Dear Editor,
With great interest I have read the article "Anatomical study on the anterolateral
ligament of the knee" in your journal.11. Helito CP, Miyahare HS, Bonadio MB, Tirico LE, Gobbi RG, Demange MK,
et al. Anatomical study on the anterolateral ligament of the knee. Rev Bras Ortop.
2013;48(4):368-73. Meanwhile
another morphological study by Claes et al.22. Claes S, Vereecke E, Maes M, Victor J, Verdonk P, Bellemans J.
Anatomy of the anterolateral ligament of the knee. J Anat.
2013;223(4):321-8. also
reported regular occurrence of the anterolateral ligament of the knee. Together with the
data of Vincent et al., these three studies have examined 57 anatomical specimen and
found the anterolateral ligament in 56 of them (98.2%).11. Helito CP, Miyahare HS, Bonadio MB, Tirico LE, Gobbi RG, Demange MK,
et al. Anatomical study on the anterolateral ligament of the knee. Rev Bras Ortop.
2013;48(4):368-73.
2. Claes S, Vereecke E, Maes M, Victor J, Verdonk P, Bellemans J.
Anatomy of the anterolateral ligament of the knee. J Anat.
2013;223(4):321-8.-33. Vincent JP, Magnussen RA, Gezmez F, Uguen A, Jacobi M, Weppe F, et
al. The anterolateral ligament of the human knee: an anatomic and histologic study.
Knee Surg Sports Traumatol Arthrosc. 2012;20(1):147-52. Given the probable
clinical impact on outcome after surgery of the anterior cruciate ligament preoperative
judgment of its integrity would be desirable. To study the visibility on standard
magnetic resonance imaging (MRI) of the knee 30 randomly selected knee MRIs from the
departmental PACS were reviewed (5 women, 25 men, mean age 38.9 years). Imaging was
performed on an outpatient basis using different scanners with a field strength of 1.0
or 1.5 T. According to the reported localization of the anatomic studies coronal images
seemed most appropriate for depiction. All patients received coronal proton-density
weighted or fat-suppressed T2-weighted images with a slice thickness of 3-4mm. The
images were reviewed using the departmental PACS (synedra view®, Synedra, Innsbruck,
Austria). The anterolateral ligament could be identified in 22 of the 30 patients
(73.3%). As shown in the figure it could be found dorsal to the ilitibial tract and
vetral to the lateral collateral ligament (Fig.
1). In most patients the anterolateral ligament could only be seen as a very thin
ligamentous structure, in some patients only the part inserting at the lateral meniscus
could be identified. Given the small number of cases no significant differences between
the different scanners/sequences could be observed. Other orientations of the sequences
(sagittal/axial) were found to be unreliable for the depiction of the anterolateral
ligament. Until now the depiction of this ligament has not been discussed in the
radiological literature. In an abstract of their work Claes et al.44. Claes SA, Bartholomeeusssen S, Vereecke EE, Victor JM, Verdonk P,
Bellemans J. The anterolateral ligament of the knee: anatomy, radiology, biomechanics
and clinical implications. Presented at the 2013 AAOS annual meeting. Disponível em:
www.abstractsonline.com
www.abstractsonline.com...
reported about a visibility of the anterolateral ligament in 95.7%
on MRI of cases with ruptured anterior cruciate ligament. The difference may be
explained by the fact that the depiction of ligamentous injury is facilitated by joint
effusion and edematous soft tissues separating the anatomical structures. In contrast,
our approach also included exams without acute pathology, but they did not report the
scanners or sequences used. In these patients a high frequency of torn anterolateral
ligaments was reported.
- Coronal fat-suppressed T2-weighted imaging of a 38-year-old male after trauma. The anterolateral ligament is arising from the femur with two insertions, the lateral meniscus and the tibia. It is located dorsal to the iliotibial tract and ventral to the lateral collateral ligament.
In conclusion, the recently reported anterolateral ligament can be depicted in the majority of patients undergoing standard MRI of the knee. With a reduction of slice thickness or higher field strengths (3T) visibility will probably further increase. Orthopedic surgeons and radiologists should be aware of the importance of this structure and report about it when reviewing MRI scans of the knee.
Referências
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1Helito CP, Miyahare HS, Bonadio MB, Tirico LE, Gobbi RG, Demange MK, et al. Anatomical study on the anterolateral ligament of the knee. Rev Bras Ortop. 2013;48(4):368-73.
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2Claes S, Vereecke E, Maes M, Victor J, Verdonk P, Bellemans J. Anatomy of the anterolateral ligament of the knee. J Anat. 2013;223(4):321-8.
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3Vincent JP, Magnussen RA, Gezmez F, Uguen A, Jacobi M, Weppe F, et al. The anterolateral ligament of the human knee: an anatomic and histologic study. Knee Surg Sports Traumatol Arthrosc. 2012;20(1):147-52.
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4Claes SA, Bartholomeeusssen S, Vereecke EE, Victor JM, Verdonk P, Bellemans J. The anterolateral ligament of the knee: anatomy, radiology, biomechanics and clinical implications. Presented at the 2013 AAOS annual meeting. Disponível em: www.abstractsonline.com
» www.abstractsonline.com
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☆
Please cite this article as: Gossner J. Ligamento anterolateral do joelho – visibilidade na ressonância nuclear magnética. Rev Bras Ortop. 2014;49:98–99.
Publication Dates
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Publication in this collection
Jan-Feb 2014