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

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. Concomitant 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.