Injuries to the anterolateral ligament are observed more frequently compared to lesions to the deep iliotibial tract (Kaplan fibers) in ... View Full Text


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Article Info

DATE

2021-03-26

AUTHORS

Armin Runer, Dietmar Dammerer, Christoph Kranewitter, Johannes M. Giesinger, Benjamin Henninger, Michael T. Hirschmann, Michael C. Liebensteiner

ABSTRACT

PurposeTo determine the accuracy of detection, injury rate and inter- and intrarater reproducibility in visualizing lesions to the anterolateral ligament (ALL) and the deep portion of the iliotibial tract (dITT) in anterior cruciate ligament (ACL) deficient knees.MethodsNinety-one consecutive patients, out of those 25 children (age 14.3 ± 3.5 years), with diagnosed ACL tears were included. Two musculoskeletal radiologists retrospectively reviewed MRI data focusing on accuracy of detection and potential injuries to the ALL or dITT. Lesion were diagnosed in case of discontinued fibers in combination with intra- or peri-ligamentous edema and graded as intact, partial or complete tears. Cohen’s Kappa and 95% confidence intervals (95% CI) were determined for inter- and intrarater reliability measures.ResultsThe ALL and dITT were visible in 52 (78.8%) and 56 (84.8%) of adult-and 25 (100%) and 19 (76.0%) of pediatric patients, respectively. The ALL was injured in 45 (58.5%; partial: 36.4%, compleate: 22.1%) patients. Partial and comleate tears, where visualized in 21 (40.4%) and 16 (30.8%) adult- and seven (28.0%) and one (4%) peditric patients. A total of 16 (21.3%; partial: 13.3%, compleate: 8.0%) dITT injuries were identified. Partal and complete lesions were seen in seven (12.5%) and five (8.9%) adult- and three (15.8%) and one (5.3%) pediatric patients. Combined injuries were visualized in nine (12.7%) patients. Inter-observer (0.91–0.95) and intra-observer (0.93–0.95) reproducibility was high.ConclusionIn ACL injured knees, tears of the ALL are observed more frequently compared to lesions to the deep iliotibial tract. Combined injuries of both structures are rare. Clinically, the preoperative visualization of potentially injured structures of the anterolateral knee is crucial and is important for a more personalized preoperative planning and tailored anatomical reconstruction. The clinical implication of injuries to the anterolateral complex of the knee needs further investigation.Level of evidenceII. More... »

PAGES

309-318

References to SciGraph publications

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  • 2021-01-08. The anatomy of Kaplan fibers in ARCHIVES OF ORTHOPAEDIC AND TRAUMA SURGERY
  • 2014-11-27. MRI features of the anterolateral ligament of the knee in SKELETAL RADIOLOGY
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  • 2011-08-30. Navigated knee kinematics after cutting of the ACL and its secondary restraint in KNEE SURGERY, SPORTS TRAUMATOLOGY, ARTHROSCOPY
  • 2015-09-16. Sectioning the anterolateral ligament did not increase tibiofemoral translation or rotation in an ACL-deficient cadaveric model in KNEE SURGERY, SPORTS TRAUMATOLOGY, ARTHROSCOPY
  • 2014-11-08. Anatomic description of the anterolateral ligament of the knee in KNEE SURGERY, SPORTS TRAUMATOLOGY, ARTHROSCOPY
  • 2018-12-28. Magnetic resonance imaging appearances of the capsulo-osseous layer of the iliotibial band and femoral attachments of the iliotibial band in the normal and pivot-shift ACL injured knee in SKELETAL RADIOLOGY
  • 2020-05-06. MRI visibility of the anterolateral ligament and the deep structures of the iliotibial tract in JOURNAL OF EXPERIMENTAL ORTHOPAEDICS
  • 1987-08. Distal femoral fixation of the iliotibial tract in ARCHIVES OF ORTHOPAEDIC AND TRAUMA SURGERY
  • Identifiers

    URI

    http://scigraph.springernature.com/pub.10.1007/s00167-021-06535-6

    DOI

    http://dx.doi.org/10.1007/s00167-021-06535-6

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    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/33770221


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    33 schema:description PurposeTo determine the accuracy of detection, injury rate and inter- and intrarater reproducibility in visualizing lesions to the anterolateral ligament (ALL) and the deep portion of the iliotibial tract (dITT) in anterior cruciate ligament (ACL) deficient knees.MethodsNinety-one consecutive patients, out of those 25 children (age 14.3 ± 3.5 years), with diagnosed ACL tears were included. Two musculoskeletal radiologists retrospectively reviewed MRI data focusing on accuracy of detection and potential injuries to the ALL or dITT. Lesion were diagnosed in case of discontinued fibers in combination with intra- or peri-ligamentous edema and graded as intact, partial or complete tears. Cohen’s Kappa and 95% confidence intervals (95% CI) were determined for inter- and intrarater reliability measures.ResultsThe ALL and dITT were visible in 52 (78.8%) and 56 (84.8%) of adult-and 25 (100%) and 19 (76.0%) of pediatric patients, respectively. The ALL was injured in 45 (58.5%; partial: 36.4%, compleate: 22.1%) patients. Partial and comleate tears, where visualized in 21 (40.4%) and 16 (30.8%) adult- and seven (28.0%) and one (4%) peditric patients. A total of 16 (21.3%; partial: 13.3%, compleate: 8.0%) dITT injuries were identified. Partal and complete lesions were seen in seven (12.5%) and five (8.9%) adult- and three (15.8%) and one (5.3%) pediatric patients. Combined injuries were visualized in nine (12.7%) patients. Inter-observer (0.91–0.95) and intra-observer (0.93–0.95) reproducibility was high.ConclusionIn ACL injured knees, tears of the ALL are observed more frequently compared to lesions to the deep iliotibial tract. Combined injuries of both structures are rare. Clinically, the preoperative visualization of potentially injured structures of the anterolateral knee is crucial and is important for a more personalized preoperative planning and tailored anatomical reconstruction. The clinical implication of injuries to the anterolateral complex of the knee needs further investigation.Level of evidenceII.
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    39 schema:keywords ACL
    40 ACL tears
    41 Cohen's kappa
    42 MRI data
    43 MethodsNinety-one consecutive patients
    44 PurposeTo
    45 accuracy
    46 accuracy of detection
    47 adults
    48 anatomical reconstruction
    49 anterior cruciate ligament-deficient knee
    50 anterolateral complex
    51 anterolateral knee
    52 anterolateral ligament
    53 cases
    54 children
    55 clinical implications
    56 combination
    57 complete lesions
    58 complete tears
    59 complexes
    60 confidence intervals
    61 consecutive patients
    62 data
    63 deep portion
    64 deficient knee
    65 detection
    66 edema
    67 fibers
    68 further investigation
    69 iliotibial tract
    70 imaging
    71 implications
    72 injury
    73 injury rates
    74 inter
    75 interval
    76 intra
    77 intrarater reliability measures
    78 investigation
    79 kappa
    80 knee
    81 lesions
    82 ligament
    83 ligament-deficient knee
    84 magnetic resonance imaging
    85 measures
    86 musculoskeletal radiologists
    87 patients
    88 pediatric patients
    89 personalized preoperative planning
    90 planning
    91 portion
    92 potential injury
    93 preoperative planning
    94 preoperative visualization
    95 radiologists
    96 rate
    97 reconstruction
    98 reliability measures
    99 reproducibility
    100 resonance imaging
    101 structure
    102 tears
    103 total
    104 tract
    105 visualization
    106 schema:name Injuries to the anterolateral ligament are observed more frequently compared to lesions to the deep iliotibial tract (Kaplan fibers) in anterior cruciate ligamant deficient knees using magnetic resonance imaging
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