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MRI alone unreliable for diagnosis of anterolateral ligament injuries
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LYON, France — Results of a prospective case-control study presented here indicated MRI scans alone should not be used to preoperatively diagnose anterolateral ligament injuries.
“The MRI scan used in a standard knee protocol is a suboptimal tool for identifying the structure described as the anterolateral ligament. It has a limited role in the preoperative diagnosis of injury, and it is essential to characterize these cases clinically,” Timothy S. Whitehead, MBBS, FRACS, of Essendon, Victoria, Australia, said in his presentation at the International Society for Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine Biennial Congress.
To assess the ability of MRI using a standard knee protocol to preoperatively identify the anterolateral ligament (ALL), the researchers matched 60 ACL-injured patients with confirmed ACL injuries for age and sex to a cohort patients with medial-side knee pain and intact ACLs. All MRI scans were evaluated by a musculoskeletal-trained radiologist and an orthopedic surgeon. The researchers divided the ALL into three regions — femoral, meniscal and tibial — and noted whether the ligament was visualized in each region. If so, the integrity of the ligament was categorized as intact, attenuated or having focal discontinuity.
In the control group, the ALL was visualized in the femoral portion in 70% of cases, in the meniscus in 55% and at the tibial end in 52%. For ACL-injured knees, these proportions were 36%, 40% and 43%, respectively.
“In our study, we had poor visualization of the ALL in ACL-injured knees,” Whitehead said, noting the ALL was seen less than 50% of the time in these cases.
“We had moderate to substantial interobserver reliability, which was better in the control group,” he said.
The researchers also found a Segond fracture in four cases. – by Gina Brockenbrough, MA
Reference:
Whitehead TS, et al. Paper #209. Presented at: International Society for Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine Biennial Congress; June 7-11, 2015; Lyon, France.
Disclosure: Whitehead reports that he is a speaker for and receives research support from Smith & Nephew.