What question did this study set out to answer?

This study aims to evaluate the reporting rate of anterolateral ligament injuries on MRI assessments in young athletes with ACL tears.

February 6, 2026

Injury Reporting Frequency of the Anterolateral Ligament in Sport-related Anterior Cruciate Ligament Tears: A Retrospective Magnetic Resonance Imaging Review

Key Points

This study aims to evaluate the reporting rate of anterolateral ligament injuries on MRI assessments in young athletes with ACL tears.
Retrospective review of patients ≤25 years with sports-related ACL tears from 2015 to 2019.
Inclusion criteria focused on patients with concomitant lateral compartment injuries.
Assessment of ALL injury visualization and grading on primary and secondary MRI reviews.
0% of ALL injuries were visualized on primary MRI versus 99.5% on secondary review.
67.5% of visualized ALLs had accompanying injuries missed on initial assessments.
Injuries were categorized as Grade I (41.5%), Grade II (44.4%), and Grade III (14.1%) sprains or tears.

Abstract

Background: The anterolateral ligament (ALL) has gained interest due to ongoing debates on its clinical significance. This retrospective study aimed to determine the ALL-injury reporting rate on primary magnetic resonance imaging (MRI) assessment compared to a secondary review by a fellowship-trained musculoskeletal radiologist. We hypothesized that ALL injuries were underreported on routine MRI assessments. Materials and Methods: Inclusion criteria consisted of patients ≤25 years with sport-related anterior cruciate ligament (ACL) tears and concomitant injuries in the lateral compartment treated with primary ACL reconstructions from 2015 to 2019. ACL revisions and non-sport–related injuries were excluded. Secondary ALL visualization was defined as full, partial, or not visualized and characterized as Grade I (mild/intermediate sprain), II (severe sprain/partial tear), or III (complete tear/avulsion). Sample size was determined using chi-squared test of independence ( P < .05). Results: A total of 370 patients met the inclusion criteria and 200 were sequentially enrolled (average age: 21.1 ± 6.0 years, 34% women, 66% men). Injuries occurred during recreational (n = 86), high school (n = 83), college (n = 29), and professional sports (n = 2). The primary ALL-visualization rate was 0% (0/200) compared to 99.5% (199/200) during secondary review (133 fully, 66 partially). Of visualized ALLs, 67.5% (n = 135) demonstrated a concomitant injury that was missed on the initial MRI assessment: 41.5% Grade I, 44.4% Grade II, and 14.1% Grade III. Conclusion: Concomitant ALL injuries are frequently missed on routine MRI in young patients with primary sports-related ACL tears. Education and heightened awareness of the ALL may improve diagnostic accuracy on routine MRIs and provide guidance for surgical management.

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