The Archives of Bone and Joint Surgery

The Archives of Bone and Joint Surgery

Associations between MRI Findings of the Anterolateral Ligament in Knee Injuries and Clinical Variables in Candidates for Anterior Cruciate Ligament Reconstruction

Document Type : RESEARCH PAPER

Authors
Farsad Nemati Karimooy 1
Reza Ganji 2
Hadi Makhmalbaf 3
Seyed Mohammad Hassan Moallem 3
Mohammad H. Ebrahimzadeh 3
Ali Moradi 4
Saber Shoja Ortekand 1
Behzad Aminzadeh 1
1 Department of Radiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
2 Department of Orthopedic Surgery, School of Medicine, North Khorasan University of Medical Sciences, Bojnurd, Iran
3 Orthopedics Research Center, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
4 Clinical Research Development Unit, Ghaem Hospital, Mashhad University of Medical Sciences (MUMS), Mashhad, Iran
10.22038/abjs.2025.87469.3956
Abstract
Objectives: 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.
Methods: This retrospective multicenter study included patients with clinically confirmed ACL tears scheduled for reconstruction between January and August 2024 at three orthopedic centers in Mashhad. MRI examinations were performed using a 1.5-T scanner and interpreted by two to three experienced radiologists. Associations between MRI-detected ALL injuries and clinical variables were analyzed statistically.
Results: Eighty-three patients (mean age, 29 years; 90.6% male) were included. MRI identified ALL injuries in 34 patients (41.0%), while 45 patients (54.2%) had no detectable ALL injury; four cases were unclassified. oncomitant ACL and ALL injuries were present in 41.7% of patients. A high-grade pivot shift test was positive in 54.2% of cases. Medial and lateral meniscal injuries were observed in 53.0% and 13.3% of patients, respectively, and joint effusion was present in 60.2%. Significant associations were found between ALL injury and MRI-detected effusion (P = 0.035) as well as a positive pivot shift test (P < 0.001). No significant relationships were observed between ALL injury and age, sex, or anterior drawer test findings.
Conclusion: ALL injuries were significantly associated with joint effusion and positive pivot shift test results in patients undergoing ACL reconstruction. Although a possible association with posterior cruciate ligament buckling was observed, larger studies are needed to confirm this finding.
Level of evidence: III
Keywords
Anterior cruciate ligament (ACL)
Anterolateral ligament (ALL)
Concomitant injury
Magnetic resonance imaging (MRI)
Pivot shift test
Subjects
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The Archives of Bone and Joint Surgery
Volume 14, Issue 8
August 2026
Pages 510-517

  • Receive Date 28 May 2025
  • Accept Date 10 August 2025