Editorial Commentary: Imaging of the Anterolateral Ligament of the Knee: The MR(eye) Sees What the Brain Knows…

Significant focus has recently been placed on the contribution of the anterolateral ligament (ALL) to controlling anterolateral rotatory laxity of the anterior cruciate ligament (ACL) injured knee. Many recent studies have investigated the use of magnetic resonance imaging and ultrasound on determining the degree of ALL injury and whether this is correlated to high-grade rotatory laxity. Unfortunately, most studies lack a reference standard, and as such it is challenging to determine whether it truly is the ALL that is injured or if the capsule-osseous layer and deep iliotibial band are involved. Historic literature has demonstrated the importance of these other structures having been noted to be injured at the time of ACL reconstruction. As such, it is clear that high-grade rotatory laxity does not result from an isolated ACL injury. We therefore must remain open to the idea that it is not just the ALL that may cause this injury pattern, and optimal solutions to address this patholaxity have yet to be fully determined.