Correlation between ACL injury and involvement of the anterolateral ligament A retrospective study

SPECIAL

FOCUS

Sports Medicine

Correlation between ACL injury and involvement of the

anterolateral ligament: A retrospective study

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Adel Hegaze, MD a , Khalid Khashoggi, MD b , Mohammed Alsayyad, MD a , Rawan Hafiz, MD b ,

Abdulraof Alqrache, MD c and Hesham N. Mustafa, MD d

a Orthopedic Department, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia

b Radiology Department, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia

c Clinical Biochemistry Department, Faculty of Medicine – Rabigh, King Abdulaziz University, Jeddah, Saudi Arabia

d Anatomy Department, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia

ABSTRACT

Background:

Clinical testing has demonstrated the role of the anterolateral ligament

(ALL) in controlling anterolateral laxity and knee instability at high

angles of flexion. Few studies have discussed the association between

an anterior cruciate ligament (ACL) injury and ALL injury, specifically

after residual internal rotation and a post-ACL reconstruction positive

pivot-shift that could be attributed to ALL injury. The goal of this study

was to assess the correlation between ALL injury and ALL injury with

concomitant ACL injury using MRI.

Material and Methods:

This was a retrospective study of 246 patients with unilateral ACL

knee injuries from a database that was reexamined to identify

whether ALL injuries occurred in association with ACL injuries. We

excluded the postoperative reconstructed cases. The charts were

reviewed on the basis of the presence or absence of diagnosed

ACL injury with no regard for age or sex.

Results:

Of the 246 patients with ACL injury, there were 165 (67.1%)

patients with complete tears, 55 (22.4%) with partial tears, and

26 (10.6%) with sprains. There were 176 (71.5%) patients with

ALL and associated ACL injuries, whereas 70 (28.5%) did not

have associated ACL injuries. There was a significant statistical

relationship between ACL and ALL injuries (P < 0.0001).

Conclusions:

There is high incidence of ALL tears associated with ACL injuries.

Clinicians should be aware of this injury and consider the possibility of

simultaneous ALL and ACL repair to prevent further knee instability.

Level of Evidence:

Level IV.

Financial Disclosure: The authors report no conflicts of

interest.

Correspondence to Hesham N. Mustafa, MD, Anatomy Department,

Faculty of Medicine, King Abdulaziz University, Jeddah 21589, Saudi

Arabia

Tel: +966566764762; fax: +0096612 640 0000-20123;

e-mail: hesham977@gmail.com.

1941-7551 Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

Key Words

knee, anterolateral ligament ALL, anterior cruciate ligament ACL,

MRI, injury, reconstruction

INTRODUCTION

Recently, many studies have been conducted after the

publication by Claes et al. 1 who described the anterolateral

ligament (ALL). The ALL has been anatomically and

biomechanically described as a lateral knee structure that provides

effective rotatory stability of the knee, specifically controlling

pivot shift. 1–3 Proximally, the ALL attaches at a location that is

adjacent to the lateral collateral ligament (LCL), and distally it

attaches to the proximal portion of the tibia approximately

halfway between Gerdy’s tubercle and the fibular head. 1,2,4,5

Although the tensile properties of the ALL have been quantified, 5

the in situ biomechanical function is not well understood. 6 It is

known that the iliotibial band and the soft tissues comprising the

mediolateral capsule together resist rotational moments and

anterior loads. It has been theorized that the ALL may be an

important stabilizer to prevent the pivot-shift phenomenon. 1

Radiographic studies of the ALL have become important for

the identification of radiographic femoral and tibial landmarks,

which are essential for biomechanical studies and ligamentous

reconstruction. 4,7–9 MRI has been used to visualize the ALL in

many studies. Coquart et al. 10 concluded that the ALL can be

identified using routine 1.5 T MRI. Other studies also have

confirmed that MRI can be used to identify the ALL. 11,12 Studies

using MRI for detection of ALL injuries occurring concomitantly

with other knee injuries were conducted in cases of Segond

fractures 13 and ACL injuries. 14,15 The findings of these studies

showed that ALL injuries can be identified with these other

injuries. 16 One study recommended performing MRI examinations

of the knee within 6 wk after surgery to increase the rate of

detection of ALL injuries in ACL-injured knees. 16 There were two

studies demonstrating that MRI alone was not reliable for

detecting simultaneous ALL and ACL injuries. 3,6

Arthroscopic and cadaver identifications of the ALL also

have been made. 17,18 Arthroscopy showed the existence of the

Volume 31 Number 1 January/February 2020 Current Orthopaedic Practice 23

Copyright r 2020 Wolters Kluwer Health, Inc. All rights reserved.

24 | www.c-orthopaedicpractice.com Volume 31 Number 1 January/February 2020

ligament and that this method of assessment could be

beneficial in extraarticular knee reconstructions. There are

very few ultrasound studies that have detected ALL with

promising results. 19,20 Most portions of the ALL, including the

femoral, meniscal, and tibial portions, as well as their

relationship with other ALL complexes, can be identified

using ultrasonography (US). As most ALL injuries occur at the

femoral or tibial portion of the ligament, US may be useful as a

diagnostic tool in ALL injuries. 21 A recent study showed that

US was superior to MRI for viewing ALL injuries. 22

Many biomechanical studies have been conducted to try to

identify the role of the ALL in promoting knee stability and

preventing internal rotation. Other biomechanical studies have

shown that the anatomical position of the ALL, which lies in an

oblique direction with an anterior insertion, tends to resist internal

rotation. Most studies showed that the function of the ALL

affects internal rotational stability during flexion. Some concluded

that the angle of flexion was greater than 35 degrees. 5 Studies

detecting the true role of the ALL in preventing internal rotation

showed that 15% to 30% of ACL reconstructions had residual

deficiencies of internal rotation stability and that pivot shifts were

persistent. 23–25

Many studies have focused on the relationship between the

ACL and the ALL with respect to internal rotation control.

Double-bundle ACL biomechanical studies showed that the

anteromedial (AM) bundle provided resistance to anterior tibial

translation but the posterolateral (PL) ligament had no role in

resisting internal rotation. 26 Meanwhile, other studies concluded

that the PL functions primarily to resist internal rotation

whenthekneeisextended. 27

These findings led to a debate whether the double-bundle or

the single-bundle ACL reconstruction would be the superior

procedure for ACL repair. 28 The residual internal rotation laxity

and pivot shift after ACL reconstruction showed that lateral repairs

must be combined with ACL repairs in the presence of high

pivot shifts. Studies in cadaver human knees in which internal

rotation torque and simulated pivot-shift tests were conducted

provided evidence of the role of the ALL in maintaining rotational

stability after sectioning of the ACL alone or in combination with

the ALL. Combined sectioning of the ACL and ALL resulted in a

significant increase in internal rotation when compared to the

intact and ACL-deficient states. Additional sectioning of the ALL

increased the level of internal rotation in comparison to the ACLdeficient

state. 29 Meanwhile, other studies showed that the ALL

is not the main functional element needed for maintaining

rotational stability because after sectioning the ACL, the rotational

stability and pivot shift are elicited in the presence of an intact

ALL and iliotibial band. Therefore, the authors concluded that

each ligament alone is not a primary restraint, but that they all

function together as anterolateral secondary restraints and that

the components of the anterolateral complex of the knee act

synergistically to provide rotatory knee stability. 30,31 However, the

recommendation to perform ALL reconstructions to correct pivotshift

abnormalities has been questioned. 25,32,33

Some studies have advocated for combined reconstruction of

both the ACL and ALL as an effective procedure with minimal

complications, 25,34,35 whereas others have shown that lateral

extraarticular tendinosis is effective for governing anterior and

rotational laxity. 36 It has also been reported that the reoperation

rate after a combined ACL and ALL reconstruction is comparable

to the reoperation rate after an isolated ACL repair. 35 In addition,

some studies have advised lateral tendinosis during revision after

ACL failure to supplement intraarticular graft revision, thus

minimizing the potential for internal rotational instability. 36

Although ALL is related to Segond fractures, a recent study

concluded that it is not necessary to reconstruct or repair

Segond fractures at the time of a primary repair of the ACL

with no early ACL graft failure. 37

Based on these reports of the ALL and its role in knee stability,

our study goal was to determine whether there is an association

between ACL and ALL injuries by retrospectively reviewing the

MRI studies of patients with ACL and ALL injuries. Examination

of the ALL with the injured ACL will increase the successful repair

of both ligaments and reduce the possibility of postoperative knee

instability.

MATERIALS AND METHODS

Ethical Review and Study Design

This retrospective study was approved by the Unit of

Biomedical Ethics at King Abdulaziz University (approval

no. 587-17) and informed consent requirements were waived

due to the retrospective nature of the study.

Data Collection

This retrospective study focused on patients who were

diagnosed with ACL injuries before any surgical intervention.

The data were collected from the hospital’s image retrieval

system in the radiology department. The evaluation was

performed by one consulting musculoskeletal radiologist (MD

FRCP[C] ABR). The variables of interest included: age, sex,

presence of ACL tear, presence of ALL injury, and Segond

fracture. Other associated injuries were not included because

our study was focused on detecting ALL injury, which is not

routinely reported. ACL tears were categorized as complete,

partial, or sprain, depending on whether there was a complete

or partial interruption of the ligament fibers or an abnormal

signal intensity, respectively. Patients who had knee MRIs

from 2012 to 2015 with ACL injuries were included in the

study. We excluded patients who had an injured ACL after

reconstruction.

Imaging

MRI was obtained in 178 patients (72.4%) 4 wk after injury, while

45 patients (18.3%) had an MRI at 6 wk, and the remaining

23 (9.3%) between 7 and 8 wk. All patients were imaged on a

1.5-T Symphony system (Siemens Medical Solutions, Erlangen,

Germany), or 3-T Verio system (Siemens Medical Solutions,

Erlangen, Germany), or 3-T Skyra system (Siemens Medical

Solutions, Erlangen, Germany). All examinations included at least

the following sequences: axial fast or turbo spin-echo proton

density-weighted sequence; coronal fast or turbo spin-echo

proton density and T2-weighted sequences; and either sagittal

conventional spin-echo proton density- and T2-weighted and fast

or turbo spin-echo T2-weighted sequences or sagittal fast or turbo

spin-echo proton density- and T2-weighted sequences. Additional

sequences included T1-weighted and T1- or T2-weighted gradientrecalled

echo sequences. All fast and turbo spin-echo sequences

were fat suppressed.


Current Orthopaedic Practice www.c-orthopaedicpractice.com | 25

TABLE 1. Patient sex

Valid Frequency Percent

Valid

percent

Cumulative

percent

Male 221 89.8 89.8 89.8

Female 25 10.2 10.2 100.0

Total 246 100.0 100.0

TABLE 3. Anterolateral ligament


Valid

percent

Cumulative

percent

Injured 176 71.5 71.5 71.5

Intact 70 28.5 28.5 100.0

Total 246 100.0 100.0

Statistical Analysis

The study data were analyzed using IBM SPSS version 24

(IBM Corp, Armonk, NY, USA). Simple descriptive statistics

were used to define the characteristics of the study variables

using counts and percentages for the categorical and nominal

variables, and mean and standard deviations for the

continuous variables. The chi-square test was used to identify

relationships between normally distributed categorical variables.

A conventional P-value <0.05 was considered statistically

significant.

RESULTS

We included a total of 246 patients with unilateral ACL tears.

Our population ranged in age from 15 to 77 yr, with a

mean ± SD of 31 ± 12.5 yr. There were 221 (89.8%) men and

25 (10.2%) women with ACL tears in our patient population.

The tears were divided into complete, partial, and strain/

sprain, with frequencies (percentages) of 165 (67.1%), 55

(22.4%), and 26 (10.6%), respectively. The ALL was visualized

in all patients. Of those with a torn ACL, 176 (71.5%) had an

injured ALL, whereas 70 (28.5%) were found to have an

intact ALL. We found a significant relationship between ACL

and ALL injuries with a P value of <0.0001 (Tables 1–3).

With respect to the demographics, there was a significant

statistical correlation between age and sex, with the ACL

tears being more common in men younger than 50 yr of age

(P = 0.001, age; P = 0.002, sex). However, we did not find a

significant relationship between ALL tears and the age or sex

of the study patients.

An association between ACL tears (Figure 1B) and ALL tears

was identified at different sites along the course of the ALL.

The proximal tear is shown in Figure 1A, and the complete

tear is also identified alone and in association with the ACL

tear in Figure 2A and B, respectively.

The anatomy of the ALL and its relationship with the lateral

knee structures were clearly identified. The femoral origin,

direction, and meniscofemoral component; its relationship

with lateral meniscus; and the tibial insertion were clearly

identified with respect to the ALL (Figure 3A through F).

TABLE 2. Anterior cruciate ligament


Valid

percent

Cumulative

percent

Complete tear 165 67.1 67.1 67.1

Partial tear 55 22.4 22.4 89.4

Strain/sprain 26 10.6 10.6 100.0

Total 246 100.0 100.0

Segond fractures were present in only 2 (0.01%) of the

patients (Figure 4A through D), and there was no concomitant

ALL tear in these patients.

There were other associated injuries in the 176 cases of

combined ACL and ALL. Injuries of menisci, bone, and

collateral ligaments were assessed (Table 4). Twenty-nine

(16.4%) patients had lateral meniscal injury, and 87 patients

(49.4%) had medial meniscal injury. Bone injuries were

found in the form of bone edema in nine patients (5.1%) and

subluxation of the patella in eight patients. Meanwhile,

collateral injuries were seen in five patients (2.8%), the lateral

collateral ligament in 12 patients (6.8%) with injuries to the

medial side.

DISCUSSION

In our study, we retrospectively evaluated patients with ACL

tears before any surgical intervention. Our results showed

that the ALL could be identified in all 246 patients. Among

the patients with a torn ACL, 176 (71.5%) had coexisting ALL

injuries, whereas 70 (28.5%) had intact ALL, which nearly

agrees with the findings of Claes et al. 1,38 who reported that

78.8% of patients had coexisting ALL injuries. Meanwhile,

Segond fracture was not frequently associated with

ACL injury, regardless of the presence or absence of ALL

injury.

In a study of the ALL, Claes et al. 1,38,39 used MRI to identify

the ligament as well as to identify an association between

ACL and ALL injuries. That study found that 78.8% of MRIs

showed ALL injuries, whereas 21.2% were normal. 38,39

Rossi 20 found that of the simultaneous ALL and ACL injuries

identified on MRI, ALL was identified in all patients. They

also showed that there was no correlation between instability

and the degree of ALL injury, which indicated that the ALL

plays a minor role in knee stability. 38,39 Other studies showed

that the ALL can be identified on MRI and it is attached to

the Segond fracture fragment. 13 Meanwhile, a study of the

ALL using routine 1.5-T MRI scans to detect all parts of the

ligament revealed that it could be at least partially visualized

in 97.8% of patients and entirely observed in 71.7% of

patients. 7,14 A similar study using 1.5-T MRI reported visualization

of all parts of the ALL ligament as a distinct

structure. 15 In an MRI study that retrospectively reviewed

patients’ preoperative data prior to torn ACL repair using

standard 1.5 T MRI to evaluate for concomitant ALL tears

revealed that ALL was identified in 100% of patients.

However, they were unable to identify whether the ALLs

were intact or torn. 40 A similar study showed that MRI alone

was not reliable for the diagnosis of ALL tears with

concomitant ACL injuries; 41 however, another study con-



FIGURE 1. A, Coronal proton density with fat saturation image in a 35-year-old male patient with a tear in the proximal portion of the anterolateral ligament

(arrow) and a partial thickness tear of the medial collateral ligament (arrowhead). B, Sagittal proton density with fat saturation image showing a complete fullthickness

tear of the anterior cruciate ligament (arrow).

cluded that ALL injuries were more often identified if MRI

was performed at 6 wk or more after the injury. 11 Recently,

there was a study that revealed that the ALL is visible on MRI

using 1.5-T and that ALL tears are related to ACL tears. 12

In recent years, combined ACL and ALL reconstruction

has begun to increase. Sonnery-Cottet et al. 17,42,43 underwent

92 combined reconstruction operations with better

results in terms of knee stability without specific complications

at 2-year follow-up. Mogos et al. 44 in a prospective

study of 32 patients concluded that combined ACL and

ALL reconstruction is an effective surgical procedure, with

improved postoperative clinical results and no significant

short-term complications. Schon, et al. 45 concluded that ALL

repair in conjunction ACL repair reduce rotatory laxity.

Sonnery-Cottet et al. 42,43 in their prospective study of 502

patients advised that combined reconstruction of the ACL

by hamstring tendon and ALL decreases the graft failure.

They also provided an overview of the latest research of the

ALL expert group on the ALL reconstruction, concluding

that recognition and repair of ALL lesions should be

considered to improve the control of rotational stability

provided by ACL reconstruction. All these studies were

short-term studies and advised for long-term follow-up to

better evaluate the results of this procedure.

CONCLUSIONS

ALL injuries are strongly correlated with ACL tears and are

visible on MRI in adult patients. This high association

between ACL and ALL injuries should alert clinicians to

FIGURE 2. A, A coronal proton density (TR = 3180, TE = 33) image with fat saturation in a 24-year-old man showing a complete tear of the anterolateral

ligament (arrows). B, A sagittal proton density (TR = 3180, TE = 33) image with fat saturation in the same patient showing a complete tear of the anterior

cruciate ligament (arrow).



FIGURE 3. Proton density-weighted, fat-suppressed MRI of the knee (sequentially through the knee, from proximal to distal). The corresponding localizers

represent slice levels between the axial and coronal images. Axial (A) and coronal (B) images, above the level of the ALL, showing the femoral origin of the

fibular collateral ligament (grey arrow) and the iliotibial band (white arrow). Axial (C) and coronal (D) images show the anterolateral ligament (blue arrows)

arising anteriorly from the fibular collateral ligament (grey arrow) continue anterior oblique, deep to the iliotibial band (white arrow), and proximal to the lateral

meniscus. The coronal image shows the meniscofemoral component merging with the body of the lateral meniscus. Axial (E) and coronal (F) images showing

the anterolateral ligament (blue arrow) at the tibial insertion site, near the insertion of the iliotibial band (white arrow) and Gerdy’s tubercle.

FIGURE 4. A 26-year-old man with an ACL tear. A, Coronal proton density fat-saturated weighted image shows complete tear of the anterior cruciate

ligament (green arrow). B, Axial proton density fat-saturated weighted image shows the iliotibial band (white arrow), fibular collateral ligament (grey), and

intermediate bright signal intensity of the anterolateral ligament (blue arrow). C, Segond fracture on radiograph (arrow). D, Corresponding T1-weighted

images (arrow) of Segon fracture.



TABLE 4. Injuries associated with anterior cruciate

ligament (ACL) and anterolateral ligament (ALL)

injuries

Associated

injuries Affection Number/176 (%)

Menisci Lateral 29 (16.4)

Medial 87 (49.4)

Both 0 (0)

Bone injuries Bone edema 9 (5.1)

Subluxation of the

8 (4.5)

Patella

Collaterals Lateral 5 (2.8)

Medial 12 (6.8)

Both 0 (0)

consider concomitant ALL and ACL injuries in MRI studies.

These associations, if present, can give the clinician the

option of repairing the ALL and ACL simultaneously to

prevent further instability of the knee.

REFERENCES

1. Claes S, Vereecke E, Maes M, et al. Anatomy of the anterolateral

ligament of the knee. J Anat. 2013; 223:321–328.

2. Dodds AL, Halewood C, Gupte CM, et al. The anterolateral

ligament: anatomy, length changes and association with the

Segond fracture. Bone Joint J. 2014; 96-B:325–331.

3. Guenther D, Griffith C, Lesniak B, et al. Anterolateral rotatory

instability of the knee. Knee Surg Sports Traumatol Arthrosc. 2015;

23:2909–2917.

4. Kennedy MI, Claes S, Fuso FA, et al. The anterolateral ligament:

an anatomic, radiographic, and biomechanical analysis. Am J

Sports Med. 2015; 43:1606–1615.

5. Parsons EM, Gee AO, Spiekerman C, et al. The biomechanical

function of the anterolateral ligament of the knee. Am J Sports

Med. 2015; 43:669–674.

6. Thein R, Boorman-Padgett J, Stone K, et al. Biomechanical

assessment of the anterolateral ligament of the knee: a secondary

restraint in simulated tests of the pivot shift and of anterior

stability. J Bone Joint Surg Am. 2016; 98:937–943.

7. HelitoCP,DemangeMK,BonadioMB,et al. Radiographic landmarks

for locating the femoral origin and tibial insertion of the knee

anterolateral ligament. Am J Sports Med. 2014; 42:2356–2362.

8. Heckmann N, Sivasundaram L, Villacis D, et al. Radiographic

landmarks for identifying the anterolateral ligament of the knee.

Arthroscopy. 2016; 32:844–848.

9. Rezansoff AJ, Caterine S, Spencer L, et al. Radiographic landmarks

for surgical reconstruction of the anterolateral ligament of the

knee. Knee Surg Sports Traumatol Arthrosc. 2015; 23:3196–3201.

10. Coquart B, Le Corroller T, Laurent PE, et al. Anterolateral

ligament of the knee: myth or reality? Surg Radiol Anat. 2016;

38:955–962.

11. Kosy JD, Schranz PJ, Patel A, et al. The magnetic resonance

imaging appearance of the anterolateral ligament of the knee in

association with anterior cruciate rupture. Skeletal Radiol. 2017;

46:1193–1200.

12. Kizilgoz V, Sivrioglu AK, Aydin H, et al. Assessment of the

anterolateral ligament of the knee by 1.5 T magnetic resonance

imaging. J Int Med Res. 2018; 46:1486–1495.

13. Porrino J Jr, Maloney E, Richardson M, et al. The anterolateral

ligament of the knee: MRI appearance, association with the

Segond fracture, and historical perspective. AJR Am J Roentgenol.

2015; 204:367–373.

14. Helito CP, Helito PV, Costa HP, et al. MRI evaluation of the

anterolateral ligament of the knee: assessment in routine 1.5-T

scans. Skeletal Radiol. 2014; 43:1421–1427.

15. Patel KA, Chhabra A, Goodwin JA, et al. Identification of the

anterolateral ligament on magnetic resonance imaging. Arthroscopy

Tech. 2017; 6:e137–e141.

16. Samuelson M, Draganich LF, Zhou X, et al. The effects of knee

reconstruction on combined anterior cruciate ligament and

anterolateral capsular deficiencies. Am J Sports Med. 1996; 24:

492–497.

17. Sonnery-Cottet B, Archbold P, Rezende FC, et al. Arthroscopic

identification of the anterolateral ligament of the knee. Arthroscopy

Tech. 2014; 3:e389–e392.

18. Zein AM. Step-by-step arthroscopic assessment of the anterolateral

ligament of the knee using anatomic landmarks. Arthroscopy

Tech. 2015; 4:e825–e831.

19. Cianca J, John J, Pandit S, et al. Musculoskeletal ultrasound

imaging of the recently described anterolateral ligament of the

knee. Am J Phys Med Rehabil. 2014; 93:186.

20. Rossi MJ. Editorial commentary: ultrasound barely beats magnetic

resonance imaging in knee anterolateral ligament evaluation…but

does this change the treatment of the anterior cruciate

ligament-deficient knee? Arthroscopy. 2017; 33:1391–1392.

21. Oshima T, Nakase J, Numata H, et al. Ultrasonography imaging

of the anterolateral ligament using real-time virtual sonography.

Knee. 2016; 23:198–202.

22. Faruch Bilfeld M, Cavaignac E, Wytrykowski K, et al. Anterolateral

ligament injuries in knees with an anterior cruciate

ligament tear: Contribution of ultrasonography and MRI. Eur

Radiol. 2018; 28:58–65.

23. Chouliaras V, Ristanis S, Moraiti C, et al. Effectiveness of

reconstruction of the anterior cruciate ligament with quadrupled

hamstrings and bone-patellar tendon-bone autografts: an in vivo

study comparing tibial internal-external rotation. Am J Sports

Med. 2007; 35:189–196.

24. Biau DJ, Tournoux C, Katsahian S, et al. ACL reconstruction: a

meta-analysis of functional scores. Clin Orthop Relate Res. 2007;

458:180–187.

25. Zein AMN, Elshafie M, Elsaid ANS, et al. Combined anatomic

anterior cruciate ligament and double bundle anterolateral

ligament reconstruction. Arthroscopy Tech. 2017; 6:e1229–e1238.

26. Gardner EJ, Noyes FR, Jetter AW, et al. Effect of anteromedial and

posterolateral anterior cruciate ligament bundles on resisting

medial and lateral tibiofemoral compartment subluxations.

Arthroscopy. 2015; 31:901–910.

27. Amis AA. The functions of the fibre bundles of the anterior

cruciate ligament in anterior drawer, rotational laxity and the

pivot shift. Knee Surg Sports Traumatol. Arthroscopy. 2012;

20:613–620.

28. Ferretti A, Monaco E, Labianca L, et al. Double-bundle anterior

cruciate ligament reconstruction: a comprehensive kinematic

study using navigation. Am J Sports Med. 2009; 37:1548–1553.

29. Rasmussen MT, Nitri M, Williams BT, et al. An in vitro robotic

assessment of the anterolateral ligament, part 1: secondary role

of the anterolateral ligament in the setting of an anterior cruciate

ligament injury. Am J Sports Med. 2016; 44:585–592.

30. Noyes FR, Huser LE, Levy MS. Rotational knee instability in ACLdeficient

knees: role of the anterolateral ligament and iliotibial

band as defined by tibiofemoral compartment translations and

rotations. J Bone Joint Surg Am. 2017; 99:305–314.

31. Herbst E, Albers M, Burnham JM, et al. The anterolateral complex

of the knee: a pictorial essay. Knee Surg Sports Traumatol Arth.

2017; 25:1009–1014.

32. Noyes FR, Huser LE, Jurgensmeier D, et al. Is an anterolateral

ligament reconstruction required in ACL-reconstructed knees

with associated injury to the anterolateral structures? A robotic

analysis of rotational knee stability. Am J Sports Med. 2017;

45:1018–1027.

33. Sonnery-Cottet B, Thaunat M, Freychet B, et al. Outcome of a

combined anterior cruciate ligament and anterolateral ligament

reconstruction technique with a minimum 2-year follow-up. Am

J Sports Med. 2015; 43:1598–1605.

34. Spencer L, Burkhart TA, Tran MN, et al. Biomechanical analysis

of simulated clinical testing and reconstruction of the anterolateral

ligament of the knee. Am J Sports Med. 2015; 43:

2189–2197.



35. Thaunat M, Clowez G, Saithna A, et al. Reoperation rates after

combined anterior cruciate ligament and anterolateral ligament

reconstruction: a series of 548 patients from the SANTI study

group with a minimum follow-up of 2 years. Am J Sports Med.

2017; 45:2569–2577.

36. Miller TK. The role of an extra-articular tenodesis in revision of

anterior cruciate ligament reconstruction. Clin Sports Med. 2018;

37:101–113.

37. Gaunder CL, Bastrom T, Pennock AT. Segond fractures are not a

risk factor for anterior cruciate ligament reconstruction railure.

Am J Sports Med. 2017; 45:3210–3215.

38. Claes S, Bartholomeeusen S, Bellemans J. High prevalence of

anterolateral ligament abnormalities in magnetic resonance

images of anterior cruciate ligament-injured knees. Acta Orthop

Belg. 2014; 80:45–49.

39. Wodicka R, Jose J, Baraga MG, et al. MRI evaluation of

the anterolateral ligament of the knee in the setting of

ACL rupture. Orthop J Sports Med. 2014; 2(7_suppl2):

2325967114S00042.

40. Hartigan DE, Carroll KW, Kosarek FJ, et al. Visibility of anterolateral

ligament tears in anterior cruciate ligament-deficient

knees with standard 1.5-Tesla magnetic resonance imaging.

Arthroscopy. 2016; 32:2061–2065.

41. Devitt BM, O’Sullivan R, Feller JA, et al. MRI is not reliable in

diagnosing of concomitant anterolateral ligament and anterior

cruciate ligament injuries of the knee. Knee Surg Sports Traumatol

Arthrosc. 2017; 25:1345–1351.

42. Sonnery-Cottet B, Saithna A, Cavalier M, et al. Anterolateral

ligament reconstruction is associated with significantly reduced

ACL graft rupture rates at a minimum follow-up of 2 years: a

prospective comparative study of 502 patients from the SANTI

study group. Am J Sports Med. 2017; 45:1547–1557.

43. Sonnery-Cottet B, Daggett M, Fayard JM, et al. Anterolateral

ligament expert group consensus paper on the management of

internal rotation and instability of the anterior cruciate ligament -

deficient knee. JOrthopTraumatol. 2017; 18:91–106.

44. Mogos S, Sendrea B, Stoica IC. Combined anatomic anterior

cruciate ligament and anterolateral ligament reconstruction.

Maedica. 2017; 12:30–35.

45. Schon JM, Moatshe G, Brady AW, et al. Anatomic anterolateral

ligament reconstruction leads to overconstraint at any fixation

angle: response. Am J Sports Med. 2016; 44:NP58–NP59.


Correlation between ACL injury and involvement of the anterolateral ligament A retrospective study

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