. The ALL was classified as follows: type A, continuous, clearly defined low-signal band; type B, warping, thinning, or iso-signal changes; and type C, without clear continuity. The comparison between imaging performed early after ACL injury (<1 month) and delayed imaging (>1 month) was evaluated, as was intraobserver and interobserver reliability.

Results: Complete visualization of the ALL was achieved in all uninjured knees. In the ACL-deficient group, 24 knees underwent early imaging, with 87.5% showing evidence of ALL injury (3 normal, or type A, knees [12.5%], 18 type B [75.0%], and 3 type C [12.5%]). The remaining 36 knees underwent delayed imaging, with 55.6% showing evidence of injury (16 type A [44.4%], 18 type B [50.0%], and 2 type C [5.6%]). The difference in the rate of injury between the 2 groups was significant (P = .03). Multivariate analysis showed that the delay from ACL injury to MRI was the only factor (negatively) associated with the rate of injury to the ALL. Interobserver reliability and intraobserver reliability of the classification of ALL type were good (κ = 0.86 and κ = 0.93, respectively).

Conclusions: Three-dimensional MRI allows full visualization of the ALL in all normal knees. The rate of injury to the ALL in acutely ACL-injured knees identified on 3D MRI is higher than previous reports using standard MRI techniques. This rate is significantly higher than the rate of injury to the ALL identified on delayed imaging of ACL-injured knees.

Level of evidence: Level IV, diagnostic, case-control study.

Publication types

  • Evaluation Study

MeSH terms

  • Adolescent
  • Adult
  • Anterior Cruciate Ligament / diagnostic imaging*
  • Anterior Cruciate Ligament / pathology
  • Anterior Cruciate Ligament / surgery
  • Anterior Cruciate Ligament Injuries / diagnostic imaging*
  • Anterior Cruciate Ligament Injuries / pathology
  • Anterior Cruciate Ligament Injuries / surgery
  • Case-Control Studies
  • Double-Blind Method
  • Female
  • Humans
  • Imaging, Three-Dimensional
  • Knee Joint*
  • Ligaments, Articular / diagnostic imaging*
  • Ligaments, Articular / pathology
  • Ligaments, Articular / surgery
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Reproducibility of Results
  • Young Adult