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首页> 外文期刊>Orthopaedic Journal of Sports Medicine >MRI Evaluation of the Anterolateral Ligament of the Knee In The Setting of ACL Rupture
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MRI Evaluation of the Anterolateral Ligament of the Knee In The Setting of ACL Rupture

机译：ACL破裂时膝关节前外侧韧带的MRI评估

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Objectives: The anterolateral ligament (ALL) of the knee was recently described in the literature. It was hypothesized to help control internal tibial rotation and affect the pivot shift phenomenon. The purpose of this study was to identify the normal appearance of the ALL on magnetic resonance imaging (MRI) and to examine its role in stability of the knee. Methods: A retrospective chart review was performed and 50 patients from a single surgeon’s practice with full thickness anterior cruciate ligament tears over a 2 year period were selected at random. Operative reports detailing the pivot shift examination under anesthesia were documented. Preoperative MRIs were reviewed by a fellowship trained musculoskeletal radiologist. Axial, sagittal, and coronal cuts were used to identify the presence and degree of injury to the ALL (Grade 0-3). The popliteus tendon, lateral collateral ligament, biceps femoris tendon, and iliotibial band were analyzed and graded 0-3. The presence or absence of a Segond fracture was noted. Results: The ALL was identified in 100% of the anterior cruciate ligament deficient knees evaluated. In 27 knees, there was no MRI evidence of ALL injury (Grade 0). A grade 1 injury was noted in 18 knees. A grade 2 injury was noted in 2 knees. A grade 3 injury was observed in only 1 knee. This was the same knee in which the single Segond fracture among the group was noted. Eighty four percent (42/50) of knees showed a positive pivot shift on examination under anesthesia. A positive pivot shift was noted in 37 patients who had no (Grade 0) or mild (Grade 1) ALL injury. Thirteen MRIs showed evidence of injury to the posterolateral corner structures, with 92% (12/13) consisting of mild (Grade 1) injuries. Conclusion: The anterolateral ligament of the knee is readily identifiable on MRI. Its structural integrity was maintained in the overwhelming majority of knees with a complete tear of the ACL, both with and without the presence of rotatory instability on examination. We found no correlation between degree of injury to the ALL and degree of instability. The only complete rupture of the ligament was in the setting of complete rupture of the IT band, which supports its identity as an extension of the IT band. Therefore, we propose that the ALL in itself plays a minimal if any role in stability of the knee. Further biomechanical studies are needed to confirm this.
机译：目的：最近文献中描述了膝盖的前外侧韧带（ALL）。据推测，这有助于控制胫骨内部旋转并影响枢轴移位现象。这项研究的目的是确定ALL在磁共振成像（MRI）上的正常外观，并检查其在膝关节稳定性中的作用。方法：进行回顾性图表审查，随机选择50名来自单名外科医生的手术，在2年的时间里全厚度的前交叉韧带撕裂。记录了详细记录麻醉下枢轴移位检查的手术报告。术前核磁共振成像由一位经过研究的肌肉骨骼放射医师审查。使用轴向，矢状和冠状切口来确定ALL的存在和程度（0-3级）。分析了lite肌腱，外侧副韧带，股二头肌腱和胫束，并将其分级为0-3。注意到是否存在Segond骨折。结果：在所有评估的前交叉韧带不足膝盖中，有100％鉴定出ALL。在27个膝盖中，没有MRI证实ALL损伤的证据（0级）。在18个膝盖中发现1级受伤。在2个膝盖中发现2级受伤。仅1个膝盖观察到3级损伤。这是同一组膝盖中唯一的Segond骨折。百分之八十四（42/50）的膝盖在麻醉下检查中显示出正向枢轴偏移。在无（0级）或轻度（1级）ALL损伤的37例患者中，观察到阳性枢轴移位。十三次MRI显示有后外侧角结构受伤的证据，其中92％（12/13）包括轻度（1级）损伤。结论：膝关节前外侧韧带在MRI上易于辨认。无论是否有旋转不稳检查，在绝大多数膝关节中，其ACL完全撕裂都可以维持其结构完整性。我们发现ALL的受伤程度与不稳定程度之间没有关联。韧带唯一的完全破裂是在IT乐队完全破裂的情况下进行的，这支持了其作为IT乐队的延伸的身份。因此，我们建议ALL本身在膝关节稳定性方面起着最小的作用。需要进一步的生物力学研究来证实这一点。

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