Objective: This study aimed to evaluate the associations between magnetic resonance imaging (MRI) findings of the anterolateral ligament (ALL) and clinical variables in patients undergoing anterior cruciate ligament (ACL) reconstruction. By focusing on ALL injuries, we aim to elucidate their imaging manifestations and their relationships with patient demographics and clinical variables.

Methods: This retrospective study was conducted across three orthopedic surgical centers in Mashhad, focusing on patients with clinically confirmed ACL tears scheduled for reconstruction surgery between January and August 2024. MRI scans were interpreted by two or three experienced radiologists using a 1.5 Tesla MRI machine. Statistical analysis was performed to assess associations between MRI-detected ALL injuries and clinical variables.

Results: Eighty-three patients were included in the study, with a mean age of 29 years; the majority were male (90.6%). MRI revealed ALL injuries in 34 patients (41%), while 45 patients (54.2%) showed no detectable ALL injuries. Four cases could not be classified. Furthermore, 41.7% of the patients had both confirmed ACL and ALL injuries. The high-grade pivot shift test yielded positive results in 54.2% of the patients. Medial meniscus injuries were found in 53% of the patients, whereas lateral meniscus injuries were noted in 13.3%. Joint effusion was present in 60.2% of the cases. A significant association was observed between MRI-detected effusion and ALL injury (P-value = 0.035), and a strong correlation was noted between a positive pivot shift test and ALL injury (P-value < 0.001). No significant associations were found between ALL injury and age, sex, or the anterior drawer test.

Conclusion: This study suggests a significant association between ALL injuries and both MRI-detected effusion and positive pivot shift test results in patients undergoing ACL reconstruction. Although a trend toward association with PCL buckling was observed, further research with larger sample sizes is warranted to confirm this finding.