Kang Ji-Hee, Moon Sung-Gyu, Lee Dhong-Won
Department of Radiology, Konkuk University Medical Center, Seoul 05030, Republic of Korea.
Department of Orthopedic Surgery, Konkuk University Medical Center, Seoul 05030, Republic of Korea.
Diagnostics (Basel). 2024 Jun 11;14(12):1226. doi: 10.3390/diagnostics14121226.
This study aimed to characterize the Magnetic Resonance Imaging (MRI) features of the Anterolateral Ligament (ALL) in young adults without Anterior Cruciate Ligament (ACL) injury and evaluate its visibility using MRI. In this retrospective analysis, MRI scans of 66 young adults without ACL injuries were assessed by two radiologists. The ALL was examined from its bone-to-bone attachment between the lateral femoral epicondyle and the lateral tibia. The visibility of the ALL was classified as normal, probably normal, abnormal, or non-visualized, based on ligament continuity and thickness relative to the Meniscotibial Ligament (MTL). A continuous structure with thickness equal to or greater than the MTL was considered normal; continuous but wavy and thin features were categorized as probably normal; discontinuity and angulation were deemed abnormal. The proximal attachment of the ALL was categorized as anterior, central, or posterior to the Fibular Collateral Ligament (FCL), while the distal attachment was noted as either at the same location or distal to the MTL. The ALL was identified in 87.9-95.5% of knees and was non-visualized in 4.5-12.1% of cases. Continuous ligamentous structures were observed in 63.7-71.2% of knees (normal in 30.3-37.9%; probably normal in 27.3-40.9%), whereas 19.7-30.3% exhibited abnormal features. Inter-observer agreement was moderate to substantial (κ = 0.66, 0.56), and intra-observer agreement was substantial to excellent (κ = 0.82, 0.66). Among the 58 visible ALLs, proximal attachments were predominantly anterior (63.8%) or central (32.8%) to the FCL, with a minority posterior (1.7%). In total, 4 of the 19 central insertions were incorporated into the FCL mid-substance, and one case was blended into the meniscofemoral ligament. Distal attachments were equally distributed between the same location (50%) and distal to the MTL (50%) (mean 3.7 mm distal). In conclusion, MRI was feasible for detecting the ALL in most young adults without ACL injury, revealing continuous ligament structures in about two-thirds of cases. Approximately 40% of cases exhibited a thickness equal to or greater than the MTL, with the majority of proximal attachments located anterior to the FCL and distal attachments evenly divided between the same insertion and distal to the MTL.
本研究旨在描述无前交叉韧带（ACL）损伤的年轻成年人中外侧副韧带（ALL）的磁共振成像（MRI）特征，并使用MRI评估其可视性。在这项回顾性分析中，两名放射科医生对66名无ACL损伤的年轻成年人的MRI扫描进行了评估。从外侧股骨髁和外侧胫骨之间的骨到骨附着处检查ALL。根据韧带的连续性和相对于半月板胫骨韧带（MTL）的厚度，将ALL的可视性分为正常、可能正常、异常或不可见。厚度等于或大于MTL的连续结构被认为是正常的；连续但呈波浪状且薄的特征被归类为可能正常；不连续和成角被视为异常。ALL的近端附着点被分类为位于腓侧副韧带（FCL）的前方、中央或后方，而远端附着点被记录为与MTL在同一位置或在MTL的远端。在87.9%至95.5%的膝关节中可识别出ALL，在4.5%至12.1%的病例中不可见。在63.7%至71.2%的膝关节中观察到连续的韧带结构（正常的占30.3%至37.9%；可能正常的占27.3%至40.9%），而19.7%至30.3%表现出异常特征。观察者间的一致性为中等至高度（κ = 0.66, 0.56），观察者内的一致性为高度至极佳（κ = 0.82, 0.66）。在58条可见的ALL中，近端附着点主要位于FCL的前方（63.8%）或中央（32.8%），少数位于后方（1.7%）。在19个中央附着点中，总共有4个融入FCL的中间部分，1例与半月板股骨韧带融合。远端附着点在同一位置（50%）和MTL远端（50%）之间平均分布（平均在MTL远端3.7 mm）。总之，MRI对于检测大多数无ACL损伤的年轻成年人中的ALL是可行的，在约三分之二的病例中显示出连续的韧带结构。约40%的病例表现出厚度等于或大于MTL，大多数近端附着点位于FCL前方，远端附着点在同一附着点和MTL远端之间平均分布。
