Fortius Clinic, 17 Fitzhardinge St, London, W1H 6EQ, UK.
Department of Trauma Surgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany.
Knee Surg Sports Traumatol Arthrosc. 2022 Jan;30(1):176-183. doi: 10.1007/s00167-021-06543-6. Epub 2021 Apr 1.
The anterolateral soft tissue envelope of the knee is frequently injured at the time of ACL rupture. This study aims to investigate the MRI injury patterns to the Anterolateral complex and their associations in patients with acute 'isolated ligament' ACL ruptures.
Professional athletes who underwent ACL reconstruction for complete ACL rupture between 2015 and 2019 were included in this study. Patients' characteristics and intraoperative findings were retrieved from clinical and surgical documentation. Preoperative MRIs were evaluated and the injuries to respective structures of the Anterolateral complex and their associations were recorded.
Anterolateral complex injuries were noted in 63% of cases. The majority of injuries were to Kaplan Fibre (39% isolated injury and 19% combined with Anterolateral ligament injury). There was a very low incidence of isolated Anterolateral ligament injuries (2%). Kaplan Fibre injuries are associated with the presence of lateral femoral condyle bone oedema, and injuries to the superficial MCL, deep MCL, and ramp lesions. High grade pivot shift test was not associated with the presence of Kaplan Fibre or Anterolateral ligament injuries. Patients with an intact Anterolateral complex sustained injury to other knee structures (13% to medial ligament complex, 14% to medial meniscus, and 16% to lateral meniscus).
There is a high incidence of concomitant Anterolateral complex injuries in combination with ACL ruptures, with Kaplan Fibre (and therefore the deep capsulo-osseous layer of the iliotibial band) being the most commonly injured structure. Anterolateral ligament injuries occur much less frequently. These findings reinforce the importance of considering the presence of, and if necessary, treating injuries to structures other than the ACL, as a truly isolated ACL injury is rare.
膝关节前外侧软组织包膜在 ACL 断裂时经常受伤。本研究旨在探讨急性“孤立性韧带”ACL 断裂患者 ACL 复合体前外侧损伤的 MRI 损伤模式及其相关性。
纳入 2015 年至 2019 年间接受 ACL 重建的专业运动员进行本研究。从临床和手术记录中检索患者特征和术中发现。评估术前 MRI，并记录各自结构的损伤情况 ACL 复合体及其相关性。
63%的病例存在前外侧复合体损伤。大多数损伤为 Kaplan 纤维（39%孤立损伤和 19%与前外侧韧带损伤合并）。单纯前外侧韧带损伤的发生率非常低（2%）。Kaplan 纤维损伤与外侧股骨髁骨水肿、前交叉韧带浅层 MCL、深层 MCL 和斜坡病变有关。高位髌腱试验与 Kaplan 纤维或前外侧韧带损伤的存在无关。前外侧复合体完整的患者其他膝关节结构受伤（13%内侧韧带复合体、14%内侧半月板和 16%外侧半月板）。
ACL 断裂时同时存在前外侧复合体损伤的发生率较高，Kaplan 纤维（因此髂胫束的深层囊骨层）是最常受伤的结构。前外侧韧带损伤发生的频率要低得多。这些发现强调了考虑存在的重要性，如果有必要，治疗 ACL 以外的结构损伤，因为真正孤立的 ACL 损伤很少见。
