MRI Study of Anterolateral Ligament and Its Association with Knee Injury-Dr. Mohammad Salim

1. MRI study of the Anterolateral Ligament
& its association with Knee injury
Mohammad Salim – Sr. Registrar
Shafiq Mohammed – Registrar
Amol Sanap – Sr. Registrar
Shreyash Gajjar - Consultant

2. Introduction
BBC 7 November 2013
NEWS HEALTH
“New ligament discovered in knee, Belgian Surgeons say
it could protect as we twist or change direction”

3. Objectives of the study
• To determine the ease in identifying the
ALL on MRI scans.
• To determine any association of tear of ALL
with other intra-articular knee injury.

4. Materials & Method
• 100 Knee MRI scans (98 patients).

5. Materials & Method
• 161 Knee 3T MRI scans (160 patients).
• M = 105, F = 56.
• Mean age 30.6 years (19-56 yrs).

6. Materials & Method
• Inclusion criteria - Adults, Knee injury
• Exclusion criteria - Previous Knee surgery
- Knee dislocation
- OA >Kellegren-Lawrence Gr. II
- Inflammatory arthritis
- Haemophilia
- Knee tumour

7. Materials & Method
• MRI Scan protocol-
• T1 , T2 (fat saturation, PD – Fast spin Echo)

8. Materials & Method
• MRI Scan evaluation
- 2 trained Observers
- ALL tear +/- assoc. injuries
- ALL divided into 3 parts

9. Materials & Method
• MRI Scan evaluation
- 2 trained Observers
- ALL divided into 3 parts

10. Materials & Method
• MRI Scan evaluation
- 2 trained Observers
- ALL divided into 3 parts

11. Materials & Method
• MRI Scan evaluation

12. Results
• Entire ALL identified in all 161 knee MRIs (100%).
• Best seen - Coronal plane T2 with fat saturation.
- PD weighted fast spin Echo sequences.

13. Results
Observer 1 Observer 2
ALL Intact 127 of 161
(79%)
126 of 161
(79%)
ALL Torn 34 of 161(21%) 35 of 161(21%)
ALL + ACL 26 of 66 (39%) 26 of 65 (40%)
Inter-rater
Agreement
(k)
0.896 – 1.000 (95% CI)

14. Discussion
Given its structure, anatomic location,
the ALL is hypothesized to control internal
tibial rotation and thus to affect the pivot
shift phenomenon, although further studies
are needed to investigate its biomechanical
function.

15. Discussion
• 206 MRI Scans of patients with ACL rupture.
• 162 patients (78.8%) – ALL + ACL tear.
• Further research reqd. to establish the clinical relevance
of associated radiological ALL damage in ACL injured
knees.

16. Discussion
• It is tempting to speculate that the ALL may have a
role in controlling pivot shift. However, more work is
needed to confirm its function.

17. Conclusions
• ALL was visualized on all 3T MRI Scans.
• ALL tear was present in 21% knees.
• 40% patients had combined tear of ALL + ACL.
• Clinical studies are reqd. to determine
whether ALL contributes to pivot shift ??

18. Thank-you