Brian Scott Martell MD, Presenter: Nothing to Disclose

Leon Lenchik MD, Abstract Co-Author: Nothing to Disclose

Scott David Wuertzer MD, MS, Abstract Co-Author: Nothing to Disclose

Maha Torabi MD, Abstract Co-Author: Nothing to Disclose

Anterolateral ligament (ALL) is a controversial term recently introduced into the orthopedic literature as a potential source for Segond fractures. ALL injures that do not result in Segond fractures may still contribute to knee instability. The purpose of our study was to determine if anterolateral knee injuries are more common in patients with arthroscopically proven ACL tears compared to controls.

Retrospective review of 122 consecutive knee MRIs in patients under age 50 who had arthroscopies performed by the same orthopedic surgeon. Patients with revision ACL surgery and those with Segond fractures were excluded. 29 patients with first-time ACL reconstruction were compared to 29 age-matched controls with normal ACL at arthroscopy. Preoperative MR images in both groups were reviewed by consensus of two expert readers, blinded to surgical intervention. The anterior lateral corner of the knee was evaluated on axial and coronal images, from the iliotibial band anteriorly to the fibular collateral ligament posteriorly. In particular, the tibial attachment of the ALL (and other meniscotibial structures) was carefully scrutinized. The ALL was categorized as present or absent. When the ALL was present, it was categorized as torn or intact. In all cases, the presence of soft tissue edema in the anterolateral corner was recorded. 

Meniscotibial portion of ALL was visualized in 24 of 29 (83%) patients without ACL tears and 23 of 29 (79%) patients with ACL tears. ALL was torn in 1 of 29 (3%) patients without ACL tears and 1 of 29 (3%) patients with ACL tears. Soft tissue edema in the anterolateral corner was present in 4 of 29 (14%) patients without ACL tears and 19 of 29 (66%) patients with ACL tears. The combination of soft tissue edema and nonvisualized ALL was more common in patients with ACL tears (17%) compared to controls (0%).

Meniscotibial portion of ALL is commonly visualized but rarely torn. The presence of edema in the expected location of ALL is common in patients with ACL tears. 

Whether ALL is a new structure or a new name for the mid-third capsular ligament; some authors suggest that it contributes to knee instability even in the absence of a Segond fracture. Further work is needed to determine if anterolateral edema on MR imaging contributes to knee instability and if such signal is associated with ALL tears (soft-tissue Segonds).

Martell, B, Lenchik, L, Wuertzer, S, Torabi, M, In Search of a Soft Tissue Segond: Anterolateral Ligament and Its Neighbors.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14013204.html