Implementing Newly Designed Anatomical Protocol Providing an Ultrasound Footplate to Identify Anterolateral Ligament

ROGERS Dylan1, Taylor DELAMARTER1, Cody LEVANTIERRE1, Brion BENNINGER1-9, Medical Anatomy Center1, Departments of Medical Anatomical Sciences2, Neuromuscular Medicine3, Family Practice4, Western University of Health Sciences,... [ view full abstract ]

ROGERS Dylan1, Taylor DELAMARTER1, Cody LEVANTIERRE1, Brion BENNINGER1-9, Medical Anatomy Center1, Departments of Medical Anatomical Sciences2, Neuromuscular Medicine3, Family Practice4, Western University of Health Sciences, COMP–Northwest, Lebanon, OR. USA. Departments of Orthopaedics5, General Surgery6 and Sports Medicine7, Samaritan Health Services, Corvallis, OR. USA. Departments of Surgery8, Orthopaedics & Rehabilitation9, Oregon Health & Science University, Portland, OR. USA.

INTRODUCTION. The recently (re)defined anterolateral ligament (ALL) has been a hot topic in the media recently. It has become particularly relevant in sports medicine due to its importance in rotational stability of the knee, anterior cruciate ligament injuries and Segond fractures. The anatomy and morphology of the ALL has been sufficiently described in multiple anatomical studies; however, imaging of this ligament has been elusive. The objective of this study was to develop a protocol to identify the ALL using ultrasound (US). METHODS. Literature search was conducted on imaging of the ALL using ultrasound. 12 MHz and 18 MHz US probes were used to identify the ALL in 2 un-embalmed and 2 embalmed donor cadaver patients (DCPs). MRI was completed on one un-embalmed DCP. Deep dissection of the DCPs was completed to reveal the morphology of the ALL. The US protocol was implemented on 40 healthy knees in an attempt to consistently identify the ALL. The protocol was then taught to 20 novice US users and US identification was attempted on a control healthy knee. 20 Novice US users were taught this protocol. 20/20 were able to identify the ALL in a control healthy knee. RESULTS. Literature search revealed no known studies. The ALL was successfully identified in 40/40 healthy human knees using the US protocol developed on DCPs. DISCUSSION. Literature search revealed no known studies. The ALL is becoming of increasing interest in sports medicine and orthopedics, but reliance on MRI to diagnose ALL injuries has been inconsistent. MRI and deep dissection confirmed the morphology of the ALL as visualized on US imaging. CONCLUSION. Ultrasonography can successfully identify the Anterolateral Ligament of the knee in healthy human knees and may be of future value in diagnostic evaluation of rotational instability of the knee, or injuries of the anterior cruciate ligament, lateral collateral ligament, or posterolateral corner.