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Anatomical study on the anterolateral ligament in a Chinese population
Abstracts / Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilitation and Technology 9 (2017) 59e124
the orthopedic surgeon. The observed proportionate agreement between the two assessors was 0.86 and the kappa was 0.176. In the group with MRI scans between a month to 2 months after knee injury (n¼ 60), the ALL tear was reported in 78% of patients by the radiologist and 92% of patients by the orthopedic surgeon. The observed proportionate agreement between the two assessors was 0.62 and the kappa was -0.14. Discussion: The detection of tear of the ALL showed a discrepancy of between 2 to 14% depending on duration of time between the MRI and the injury. The reduction in accuracy in detection of presence of a tear on MRI was affected by duration between time of injury and time when the MRI was taken. (p value < 0.01). In the group with MRI scans within the month after knee injury, the observed proportionate agreement of identifying the location of the ALL tear at the femoral, meniscal and tibial insertions were 0.53, 0.72 and 0.76 respectively. The kappa for the above was 0.09, 0.28 and 0.37 respectively. This indicated that the ALL tears could still be fairly accurately identified on the tibial side. In the group with MRI scans between a month to 2 months after knee injury, the observed proportionate agreement was 0.55, 0.52 and 0.57 respectively. The kappa was -0.02, 0.11 and 0.12 respectively for the above. When we compared the pre-surgery Subjective IKDC and Lysholm scores for the patients with ACL tears versus those with combined ACL and ALL tears, we found no statistically significant differences between the two groups. Conclusion: We have shown the Anterolateral Ligament can be accurately identified on MRI. If the MRI is performed within one month of injury, the ALL tear can be identified fairly accurately, especially if the tear occurs on the tibial side. Duration of the MRI from the knee injury will also affect the accuracy of ALL tears being identified on MRI. Keywords: ALL, tears, MRI
Knee - Ligament > Anterolateral ligament EP-070 ANATOMICAL STUDY ON THE ANTEROLATERAL LIGAMENT IN A CHINESE POPULATION Jiangyu Cai, Shiyi Chen. Department of Sports Medicine, Huashan Hospital, China Objective: There have been different descriptions of the anterolateral ligament (ALL) of the knee. Therefore, a thorough study of the anatomy of the anterolateral structure of the knee is needed. This article aims to make further exploration of the structure characteristics of ALL and provide clinical reference for diagnosis and treatment of ALL injury, especially for ALL reconstruction through anatomical study of ALL in a Chinese population. Methods: 16 cadaveric knees, including 8 left knees and 8 right knees with sex ratio of 1:1 and a mean age of 73.5±9.6 years old were dissected to reveal the ALL through a standard approach. A qualitative and a quantitative characterization of the ALL were performed. Each ALL was described in terms of its origin, insertion, association with the lateral meniscus, ligamentous tension at 0 and 60 flexion and maximal internal rotation. A digital caliper with an accuracy of 0.1 mm and a protractor were used to measure the following aspects of the ALL: length at 0 and 60 flexion and neutral knee rotation, width at the femoral origin, the joint line and the tibial insertion, thickness at the joint line, distance to the center of the Gerdy tubercle and the lateral margin of the fibular head as well as angle between the ALL and the lateral collateral ligament (LCL) at 60 flexion. The mean and standard deviation were used to describe the data, and the statistical analysis was performed using SPSS19.0 software. Results: ALL was seen in 75.0% of the specimens, originating on the lateral femoral epicondyle, proximal and posterior to the LCL. It coursed on LCL or parallelly to LCL, anterodistally to its anterolateral tibial attachment approximately midway between the center of the Gerdy tubercle and the lateral margin of the fibular head (23.9±3.3mm and 23.8±4mm). A strong connection was observed between the middle part of the ALL and the periphery of the meniscal body of the lateral meniscus. The ALL length at 0 and 60 flexion and neutral knee rotation were 44.8±5.1mm and
83
47.8±5.5mm respectively (P¼0.000) , and the ligament had its great extend at 60 of knee flexion and internal rotation. The width at the femoral origin, the joint line and the tibial insertion were 7.7±1.8mm, 6.3±1.4mm and 8.7±1.6mm. the thickness at the joint line 1.7±0.7mm. The mean angle between the ALL and the lateral collateral ligament (LCL) at 60 flexion was 16.8±3.5 . Furthermore, the ALL length at 0 and 60 flexion of male were both significantly higher than those of female (P¼0.015,P¼0.019) , while other measurements did not have a significant difference. Conclusions: ALL is an independent and a non-isometric ligament located in the anterolateral area to the knee, of which the length is different between male and female. ALL plays an important role in rotational stability of the knee, and should be put much emphasis in clinical practice. Keywords: anterolateral ligament, knee, anatomy
Knee - Ligament > Anterolateral ligament EP-160 ANTEROLATERAL LIGAMENT ABNORMALITY IN ACUTE ANTERIOR CRUCIATE LIGAMENT INJURIES A MAGNETIC RESONANCE IMAGING ASSESSMENT ON PATIENTS WITH HIGH-GRADE PIVOT-SHIFT PHENOMENON Guan-yang Song, Hua Feng. Department of Sports Medicine Service, Beijing Jishuitan Hospital, China Purpose: To report the epidemiology of injuries and abnormalities of the anterolateral ligament (ALL) by magnetic resonance imaging (MRI) in patients with high-grade (grade II & III) pivot-shift phenomenon after acute anterior cruciate ligament (ACL) injuries. Methods: MRIs of patients with high-grade pivot-shift phenomenon after acute ACL injury were retrospectively evaluated. The ALL was first marked as visualized and non-visualized. Then ALL abnormalities were considered when proximal or distal bone detachment, discontinuity of its fibers or irregular contour associated with periligamentous edema or a combination of these MRI features was observed. The ALL was divided into proximal and distal portions, and the abnormalities of each portion were characterized. The correlation of ALL injury with the severity of lateral compartment [lateral femoral condyle (LFC) & lateral tibial plateau (LTP)] bone contusions were also investigated. Results: A total of 68 MRI scans were initially evaluated. The ALL was unable to be characterized in 7 (10%) examinations, resulting in 61 (90%) cases of injury evaluation. Of these, 5 (8%) patients had a normal ALL, and the remaining 56 (92%) all showed signs of injury. Among the cases with ALL injury, 44 (79%) patients showed proximal injuries, 9 (16%) patients showed distal lesions, and 3 (5%) patients presented both proximal and distal lesions. Moreover, statistically significant relationship were found between ALL injury and the moderate/severe lateral compartment (LFC & LTP) bone contusions (PLFC ¼ 0.025; PLTP ¼ 0.041). Conclusions: Based on the MRI assessments of this study, 92% of the patients with high-grade pivot-shift phenomenon after acute ACL injury presented ALL abnormalities, which was significantly associated with moderate/severe lateral compartment bone contusions. Keywords: anterolateral ligament, magnetic resonance imaging, highgrade pivot-shift, acute anterior cruciate ligament injury
Knee - Ligament > PCL/PLRI EP-173 ARTHROSCOPIC ALL-INSIDE RECONSTRUCTION FOR POSTERIOR CRUCIATE LIGAMENT AND POPLITEUS TENDON COMPARED WITH POPLITEOFIBULAR LIGAMENT RECONSTRUCTION Hui Zhang, Hua Feng. Department of Sports Medicine Service, Beijing Jishuitan Hospital, Beijing, China Objective: The purpose of this study was to describe the clinical results of a one-stage operation for posterior cruciate ligament reconstruction and a posterolateral corner reconstruction of popliteus tendon reconstruction, compared with an open popliteofibular ligament reconstruction. Methods: Our study included 33 patients who had undergone posterior cruciate ligament reconstruction with use of an Achilles tendon-bone
the orthopedic surgeon. The observed proportionate agreement between the two assessors was 0.86 and the kappa was 0.176. In the group with MRI scans between a month to 2 months after knee injury (n¼ 60), the ALL tear was reported in 78% of patients by the radiologist and 92% of patients by the orthopedic surgeon. The observed proportionate agreement between the two assessors was 0.62 and the kappa was -0.14. Discussion: The detection of tear of the ALL showed a discrepancy of between 2 to 14% depending on duration of time between the MRI and the injury. The reduction in accuracy in detection of presence of a tear on MRI was affected by duration between time of injury and time when the MRI was taken. (p value < 0.01). In the group with MRI scans within the month after knee injury, the observed proportionate agreement of identifying the location of the ALL tear at the femoral, meniscal and tibial insertions were 0.53, 0.72 and 0.76 respectively. The kappa for the above was 0.09, 0.28 and 0.37 respectively. This indicated that the ALL tears could still be fairly accurately identified on the tibial side. In the group with MRI scans between a month to 2 months after knee injury, the observed proportionate agreement was 0.55, 0.52 and 0.57 respectively. The kappa was -0.02, 0.11 and 0.12 respectively for the above. When we compared the pre-surgery Subjective IKDC and Lysholm scores for the patients with ACL tears versus those with combined ACL and ALL tears, we found no statistically significant differences between the two groups. Conclusion: We have shown the Anterolateral Ligament can be accurately identified on MRI. If the MRI is performed within one month of injury, the ALL tear can be identified fairly accurately, especially if the tear occurs on the tibial side. Duration of the MRI from the knee injury will also affect the accuracy of ALL tears being identified on MRI. Keywords: ALL, tears, MRI
Knee - Ligament > Anterolateral ligament EP-070 ANATOMICAL STUDY ON THE ANTEROLATERAL LIGAMENT IN A CHINESE POPULATION Jiangyu Cai, Shiyi Chen. Department of Sports Medicine, Huashan Hospital, China Objective: There have been different descriptions of the anterolateral ligament (ALL) of the knee. Therefore, a thorough study of the anatomy of the anterolateral structure of the knee is needed. This article aims to make further exploration of the structure characteristics of ALL and provide clinical reference for diagnosis and treatment of ALL injury, especially for ALL reconstruction through anatomical study of ALL in a Chinese population. Methods: 16 cadaveric knees, including 8 left knees and 8 right knees with sex ratio of 1:1 and a mean age of 73.5±9.6 years old were dissected to reveal the ALL through a standard approach. A qualitative and a quantitative characterization of the ALL were performed. Each ALL was described in terms of its origin, insertion, association with the lateral meniscus, ligamentous tension at 0 and 60 flexion and maximal internal rotation. A digital caliper with an accuracy of 0.1 mm and a protractor were used to measure the following aspects of the ALL: length at 0 and 60 flexion and neutral knee rotation, width at the femoral origin, the joint line and the tibial insertion, thickness at the joint line, distance to the center of the Gerdy tubercle and the lateral margin of the fibular head as well as angle between the ALL and the lateral collateral ligament (LCL) at 60 flexion. The mean and standard deviation were used to describe the data, and the statistical analysis was performed using SPSS19.0 software. Results: ALL was seen in 75.0% of the specimens, originating on the lateral femoral epicondyle, proximal and posterior to the LCL. It coursed on LCL or parallelly to LCL, anterodistally to its anterolateral tibial attachment approximately midway between the center of the Gerdy tubercle and the lateral margin of the fibular head (23.9±3.3mm and 23.8±4mm). A strong connection was observed between the middle part of the ALL and the periphery of the meniscal body of the lateral meniscus. The ALL length at 0 and 60 flexion and neutral knee rotation were 44.8±5.1mm and
83
47.8±5.5mm respectively (P¼0.000) , and the ligament had its great extend at 60 of knee flexion and internal rotation. The width at the femoral origin, the joint line and the tibial insertion were 7.7±1.8mm, 6.3±1.4mm and 8.7±1.6mm. the thickness at the joint line 1.7±0.7mm. The mean angle between the ALL and the lateral collateral ligament (LCL) at 60 flexion was 16.8±3.5 . Furthermore, the ALL length at 0 and 60 flexion of male were both significantly higher than those of female (P¼0.015,P¼0.019) , while other measurements did not have a significant difference. Conclusions: ALL is an independent and a non-isometric ligament located in the anterolateral area to the knee, of which the length is different between male and female. ALL plays an important role in rotational stability of the knee, and should be put much emphasis in clinical practice. Keywords: anterolateral ligament, knee, anatomy
Knee - Ligament > Anterolateral ligament EP-160 ANTEROLATERAL LIGAMENT ABNORMALITY IN ACUTE ANTERIOR CRUCIATE LIGAMENT INJURIES A MAGNETIC RESONANCE IMAGING ASSESSMENT ON PATIENTS WITH HIGH-GRADE PIVOT-SHIFT PHENOMENON Guan-yang Song, Hua Feng. Department of Sports Medicine Service, Beijing Jishuitan Hospital, China Purpose: To report the epidemiology of injuries and abnormalities of the anterolateral ligament (ALL) by magnetic resonance imaging (MRI) in patients with high-grade (grade II & III) pivot-shift phenomenon after acute anterior cruciate ligament (ACL) injuries. Methods: MRIs of patients with high-grade pivot-shift phenomenon after acute ACL injury were retrospectively evaluated. The ALL was first marked as visualized and non-visualized. Then ALL abnormalities were considered when proximal or distal bone detachment, discontinuity of its fibers or irregular contour associated with periligamentous edema or a combination of these MRI features was observed. The ALL was divided into proximal and distal portions, and the abnormalities of each portion were characterized. The correlation of ALL injury with the severity of lateral compartment [lateral femoral condyle (LFC) & lateral tibial plateau (LTP)] bone contusions were also investigated. Results: A total of 68 MRI scans were initially evaluated. The ALL was unable to be characterized in 7 (10%) examinations, resulting in 61 (90%) cases of injury evaluation. Of these, 5 (8%) patients had a normal ALL, and the remaining 56 (92%) all showed signs of injury. Among the cases with ALL injury, 44 (79%) patients showed proximal injuries, 9 (16%) patients showed distal lesions, and 3 (5%) patients presented both proximal and distal lesions. Moreover, statistically significant relationship were found between ALL injury and the moderate/severe lateral compartment (LFC & LTP) bone contusions (PLFC ¼ 0.025; PLTP ¼ 0.041). Conclusions: Based on the MRI assessments of this study, 92% of the patients with high-grade pivot-shift phenomenon after acute ACL injury presented ALL abnormalities, which was significantly associated with moderate/severe lateral compartment bone contusions. Keywords: anterolateral ligament, magnetic resonance imaging, highgrade pivot-shift, acute anterior cruciate ligament injury
Knee - Ligament > PCL/PLRI EP-173 ARTHROSCOPIC ALL-INSIDE RECONSTRUCTION FOR POSTERIOR CRUCIATE LIGAMENT AND POPLITEUS TENDON COMPARED WITH POPLITEOFIBULAR LIGAMENT RECONSTRUCTION Hui Zhang, Hua Feng. Department of Sports Medicine Service, Beijing Jishuitan Hospital, Beijing, China Objective: The purpose of this study was to describe the clinical results of a one-stage operation for posterior cruciate ligament reconstruction and a posterolateral corner reconstruction of popliteus tendon reconstruction, compared with an open popliteofibular ligament reconstruction. Methods: Our study included 33 patients who had undergone posterior cruciate ligament reconstruction with use of an Achilles tendon-bone