3T MRI-based anatomy of the anterolateral knee ligament in patients with and without an ACL-rupture: Implications for anatomical anterolateral ligament reconstruction.

Abstract

Anterior cruciate ligament (ACL) rupture is often accompanied by an injury to the anterolateral ligament (ALL) of the knee. Detailed knowledge of the ALL attachments in ACL-ruptured patients is essential for an anatomical ALL reconstruction to avoid knee over-constraint and successfully treat the residual rotational instability. The aim of the present study was to investigate the three-dimensional (3D), topographic anatomy of the ALL attachment in both ACL-ruptured and ACL-intact patients using 3 Tesla magnetic resonance imaging (3T MRI). In the present, retrospective case-control study, the magnetic resonance images of 90 knees with an ACL-rupture and 90 matched-controlled subjects, who suffered a non-contact knee injury without an ACL-rupture, were used to create 3D models of the knee. The femoral and tibial ALL footprints were outlined on each model, and their position was measured using an anatomical coordinate system. The femoral origin of the ALL was located 4.9 ± 2.8 mm posterior and 3.8 ± 2.4 mm proximal to the lateral epicondyle in a non-isometric location in control subjects. In ACL-ruptured patients, it was located in a more posterior and distal, at 6.0 ± 1.9 mm posterior and 2.4 ± 1.7 mm proximal to the lateral epicondyle (p < 0.01), also in a non-isometric location. No difference was found in the tibial ALL insertion between groups. The femoral ALL origin was significantly different in ACL-ruptured patients compared to ACL-intact patients. The recommended femoral tunnel position for the anatomical ALL reconstruction, does not represent the femoral ALL origin in the ACL-ruptured knee.