Ultrasonographic visualization and assessment of the anterolateral ligament
Tóm tắt
Injury to the anterolateral ligament (ALL) of the knee has recently received attention as a potential risk factor for failure of anterior cruciate ligament reconstruction. However, evaluation of the anterolateral ligament is currently difficult, and radiologic data are sparse with regard to the normal appearance of this ligament. The purpose of the present study was to determine whether the ALL could be identified and visualized using ultrasonography. Ten non-paired, fresh-frozen cadaveric knees underwent ultrasound by an experienced musculoskeletal radiologist using a Siemens S2000 Acuson Ultrasound machine with a 14-MHz linear transducer. After first identifying anatomical landmarks by palpation, a thin band of tissue originating in the vicinity of the fibular collateral ligament (FCL) origin was identified and followed up distally. The tibia was held at 30° of flexion and internally rotated to verify tightening of the structure. Under ultrasound guidance, 25-gauge hypodermic needles were placed at what were sonographically determined to be the origin and insertion points of the ligament. One-tenth of a CC of aniline blue dye was injected. The specimens were then dissected to confirm the presence and location of the ALL. If an ALL was found, distances between the epicentre of the injected dye and the actual origin and insertion points were calculated. Additionally, ligament length based on dissection images and ultrasound images was calculated. Eight of ten specimens had an anterolateral structure that originated from the lateral femoral epicondyle just posterior and superior to the origin of the FCL and inserted on the lateral plateau approximately halfway between Gerdy’s tubercle and the fibular head. The average length based on ultrasound was 3.8 cm (±.7; range 3.1–4.7) and 4.1 cm (±1.1; range 2.6–6.1) based on dissection. Length based on dissection and ultrasound had minimal agreement (ICC = .308; 95 % confidence interval .257–.382, p = .265). The average width of the structure on dissection was .8 cm (±.24; range .5–1.2). The mean distance from ultrasound-determined origin and insertion points to anatomical origin and insertion based on dissection was 10.9 mm (±2.9, range 7.0–15.8) and 12.5 mm (±5.7 range 3.2–19.3), respectively. Inter-observer reliability was excellent for all measurements based on dissection and ultrasound. Ultrasound was unable to reliably identify the anterolateral structure from its femoral to tibial attachment sites. Distinguishing it from the posterior IT band and anterolateral capsule was challenging, and it is possible that the structure is a thickened band of fascia rather than a true ligament. As a clinical diagnostic tool, ultrasound likely offers little utility in the evaluation of the ALL for injury. IV.
Tài liệu tham khảo
Caterine S, Litchfield R, Johnson M, Chronik B, Getgood A (2014) A cadaveric study of the anterolateral ligament: re-introducing the lateral capsular ligament. Knee Surg Sports Traumatol Arthroscopy 23:3186–3195
Cavaignac E, Wytrykowski K, Reina N, Pailhe R, Murgier J, Faruch M, Chiron P (2015) Ultrasonographic Identification of the anterolateral ligament of the knee. Arthroscopy 32:120–126
Cianca J, John J, Pandit S, Chiou-Tan FY (2014) Musculoskeletal ultrasound imaging of the recently described anterolateral ligament of the knee. Am J Phys Med Rehabil 93:186
Claes S, Bartholomeeusen S, Bellemans J (2014) High prevalence of anterolateral ligament abnormalities in magnetic resonance images of anterior cruciate ligament-injured knees. Acta Orthop Belg 80:45–49
Claes S, Vereecke E, Maes M, Victor J, Verdonk P, Bellemans J (2013) Anatomy of the anterolateral ligament of the knee. J Anat 223:321–328
Dodds AL, Halewood C, Gupte CM, Williams A, Amis AA (2014) The anterolateral ligament: anatomy, length changes and association with the segond fracture. Bone Joint J 96 B:325–331
Goldman AB, Pavlov H, Rubenstein D (1988) The Segond fracture of the proximal tibia: a small avulsion that reflects major ligamentous damage. Am J Roentgenol 151:1163–1167
Helito CP, Demange MK, Helito PVP, Costa HP, Bonadio MB, Pecora JR, Rodrigues MB, Camanho GL (2014) Evaluation of the anterolateral ligament of the knee by means of magnetic resonance examination. Rev Bras Ortop 50:214–219
Helito CP, Victor P, Helito P, Costa HP, Bordalo-rodrigues M, Pecora JR, Camanho GL (2014) MRI evaluation of the anterolateral ligament of the knee: assessment in routine 1. 5-T scans. Skelet Radiol 43:1421–1427
Kennedy MI, Claes S, Fuso FAF, Williams BT, Goldsmith MT, Turnbull TL, Wijdicks CA, LaPrade RF (2015) The anterolateral ligament: an anatomic, radiographic, and biomechanical analysis. Am J Sports Med 43:1606–1615
Kosy JD, Mandalia VI, Anaspure R (2015) Characterization of the anatomy of the anterolateral ligament of the knee using magnetic resonance imaging. Skelet Radiol 44:1647–1653
Lutz C, Sonnery-Cottet B, Niglis L, Freychet B, Clavert P, Imbert P (2015) Behavior of the anterolateral structures of the knee during internal rotation. Orthop Traumatol Surg Res 101:523–528
Oshima T, Nakase J, Numata H, Takata Y, Tsuchiya H (2016) The knee ultrasonography imaging of the anterolateral ligament using real-time virtual sonography. Knee 23:198–202
Pomajzl R, Maerz T, Shams C, Guettler J, Bicos J (2015) A review of the anterolateral ligament of the knee: current knowledge regarding its incidence, anatomy, biomechanics, and surgical dissection. Arthroscopy 31:583–591
Porrino J, Maloney E, Richardson M, Mulcahy H, Ha A, Chew FS (2015) The anterolateral ligament of the knee: MRI appearance, association with the segond fracture, and historical perspective. Am J Roentgenol 204:367–373
Rasmussen MT, Nitri M, Williams BT, Moulton SG, Cruz RS, Dornan GJ, Goldsmith MT, LaPrade RF (2015) 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 44(3):585–592
Segond P (1879) Recherches cliniques et expérimentales sur les épanchements sanguins du fenou par entorse. Progres Med 7:297–341
Sonnery-Cottet B, Lutz C, Daggett M, Dalmay F, Freychet B, Niglis L, Imbert P (2016) The involvement of the anterolateral ligament in rotational control of the knee. Am J Sports Med 44(5):1209–1214
Taneja AK, Miranda FC, Braga CAP, Gill CM, Hartmann LGC, Santos DCB, Rosemberg LA (2014) MRI features of the anterolateral ligament of the knee. Skelet Radiol 44:403–410
Van Der Watt L, Khan M, Rothrauff BB, Ayeni OR, Musahl V, Getgood A, Peterson D (2015) The structure and function of the anterolateral ligament of the knee: a systematic review. Arthroscopy 31(569–582):e3