MR Imaging of anterolateral knee pain

Rafaela M. Smarlamaki, Foteini I. Terezaki, Eirini D. Savva, Apostolos Karantanas


The anterolateral knee represents a complex anatomic area including osseous, fatty, tendinous and ligamentous structures. Disorders afflicting this anatomic area include acute trauma, which usually involves more than one structures, repetitive trauma, degeneration, inflammation and tumours and tumour-like lesions. A detailed understanding of the anatomy, biomechanics and pathology of the anterolateral knee is essential for proper imaging interpretation and treatment management. Magnetic resonance (MR) imaging has been established as the method of choice, showing high accuracy in diagnosing painful knees. The present review aims to explore the role of MR imaging in diagnosing the various disorders located in this anatomic area and to present representative cases derived from a single center.


MR imaging/diagnosis; knee joint; anterolateral knee/anatomy; anterolateral knee/pathology

Full Text:



James EW, LaPrade CM, LaPrade RF. Anatomy and biomechanics of the lateral side of the knee and surgical implications. Sports Med Arthrosc 2015; 23(1): 2-9.

Guenther D, Griffith C, Lesniak B, et al. Anterolateral rotator instability of the knee. Knee Surg Sports Traumatol Arthrosc 2015; 23(10): 2909-2917.

Graham GP, Fairclough JA. Early osteoarthritis in young sportsmen with severe anterolateral instability of the knee. Injury 1988; 19(4): 247-248.

Ferrer GA, Guentther D, Pauyo T, et al. Structural properties of the anterolateral complex and their clinical implications. Clin Sports Med 2018; 37(1): 41-47.

Kittl C, Inderhaug E, Williams A, et al. Biomechanics of the anterolateral structures of the knee. Clin Sports Med 2018; 37(1): 21-31.

Panni AS, Cerciello S, Maffulli N, et al. Patellar shape can be a predisposing factor in patellar instability. Knee Surg Sports Traumatol Arthrosc 2011; 19: 663-670.

Loudon JK. Biomechanics and pathomechanics of the patellofemoral joint. Int J Sports Phys Ther 2016; 11(6): 820-830.

Starok M, Lenchik L, Trudell D, et al. Normal patellar retinaculum: MR and sonographic imaging with cadaveric correlation. AJR Am J Roentgenol 1997; 168(6): 1493-1499.

Shah KN, DeFroda SF, Ware JK, et al. Lateral patellofemoral ligament-an anatomic study. Orthop J Sports Med 2017; 5(12): 2325967117741439.

Hamill J, Miller R, Noehren B, et al. A prospective study of iliotibial band strain in runners. Clin Biomech 2008; 23(8): 1018-1025.

Seebacher JR, Inglis AE, Marshall JL, et al. The structure of the posterolateral aspect of the knee. J Bone Joint Surg Am 1982; 64(4): 536-541.

Dodds AL, Halewood C, Gupte CM, et al. The anterolateral ligament: Anatomy, length changes and association with the Segond fracture. Bone Joint J 2014; 96-B(3): 325-331.

Claes S, Vereecke E, Maes M, et al. Anatomy of the anterolateral ligament of the knee. J Anat 2013; 223(4): 321-328.

Caterine S, Litchfeld R, Johnson M, et al. A cadaveric study of the anterolateral ligament: Re-introducing the lateral capsular ligament. Knee Surg Sports Traumatol Arthrosc 2015; 23(11): 3186-3195.

Daggett M, Ockuly AC, Cullen M, et al. Femoral origin of the anterolateral ligament: an anatomic analysis. Arthroscopy 2016; 32(5): 835-841.

Klontzas ME, Maris TG, Zibis AH, et al. Normal magnetic resonance imaging anatomy of the anterolateral knee ligament with a T2/T1-weighted 3-dimensional sequence: a feasibility study. Can Assoc Radiol J 2016; 67(1): 52-59.

Spencer L, Burkhart TA, Tran MN, et al. Biomechanical analysis of simulated clinical testing and reconstruction of the anterolateral ligament of the knee. Am J Sports Med 2015; 43(9): 2189-2197.

Parsons EM, Gee AO, Spiekerman C, et al. The biomechanical function of the anterolateral ligament of the knee. Am J Sports Med 2015; 43(3): 669-674.

Jacobson JA, Lenchik L, Ruboy MK, et al. MR imaging of the infrapatellar fat pad of Hoffa. Radiographics 1997; 17(3): 675-691.

Bellon EM, Sacco DC, Steiger DA, et al. MRI in “housemaid’s knee” (prepatellar bursitis). Magn Reson Imaging 1987; 5(3): 175-177.

Bonilla-Yoon I, Masih D, Paterl DB, et al. The Morel- Lavallée lesion: Pathophysiology, clinical presentation, imaging features, and treatment options. Emerg Radiol 2014; 21(1): 35-43.

Mellado JM, Bencardino JT. Morel-Lavallée lesion: Review with emphasis on MR imaging. Magn Reson Imaging Clin N Am 2005; 13(4): 775-782.

Borrero CG, Maxwell N, Kavanagh E. MRI findigns of prepatellar Morel- Lavallée effusions. Skeletal Radiol 2012; 37: 451-455.

Vassalou EE, Zibis AH, Raoulis VA, et al. Morel-Lavallée lesions of the knee: MR Imaging findings compared with a cadaveric study. AJR Am J Roentgenol 2018 (in press).

Diviti S, Gupta N, Hooda K, et al. Morel-Lavallée lesions-review of pathophysiology, clinical findings, imaging findigns and management. J Clin Diagn Res 2017; 11(4): TE1-TE4.

Vanhoenacker F, De Vos N, Van Dyck P. Common mistakes and pitfalls in magnetic resonance imaging of the knee. J Belg Soc Radiol 2016; 100(1): 1-17.

Weaver JK. Bipartite patellae as a cause of disability in the athlete. Am J Sports Med 1977; 5(4): 137-143.

Iwamoto J, Takeda T. Stress fractures in athletes: Review of 196 cases. J Orthop Sci 2003; 8(3): 273-278.

Behrens SB, Deren ME, Matson A, et al. Stress fractures of the pelvis and legs in athletes: A review. Sports Health 2013; 5(2): 165-174.

Karantanas AH, Drakonaki E, Karachalios T, et al. Acute non-traumatic marrow edema syndrome in the knee: MRI findings at presentation, correlation with spinal DEXA and outcome. Eur J Radiol 2008; 67(1): 22-33.

Hunt DM, Somashekar N. A review of sleeve fractures of the patella in children. Knee 2005; 12(1): 3-7.

Earhart C, Patel DB, White EA, et al. Transient lateral patellar dislocation: Review of imaging findings, patellofemoral anatomy, and treatment options. Emerg Radiol 2013; 20(1): 11-23.

Köhlitz T, Scheffler S, Jung T, et al. Prevalence and patterns of anatomical risk factors in patients after patellar dislocation: A case control study using MRI. Eur Radiol 2013; 23(4): 1067-1074.

Tsavalas N, Katonis P, Karantanas AH. Knee joint anterior malalignment and patellofemoral osteoarthritis: An MRI study. Eur Radiol 2012; 22(2): 418-428.

Karachalios T, Zibis A, Papanagiotou P, et al. MR imaging findings in early osteoarthritis of the knee. Eur J Radiol 2004; 50(3): 225-230.

Ho VB, Kransdorf MJ, Jelinek JS, et al. Dorsal defect of the patella: MR features. J Comput Assist Tomogr 1991; 15(3): 474-476.

Posadzy M, Desimpel J, Vanhoenacker F. Cone beam CT of the musculoskeletal system: Clinical applications. Insights Imaging 2018; 9(1): 35-45.

Kwee TC, Sonneveld H, Nix M. Successful conservative management of symptomatic bilateral dorsal patellar defects presenting with cartilage involvement and bone marrow edema: MRI findings. Skeletal Radiol 2016; 45(5): 723-727.

Singh J, James SL, Kroon HM, et al. Tumour and tumour-like lesions of the patella-a multicentre experience. Eur Radiol 2009(3); 19: 701-712.

Casadei R, Kreshak J, Rinaldi R, et al. Imaging tumors of the patella. Eur J Radiol 2013; 82(12): 2140-2148.

Yablon CM, Pai D, Dong Q, et al. Magnetic resonance imaging of the extensor mechanism. Magn Reson Imaging Clin N Am 2014; 22(4): 601-620.

McMahon CJ, Ramappa A, Lee K. The extensor mechanism: Imaging and intervention. Semin Musculoskelet Radiol 2017; 21(2): 89-101.

Ostlere S. The extensor mechanism of the knee. Radiol Clin N Am 2013; 51(3): 393-411.

Roth C, Jacobson J, Jamadar D, et al. Quadriceps fat pad signal intensity and enlargement on MRI: Prevalence and associated findings. AJR Am J Roentgenol 2004; 182(6): 1383-1387.

Shabshin N, Schweitzer ME, Morrison WB. Quadriceps fat pad edema: Significance on magnetic resonance images of the knee. Skeletal Radiol 2006; 35(5): 269-274.

Tsavalas N, Karantanas AH. Suprapatellar fat-pad mass effect: MRI findings and correlation with anterior knee pain. AJR Am J Roentgenol 2013; 200(3): W291-296.

Samin M, Smitaman E, Lawrence D, et al. MRI of anterior knee pain. Skeletal Radiol 2014; 43(7): 875-893.

Soder RB, Mizerkowski MD, Petkowicz R, et al. MRI of the knee in asymptomatic adolescent swimmers: A controlled study. Br J Sports Med 2012; 46(4): 268-272.

Grando H, Chang EY, Chen KC, et al. MR imaging of extrasynovial inflammation and impingement about the knee. Magn Reson Imaging Clin N Am 2014; 22(4): 725-741.

Johnson DP, Wakeley CJ, Watt I. Magnetic resonance imaging of patellar tendonitis. J Bone Joint Surg Br 1996; 78(3): 452-457.

O’Keeffe SA, Hogan BA, Eustace SJ, et al. Overuse injuries of the knee. Magn Reson Imaging Clin N Am 2009; 17(4):725-739.

Peace KA, Lee JC, Healy J. Imaging the infrapatellar tendon in the elite athlete. Clin Radiol 2006; 61(7): 570-578.

Hirano A, Fukubayashi T, Ishii T, et al. Magnetic resonance imaging of Osgood-Schlatter disease: The course of the disease. Skeletal Radiol 2002; 31(6): 334-342.

Bohnsack M, Wilharm A, Hurschler C, et al. Biomechanical and kinematic influences of a total infrapatellar fat pad resection on the knee. Am J Sports Med 2004; 32(8): 1873-1880.

Chung CB, Skaf A, Roger B, et al. Patellar tendon-lateral femoral condyle friction syndrome: MR imaging in 42 patients. Skeletal Radiol 2001; 30(12): 694-697.

Jarraya M, Diaz LE, Roemer FW, et al. MRI findings consistent with peripatellar fat pad impingement: how much related to patellofemoral maltracking? Magn Reson Med Sci 2017; Oct 10. doi: 10.2463/mrms.rev. 2017-0063. [Epub ahead of print].

Matcuk GR Jr, Cen SY, Keyfes V, et al. Superolateral hoffa fat-pad edema and patellofemoral maltracking: predictive modeling. AJR Am J Roentgenol 2014; 203(2): W207-212.

Campagna R, Pessis E, Biau DJ, et al. Is superolateral Hoffa fat pad edema a consequence of impingement between lateral femoral condyle and patellar ligament? Radiology 2012; 263(2): 469-474.

De Smet AA, Davis KW, Dahab KS, et al. Is there an association between superolateral Hoffa fat pad edema on MRI and clinical evidence of fat pad impingement? AJR Am J Roentgenol 2012; 199(5): 1099-1104.

Jarraya M, Guermazi A, Felson DT, et al. Is superolateral Hoffa’s fat pad hyperintensity a marker of local patellofemoral joint disease? - The MOST study. Osteoarthritis Cartilage 2017; 25(9): 1459-1467.

Widjajahakim R, Roux M, Jarraya M, et al. Relationship of trochlear morphology and patellofemoral joint alignment to superolateral hoffa fat pad edema on MR Images in individuals with or at risk for osteoarthritis of the knee: The MOST study. Radiology 2017; 284(3): 806-814.

Jacobson JA, Lenchik L, Ruhoy MK, et al. MR imaging of the infrapatellar fat pad of Hoffa. Radiographics 1997; 17(3): 675-691.

Flato R, Passanante GJ, Skalski MR, et al. The iliotibial tract: Imaging, anatomy, injuries, and other pathology. Skeletal Radiol 2017; 46(5): 605-622.

Vasilevska V, Szeimies U, Stäbler A. Magnetic resonance imaging signs of iliotibial band friction in patients with isolated medial compartment osteoarthritis of the knee. Skeletal Radiol 2009; 38(9): 871-875.

Cruz-López F, Mallen-Trejo A, Pascual-Vidriales C, et al. Iliotibial band friction syndrome due to bioabsorbable pins in ACL reconstruction. Acta Ortop Mex 2016; 30(6): 307-310.

Fox MG. MR Imaging of the meniscus: Review, current trends, and clinical implications. Magn Reson Imaging Clin N Am 2007; 15(1): 103-123.

Nguyen JC, De Smet AA, Graf BK, et al. MR imaging-based diagnosis and classification of meniscal tears. Radiographics 2014; 34(4): 981-999.

Wadhwac V, Omar H, Coyner K, et al. ISAKOS classification of meniscal tears-illustration on 2D and 3D isotropic spin echo MR imaging. Eur J Radiol 2016; 85(1): 15-24.

Ryu KN, Kim IS, Kim EJ, et al. MR imaging of discoid lateral menisci. AJR Am J Roentgenol 1998; 171(4): 963-967.

Wu CC, Hsu YC, Chiu YC, et al. Parameniscal cyst formation in the knee is associated with meniscal tear size: An MRI study. The Knee 2013; 20(6): 556-561.

Van Dyck P, De SMet E, Lambrecht V, et al. The anterolateral ligament of the knee: What the radiologist needs to know. Semin Musculoskelet Radiol 2016; 20(1): 26-32.

Murawski CD, van Eck CF, Irrgang JJ, et al. Operative treatment of primary anterior cruciate ligament rupture in adults. J Bone Joint Surg Am 2014; 96(8): 685-694.

Helito CP, Helito PV, Costa HP, et al. MRI evaluation of the anterolateral ligament of the knee: Assessment in routine 1.5-T scans. Skeletal Radiol 2014; 43(10): 1421-1427.

Taneja AK, Miranda FC, Braga CA, et al. MRI features of the anterolateral ligament of the knee. Skeletal Radiol 2015; 44(3): 403-410.

Claes S, Bartholomeeusen S, Bellemans J. High prevalence of anterolateral ligament abnormalities in magnetic resonance images of anterior cruciate ligament-injured knees. Acta Orthop Belg 2014; 80(1): 45-49.

Faruch Bilfeld M, Cavaignac E, Wytrykowski K, et al. Anterolateral ligament injuries in knees with an anterior cruciate ligament tear: Contribution of ultrasonography and MRI. Eur Radiol 2018; 28(1): 58-65.

Hartigan DE, Carroll KW, Kosarek FJ, et al. Visibility of anterolateral ligament tears in anterior cruciate ligament-deficient knees with standard 1.5-Tesla magnetic resonance imaging. Arthroscopy 2016; 32(10): 2061-2065.

Kosy JD, Schranz PJ, Patel A, et al. The magnetic resonance imaging appearance of the anterolateral ligament of the knee in association with anterior cruciate rupture. Skeletal Radiol 2017; 46(9): 1193-1200.

Devitt BM, O’Sullivan R, Feller JA, et al. MRI is not reliable in diagnosing of concomitant anterolateral ligament and anterior cruciate ligament injuries of the knee. Knee Surg Sports Traumatol Arthrosc 2017; 25(4): 1345-1351.

Sanders TG, Medynski MA, Feller JF, et al. Bone contusion patterns of the knee at MR imaging: Footprint of the mechanism of injury. Radiographics 2000; 20: S135-S151.

Matcuk GR Jr, Mahanty SR, Skalski MR, et al. Stress fractures: Pathophysiology, clinical presentation, imaging features, and treatment options. Emerg Radiol 2016; 23(4): 365-375.

Claes S, Luyckx T, Vereecke E, et al. The Segond fracture: a bony injury of the anterolateral ligament of the knee. Arthroscopy 2014; 30(11): 1475-1482.

Freeman AK, Sumathi VP, Jeys L. Primary malignant tumours of the bone. Surgery 2018; 36(1): 27-34.

Toms AP, Fowkes LA. Bone marrow oedema of the knee. The knee 2010; 17(1): 1-6.

Crema MD, Roemer FW, Zhu Y, et al. Subchondral cystlike lesions develop longitudinally in areas of bone marrow edema-like lesions in patients with or at risk for knee osteoarthritis: Detection with MR imaging-the MOST study. Radiology 2010; 256(3): 855-862.

Karantanas AH, Nikolakopoulos I, Korompilias AV, et al. Regional migratory osteoporosis in the knee: MRI findings in 22 patients and review of the literature. Eur J Radiol 2008; 67(1): 34-41.


  • There are currently no refbacks.