Helito Camilo Partezani, Helito Paulo Victor Partezani, Leão Renata Vidal, Demange Marco Kawamura, Bordalo-Rodrigues Marcelo
Hospital Sírio-Libanês, São Paulo, Brazil.
Knee Surgery Division, Faculty of Medicine, Institute of Orthopedics and Traumatology, University of São Paulo, São Paulo, Brazil.
Knee Surg Sports Traumatol Arthrosc. 2017 Apr;25(4):1140-1148. doi: 10.1007/s00167-017-4498-6. Epub 2017 Mar 14.
Few studies have used MRI to identify the ALL. As it was shown that it is not possible to precisely characterize this ligament in all examination, it is important to identify concomitant lesions that can help in diagnosing ALL abnormalities. It is important to characterise this injury due to its association with anterolateral knee instability. Thus, the present study was performed to determine the frequency of ALL injuries in patients with acute ACL rupture and to analyse its associated knee lesions.
Patients with acute ACL injuries were evaluated by MRI. Among this population, the ALL was classified as non-visualised, injured or normal. The possible abnormalities of the meniscus, collateral ligaments, popliteus tendon, posterior cruciate ligament, Iliotibial band (ITB), anterolateral capsule and osseus injuries were evaluated. The association of an ALL injury with these other knee structures as well as sex and age was calculated.
Among the 228 knees evaluated, the ALL could not be entirely identified in 61 (26.7%). Of the remaining 167, 66 (39.5%) presented an ALL abnormality and only four (6.1%) were Segond fractures. ALL abnormalities were associated with lesions of the lateral collateral ligament, medial collateral ligament, popliteus tendon, ITB, anterolateral capsule and osseous contusions of the femoral condyle and tibial plateau. No correlation was found with medial meniscus, lateral meniscus and posterior cruciate ligament injuries. There was no association between ALL injuries and gender, and older patients were more likely to present an ALL injury.
ALL injuries are present in approximately 40% of ACL injuries, and a minority of these are Segond fractures. These injuries are associated with peripheral ligament injuries, anterolateral structures lesions and bone contusions, but there is no association with meniscal injuries. Surgeons must be aware of these associations to consider an ALL lesion even if it is not completely clear in imaging evaluation, especially if a high degree of anterolateral instability is present on physical examination.
III.
很少有研究使用MRI来识别前外侧韧带（ALL）。由于已表明在所有检查中都不可能精确地对该韧带进行特征描述，因此识别可能有助于诊断ALL异常的伴随损伤很重要。鉴于其与膝关节前外侧不稳定相关，对这种损伤进行特征描述很重要。因此，本研究旨在确定急性前交叉韧带（ACL）断裂患者中ALL损伤的频率，并分析其相关的膝关节损伤。
对急性ACL损伤患者进行MRI评估。在该人群中，ALL被分类为未显示、损伤或正常。评估半月板、侧副韧带、腘肌腱、后交叉韧带、髂胫束（ITB）、前外侧关节囊和骨损伤的可能异常情况。计算ALL损伤与这些其他膝关节结构以及性别和年龄之间的关联。
在评估的228个膝关节中，61个（26.7%）无法完全识别ALL。在其余167个中，66个（39.5%）存在ALL异常，只有4个（6.1%）是Segond骨折。ALL异常与外侧副韧带、内侧副韧带、腘肌腱、ITB、前外侧关节囊损伤以及股骨髁和胫骨平台的骨挫伤相关。未发现与内侧半月板、外侧半月板和后交叉韧带损伤有相关性。ALL损伤与性别之间无关联，老年患者更有可能出现ALL损伤。
ALL损伤约占ACL损伤的40%，其中少数是Segond骨折。这些损伤与周围韧带损伤、前外侧结构损伤和骨挫伤相关，但与半月板损伤无关。外科医生必须了解这些关联，即使在影像学评估中不完全清楚，也要考虑ALL损伤，特别是如果体格检查发现高度的前外侧不稳定。
III级。
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