Multiplanar reformation improves identification of the anterolateral ligament with MRI of the knee

Abstract The anterolateral ligament (ALL) is subject of the current debate concerning rotational stability in case of anterior cruciate ligament (ACL) injuries. Today, reliable anatomical and biomechanical evidence for its existence and course is available. Some radiologic studies claim to be able t...

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Autores principales:	Andreas Hecker, Rainer J. Egli, Emanuel F. Liechti, Christiane S. Leibold, Frank M. Klenke
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/fb1fc7dd1e8c40b68b51ba0616da6c57
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spelling	oai:doaj.org-article:fb1fc7dd1e8c40b68b51ba0616da6c572021-12-02T16:07:02ZMultiplanar reformation improves identification of the anterolateral ligament with MRI of the knee10.1038/s41598-021-92707-w2045-2322https://doaj.org/article/fb1fc7dd1e8c40b68b51ba0616da6c572021-06-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-92707-whttps://doaj.org/toc/2045-2322Abstract The anterolateral ligament (ALL) is subject of the current debate concerning rotational stability in case of anterior cruciate ligament (ACL) injuries. Today, reliable anatomical and biomechanical evidence for its existence and course is available. Some radiologic studies claim to be able to identify the ALL on standard coronal plane MRI sections. In the experience of the authors, however, ALL identification on standard MRI sequences frequently fails and is prone to errors. The reason for this mainly lies in the fact, that the entire ALL often cannot be identified on a single MRI image. This study aimed to establish an MRI evaluation protocol improving the visualization of the ALL, using multiplanar reformation (MPR) with the goal to be able to evaluate the ALL on one MRI image. A total of 47 knee MRIs performed due to atraumatic knee pain between 2018 and 2019 without any pathology were analyzed. Identification of the ALL was performed twice by an orthopedic surgeon and a radiologist on standard coronal plane and after MPR. For the latter axial and coronal alignment was obtained with the femoral condyles as a reference. Then the coronal plane was adjusted to the course of the ALL with the lateral epicondyle as proximal reference. Visualization of the ALL was rated as “complete” (continuous ligamentous structure with a tibial and femoral insertion visible on one coronal image), “partial” (only parts of the ALL like the tibial insertion were visible) and “not visible”. The distances of its tibial insertion to the bony joint line, Gerdy’s tubercle and the tip of the fibular head were measured. On standard coronal images the ALL was fully visible in 17/47, partially visible in 27/47, and not visible in 3/47 cases. With MPR the ALL was fully visible in 44/47 and not visible in 3/47 cases. The median distance of its tibial insertion to the bony joint line, Gerdy’s tubercle and the tip of the fibular head were 9, 21 and 25 mm, respectively. The inter- (ICC: 0.612; 0.645; 0.757) and intraobserver (ICC: 0.632; 0.823; 0.857) reliability was good to excellent. Complete visualization of the ALL on a single MRI image is critical for its identification and evaluation. Applying multiplanar reformation achieved reliable full-length visualization of the ALL in 94% of cases. The described MPR technique can be applied easily and fast in clinical routine. It is a reliable tool to improve the assessment of the ALL.Andreas HeckerRainer J. EgliEmanuel F. LiechtiChristiane S. LeiboldFrank M. KlenkeNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-8 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Andreas Hecker Rainer J. Egli Emanuel F. Liechti Christiane S. Leibold Frank M. Klenke Multiplanar reformation improves identification of the anterolateral ligament with MRI of the knee
description	Abstract The anterolateral ligament (ALL) is subject of the current debate concerning rotational stability in case of anterior cruciate ligament (ACL) injuries. Today, reliable anatomical and biomechanical evidence for its existence and course is available. Some radiologic studies claim to be able to identify the ALL on standard coronal plane MRI sections. In the experience of the authors, however, ALL identification on standard MRI sequences frequently fails and is prone to errors. The reason for this mainly lies in the fact, that the entire ALL often cannot be identified on a single MRI image. This study aimed to establish an MRI evaluation protocol improving the visualization of the ALL, using multiplanar reformation (MPR) with the goal to be able to evaluate the ALL on one MRI image. A total of 47 knee MRIs performed due to atraumatic knee pain between 2018 and 2019 without any pathology were analyzed. Identification of the ALL was performed twice by an orthopedic surgeon and a radiologist on standard coronal plane and after MPR. For the latter axial and coronal alignment was obtained with the femoral condyles as a reference. Then the coronal plane was adjusted to the course of the ALL with the lateral epicondyle as proximal reference. Visualization of the ALL was rated as “complete” (continuous ligamentous structure with a tibial and femoral insertion visible on one coronal image), “partial” (only parts of the ALL like the tibial insertion were visible) and “not visible”. The distances of its tibial insertion to the bony joint line, Gerdy’s tubercle and the tip of the fibular head were measured. On standard coronal images the ALL was fully visible in 17/47, partially visible in 27/47, and not visible in 3/47 cases. With MPR the ALL was fully visible in 44/47 and not visible in 3/47 cases. The median distance of its tibial insertion to the bony joint line, Gerdy’s tubercle and the tip of the fibular head were 9, 21 and 25 mm, respectively. The inter- (ICC: 0.612; 0.645; 0.757) and intraobserver (ICC: 0.632; 0.823; 0.857) reliability was good to excellent. Complete visualization of the ALL on a single MRI image is critical for its identification and evaluation. Applying multiplanar reformation achieved reliable full-length visualization of the ALL in 94% of cases. The described MPR technique can be applied easily and fast in clinical routine. It is a reliable tool to improve the assessment of the ALL.
format	article
author	Andreas Hecker Rainer J. Egli Emanuel F. Liechti Christiane S. Leibold Frank M. Klenke
author_facet	Andreas Hecker Rainer J. Egli Emanuel F. Liechti Christiane S. Leibold Frank M. Klenke
author_sort	Andreas Hecker
title	Multiplanar reformation improves identification of the anterolateral ligament with MRI of the knee
title_short	Multiplanar reformation improves identification of the anterolateral ligament with MRI of the knee
title_full	Multiplanar reformation improves identification of the anterolateral ligament with MRI of the knee
title_fullStr	Multiplanar reformation improves identification of the anterolateral ligament with MRI of the knee
title_full_unstemmed	Multiplanar reformation improves identification of the anterolateral ligament with MRI of the knee
title_sort	multiplanar reformation improves identification of the anterolateral ligament with mri of the knee
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/fb1fc7dd1e8c40b68b51ba0616da6c57
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Multiplanar reformation improves identification of the anterolateral ligament with MRI of the knee

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