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Li J, Mao Y, Wang D, Fu W, Li Q, Tang X, Chen G, Chen X, Yao L, You M, Xiong Y, Li J. Correlation Between the Location and Distance of Kissing Contusions and Knee Laxity in Acute Noncontact ACL Injury. Am J Sports Med 2023; 51:3179-3189. [PMID: 37715506 DOI: 10.1177/03635465231196865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/17/2023]
Abstract
BACKGROUND Bone bruise (BB) and kissing contusion are common features of acute anterior cruciate ligament (ACL) injury on magnetic resonance imaging (MRI). The correlation between the location and distance of kissing contusions and knee laxity remains unclear. PURPOSE To determine the significance of different patterns of BB in acute noncontact ACL injury and assess the correlation between the location and distance of kissing contusions and the severity of knee laxity. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS A total of 205 patients with acute noncontact ACL injury undergoing arthroscopic treatment between January 2021 and May 2022 were included in this retrospective analysis. Patients were grouped according to the different patterns of BB. The type of ACL injury and concomitant injuries were analyzed on MRI and confirmed by arthroscopy. Anterior knee laxity was assessed by the Ligs digital arthrometer and stress radiography, and rotational knee laxity was assessed by the intraoperative pivot-shift test. The MRI parameters of the location and distance of kissing contusions were measured to assess their correlations with the severity of knee laxity. RESULTS Of the 205 patients with acute noncontact ACL injury, 38 were in the non-BB group and 167 were in the BB group, the latter including 32 with the isolated BB on the lateral tibial plateau and 135 with kissing contusions. There was no significant difference in the mean time from initial injury to MRI scan between the non-BB group and the BB group (14.34 ± 2.92 vs 15.17 ± 2.86 days; P = .109) or between the isolated BB subgroup and the kissing contusion subgroup (14.94 ± 2.92 vs 15.23 ± 2.85 days; P = .605). The side-to-side difference (SSD) in anterior knee laxity and the incidences of complete ACL injury, concomitant injuries, and high-grade pivot-shift test were significantly higher in the BB group than in the non-BB group, and in the kissing contusion subgroup compared with the isolated BB subgroup. The kissing contusion index of the lateral femoral condyle (LFC) and the sagittal distance of kissing contusions were significantly correlated with the SSD in anterior knee laxity and the grade of pivot-shift test (P < .001). CONCLUSION The presence of BB, in particular the appearance of kissing contusions, was related to greater knee laxity and higher incidences of complete ACL injury and concomitant injuries in acute noncontact ACL injury. For patients with kissing contusions, as the location of BB on the LFC moved forward and the distance between kissing contusions increased, anterior and rotational knee laxity became more serious.
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Affiliation(s)
- Junqiao Li
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Yunhe Mao
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Duan Wang
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Weili Fu
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Qi Li
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Xin Tang
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Gang Chen
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Xi Chen
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Lei Yao
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Mingke You
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Yan Xiong
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Jian Li
- Sports Medicine Center, West China Hospital, Sichuan University, Chengdu, China
- Department of Orthopedics and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
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Zhang ZY, Wang C, Maimaitimin M, Huang HJ, Pan XY, Maimaitijiang P, He ZY, Wang XW, Zhang X, Wang JQ. Anterior and rotational tibial subluxation in the setting of anterior cruciate ligament injuries: An MRI analysis. Knee 2021; 33:365-373. [PMID: 34753026 DOI: 10.1016/j.knee.2021.10.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 08/10/2021] [Accepted: 10/11/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND The relationship between preoperative tibiofemoral position and failure of anterior cruciate ligament (ACL) reconstruction has been widely discussed. Most established methods for measuring tibiofemoral position on magnetic resonance imaging (MRI) mainly focus on anterior tibial subluxation (ATS), while a quantitative measuring method for rotational tibial subluxation (RTS) is still undetermined. Moreover, there are still controversies about the related factors for ATS. The aim of this study was to quantitatively describe preoperative ATS and RTS in ACL-injured and ACL-intact knees and identify the related factors for ATS and RTS based on MRI images. METHODS Demographic data and preoperative MRIs of 104 ACL-injured patients were retrospectively analyzed. ACL-intact knees were 1:1 matched as control group. ATS was measured using longitudinal tibial axis, and RTS was determined by the difference between lateral and medial ATS. Related factors for ATS and RTS were examined. RESULTS Increased lateral ATS (P < 0.0001), medial ATS (P < 0.0001) and RTS (P = 0.0479) were observed in ACL-injured knees compared with the control group. Increased posterior tibial slope (PTS), Beighton Score ≥ 4, presence of meniscal injury and long injury-to-MRI time were identified as being correlated with the increase of ATS. Factors for the increase of RTS were increased lateral PTS, Beighton score ≥ 4, presence of lateral meniscal injury, and left side. CONCLUSIONS In ACL-injured knees, tibia not only subluxated anteriorly in both lateral and medial compartments, but also rotated internally. During preoperative planning, attentions should be paid to the factors that are correlated with altered tibiofemoral position.
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Affiliation(s)
- Zhi-Yu Zhang
- Department of Sports Medicine, Peking University Third Hospital, Beijing, China; Institute of Sports Medicine of Peking University, Beijing, China; Beijing Key Laboratory of Sports Injuries, Beijing, China; Peking University Health Science Center, Beijing, China
| | - Cheng Wang
- Department of Sports Medicine, Peking University Third Hospital, Beijing, China; Institute of Sports Medicine of Peking University, Beijing, China; Beijing Key Laboratory of Sports Injuries, Beijing, China; Peking University Health Science Center, Beijing, China
| | - Maihemuti Maimaitimin
- Department of Sports Medicine, Peking University Third Hospital, Beijing, China; Institute of Sports Medicine of Peking University, Beijing, China; Beijing Key Laboratory of Sports Injuries, Beijing, China; Peking University Health Science Center, Beijing, China
| | - Hong-Jie Huang
- Department of Sports Medicine, Peking University Third Hospital, Beijing, China; Institute of Sports Medicine of Peking University, Beijing, China; Beijing Key Laboratory of Sports Injuries, Beijing, China; Peking University Health Science Center, Beijing, China
| | - Xiao-Yu Pan
- Department of Sports Medicine, Peking University Third Hospital, Beijing, China; Institute of Sports Medicine of Peking University, Beijing, China; Beijing Key Laboratory of Sports Injuries, Beijing, China; Peking University Health Science Center, Beijing, China
| | - Pakezhati Maimaitijiang
- Department of Sports Medicine, Peking University Third Hospital, Beijing, China; Institute of Sports Medicine of Peking University, Beijing, China; Beijing Key Laboratory of Sports Injuries, Beijing, China; Department of Sports Medicine, Peking University Third Hospital, Beijing, China
| | - Zi-Yi He
- Department of Sports Medicine, Peking University Third Hospital, Beijing, China; Institute of Sports Medicine of Peking University, Beijing, China; Beijing Key Laboratory of Sports Injuries, Beijing, China; Peking University Health Science Center, Beijing, China
| | - Xue-Wen Wang
- Department of Sports Medicine, Peking University Third Hospital, Beijing, China; Institute of Sports Medicine of Peking University, Beijing, China; Beijing Key Laboratory of Sports Injuries, Beijing, China; Peking University Health Science Center, Beijing, China
| | - Xin Zhang
- Department of Sports Medicine, Peking University Third Hospital, Beijing, China; Institute of Sports Medicine of Peking University, Beijing, China; Beijing Key Laboratory of Sports Injuries, Beijing, China; Peking University Health Science Center, Beijing, China.
| | - Jian-Quan Wang
- Department of Sports Medicine, Peking University Third Hospital, Beijing, China; Institute of Sports Medicine of Peking University, Beijing, China; Beijing Key Laboratory of Sports Injuries, Beijing, China; Peking University Health Science Center, Beijing, China.
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Concomitant Posterolateral Corner Injuries in Skeletally Immature Patients With Acute Anterior Cruciate Ligament Injuries. J Pediatr Orthop 2020; 40:271-276. [PMID: 32501906 DOI: 10.1097/bpo.0000000000001450] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Missed posterolateral corner (PLC) injuries are a known cause of anterior cruciate ligament reconstruction (ACL) failure in the adult population. Failed ACL reconstruction causes significant morbidity in the skeletally immature pediatric population. There is little literature on the character and potential significance of PLC injuries in skeletally immature patients. METHODS Magnetic resonance imaging studies of the knee at a tertiary care children's hospital for patients who underwent an ACL reconstruction without PLC surgery were retrospectively reviewed. Demographic variables were obtained through chart review, and magnetic resonance imaging studies were evaluated for PLC (popliteus, fibular collateral ligament, popliteofibular ligament, and arcuate ligament) injury, and ACL, medial collateral ligament (MCL), bone bruise, fracture, and meniscal pathology by an experienced pediatric musculoskeletal radiologist. RESULTS A total of 50 patients with a mean age at 13.3 years at injury were analyzed. PLC injuries were found in 26 patients (52%), with 7 patients (14%) having a complete tear of a component of the PLC. There was no association between sex (P=0.35), Segond fracture (P=0.09), meniscus injury (P=0.92), or MCL injury (P=0.24) with the risk of PLC injury. There was an association between patient age and PLC injury (P=0.02). For each additional year of age, the odds of PLC injury increased by 1.8 times (odds ratio, 1.8; 95% confidence interval, 1.4-2.2). There was no association between PLC injury and ACL graft failure (P=0.19). CONCLUSIONS Missed PLC injuries are a significant source of morbidity and poor clinical outcomes in the management of concomitant ACL injuries in adults. This study demonstrates the prevalence of PLC injuries in the setting of concomitant ACL injuries in the unique skeletally immature patient population. Incomplete PLC injuries are relatively common. Complete PLC injuries are relatively uncommon. PLC injury was more common in older patients. No other concomitant injury predicted the likelihood of PLC injury. Further research is needed regarding the risk of ACL reconstruction failure from associated PLC injury and the indications for PLC reconstruction in skeletally immature patients. LEVEL OF EVIDENCE Level IV-diagnostic study.
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Kim SH, Park YB, Ham DW, Lim JW, Lee HJ. Stress radiography at 30° of knee flexion is a reliable evaluation tool for high-grade rotatory laxity in complete ACL-injured knees. Knee Surg Sports Traumatol Arthrosc 2020; 28:2233-2244. [PMID: 31784781 DOI: 10.1007/s00167-019-05803-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 11/12/2019] [Indexed: 01/25/2023]
Abstract
PURPOSE To evaluate the diagnostic value of stress radiography and determine the cutoff values for high-grade anterolateral rotatory laxity in complete anterior cruciate ligament (ACL)-deficient knees at different positions. METHODS Forty-two patients with complete ACL rupture (group 1) and 37 normal subjects (group 2) were prospectively enrolled. The amount of anterior translation in the medial (MM) and lateral (LL) distance compartments and the difference between them (LL-MM distance) were measured using stress radiography at 30°, 45°, 60°, and 90° positions. The area under the receiver operating characteristic curve (AUC) was assessed for the presence of a high-grade (grade > 2) pivot shift. RESULTS The MM and LL distances in group 1 were significantly different at 30° and 45° positions (P < 0.05). The AUC of the MM (AUC, 0.903) and LL (AUC, 0.901) distances at the 30° position was significantly higher than that of the other positions (P = 0.000); however, the cutoff values were different to diagnose ACL injury (MM vs. LL, 3.1 mm vs. 5.4 mm). A 2.1-mm cutoff for the LL-MM distance showed 78.4% sensitivity and 90.3% specificity for detecting the presence of a high-grade pivot shift (AUC = 0.905, P = 0.000). CONCLUSION The cutoff values of stress radiography differed according to anatomical references and knee flexion positions. Stress radiography of a 2.1 mm difference in LL-MM distance at 30° of knee flexion can be a reliable method for high-grade rotatory laxity in complete ACL-injured knees. LEVEL OF EVIDENCE Level 1, diagnostic study.
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Affiliation(s)
- Seong Hwan Kim
- Department of Orthopedic Surgery, Hyundae General Hospital, Chung-Ang University College of Medicine, 21, Bonghyeon-ro, Jinjeop-eup, Namyangju-si, Gyeonggi-do, 12013, South Korea
| | - Yong-Beom Park
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, South Korea.
| | - Dae-Woong Ham
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, South Korea
| | - Jung-Won Lim
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, South Korea
| | - Han-Jun Lee
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, South Korea
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Signorelli C, Cinti F, Zaffagnini S, Pisoni L, Lopomo NF. Validation of an optical, computer-assisted technique for intraoperative tracking of 3-dimensional canine stifle joint motion. Open Vet J 2020; 10:86-93. [PMID: 32426262 PMCID: PMC7193875 DOI: 10.4314/ovj.v10i1.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 03/05/2020] [Indexed: 11/17/2022] Open
Abstract
Background: Cranial cruciate ligament (CCL) rupture is the most common orthopedic pathology in dog and in men. In human, optical computer-assisted technique is considered as a repeatable and reliable method for the biomechanical assessment of joint kinematics and laxity in case of CCL surgery. Aim: To evaluate the repeatability and reliability afforded by clinical tests in terms of laxity measured by means of a computer-assisted tracking system in two canine CCL conditions: CCL-Intact, CCL-Deficient. Methods: Fourteen fresh frozen canine stifles were passively subjected to Internal/External (IE) rotation at 120° of flexion and Cranial drawer test (CC). To quantify the repeatability and the reliability, intra-class correlation coefficient (ICC) and the mean percent error were evaluated (Δ r %). Results: The study showed a very good intra-class correlation, before and after CCL resection for kinematics tests. It was found a minimum ICC = 0.73 during the IE rotation in CCL-Intact and a maximum value of ICC = 0.97 for the CC displacement in CC-Deficient. IE rotation with CCL-Intact is the condition with the greatest Δ r % = 14%, while the lowest Δ r % = 6% was obtained for CC displacement in CCL-Deficient. Conclusion: The presented work underlined the possibility of using a computer-assisted method also for biomechanical studies concerning stifle kinematics and laxity.
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Affiliation(s)
- Cecilia Signorelli
- Laboratorio di Biomeccanica e Innovazione Tecnologica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Stefano Zaffagnini
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Luciano Pisoni
- Dipartimento di Scienze Mediche Veterinarie, Università degli studi di Bologna, Bologna, Italy
| | - Nicola Francesco Lopomo
- Dipartimento di Ingegneria dell'Informazione, Università degli Studi di Brescia, Brescia, Italy
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Slichter ME, Wolterbeek N, Auw Yang KG, Zijl JAC, Piscaer TM. A novel test for assessment of anterolateral rotatory instability of the knee: the tibial internal rotation test (TIR test). J Exp Orthop 2018; 5:29. [PMID: 30094573 PMCID: PMC6085217 DOI: 10.1186/s40634-018-0141-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 06/22/2018] [Indexed: 01/26/2023] Open
Abstract
Background Rotational instability of the knee may persist after anterior cruciate ligament (ACL) reconstruction, which may be due to insufficiency of anterolateral stabilizing structures. However, no reliable diagnostic tool or physical examination test is available for identifying patients with anterolateral rotatory instability (ALRI). As shown in cadaveric studies, static internal rotation of the knee is increased in higher flexion angles of the knee after severing the anterolateral structures. This might also be the case in patients with an ACL-deficient knee and concomitant damage to the anterolateral structures. The objective of this study is to assess anterolateral rotatory instability of the knee during physical examination with a tibial internal rotation test. Methods ACL-injured knees of 52 patients were examined by two examiners and side-to-side differences were compared. Both lower legs were internally rotated by applying manual internal rotation torque to both feet in prone position with the knees in 30°, 60° and 90° of flexion. For quantification of the amount of rotation in degrees, a torque adapter on a booth was used. Intra-rater, inter-rater and rater-device agreement were determined by calculating kappa (κ) for the tibial internal rotation test. Results Tibial internal rotation is increased in 19.2% of the patients with ACL injury according to the tibial internal rotation test. Good intra-rater agreement was found for the tibial internal rotation test, κC = 0.63 (95%CI -0.02-1.28), p = 0.015. Fair inter-rater agreement was found, κF = 0.29 (95%CI 0.02–0.57), p = 0.038. Good rater-device agreement was found, κC = 0.62 (95%CI 0.15–1.10), p = 0.001. Conclusion The tibial internal rotation test shows increased tibial internal rotation in a small amount of patients with ACL injury. Even though no gold standard for assessment of increased tibial internal rotation of the knee is available yet, the test can be of additional value. It can be used for assessment of internal rotatory laxity of the knee as part of ALRI in addition to the pivot shift test. No clinical implications should yet be based on this test alone. Electronic supplementary material The online version of this article (10.1186/s40634-018-0141-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Malou E Slichter
- Department of Orthopaedic Surgery, St. Antonius hospital, P.O. Box 2500, 3430 EM, Nieuwegein, The Netherlands
| | - Nienke Wolterbeek
- Department of Orthopaedic Surgery, St. Antonius hospital, P.O. Box 2500, 3430 EM, Nieuwegein, The Netherlands
| | - K Gie Auw Yang
- Department of Orthopaedic Surgery, St. Antonius hospital, P.O. Box 2500, 3430 EM, Nieuwegein, The Netherlands
| | - Jacco A C Zijl
- Department of Orthopaedic Surgery, St. Antonius hospital, P.O. Box 2500, 3430 EM, Nieuwegein, The Netherlands
| | - Tom M Piscaer
- Department of Orthopaedic Surgery, St. Antonius hospital, P.O. Box 2500, 3430 EM, Nieuwegein, The Netherlands. .,Department of Orthopaedic Surgery, Erasmus Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands.
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Slichter ME, Wolterbeek N, Auw Yang KG, Zijl JAC, Piscaer TM. Rater agreement reliability of the dial test in the ACL-deficient knee. J Exp Orthop 2018; 5:18. [PMID: 29900519 PMCID: PMC5999596 DOI: 10.1186/s40634-018-0131-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 05/17/2018] [Indexed: 01/13/2023] Open
Abstract
Background Posterolateral rotatory instability (PLRI) of the knee can easily be missed, because attention is paid to injury of the cruciate ligaments. If left untreated this clinical instability may persist after reconstruction of the cruciate ligaments and may put the graft at risk of failure. Even though the dial test is widely used to diagnose PLRI, no validity and reliability studies of the manual dial test are yet performed in patients. This study focuses on the reliability of the manual dial test by determining the rater agreement. Methods Two independent examiners performed the dial test in knees of 52 patients after knee distorsion with a suspicion on ACL rupture. The dial test was performed in prone position in 30°, 60° and 90° of flexion of the knees. ≥10° side-to-side difference was considered a positive dial test. For quantification of the amount of rotation in degrees, a measuring device was used with a standardized 6 Nm force, using a digital torque adapter on a booth. The intra-rater, inter-rater and rater-device agreement were determined by calculating kappa (κ) for the dial test. Results A positive dial test was found in 21.2% and 18.0% of the patients as assessed by a blinded examiner and orthopaedic surgeon respectively. Fair inter-rater agreement was found in 30° of flexion, κF = 0.29 (95% CI: 0.01 to 0.56), p = 0.044 and 90° of flexion, κF = 0.38 (95% CI: 0.10 to 0.66), p = 0.007. Almost perfect rater-device agreement was found in 30° of flexion, κC = 0.84 (95% CI: 0.52 to 1.15), p < 0.001. Moderate rater-device agreement was found in 30° and 90° combined, κC = 0.50 (95% CI: 0.13 to 0.86), p = 0.008. No significant intra-rater agreement was found. Conclusions Rater agreement reliability of the manual dial test is questionable. It has a fair inter-rater agreement in 30° and 90° of flexion.
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Affiliation(s)
- Malou E Slichter
- Department of Orthopaedic Surgery, St. Antonius Hospital, P.O. Box 2500, 3430, EM, Nieuwegein, The Netherlands
| | - Nienke Wolterbeek
- Department of Orthopaedic Surgery, St. Antonius Hospital, P.O. Box 2500, 3430, EM, Nieuwegein, The Netherlands
| | - K Gie Auw Yang
- Department of Orthopaedic Surgery, St. Antonius Hospital, P.O. Box 2500, 3430, EM, Nieuwegein, The Netherlands
| | - Jacco A C Zijl
- Department of Orthopaedic Surgery, St. Antonius Hospital, P.O. Box 2500, 3430, EM, Nieuwegein, The Netherlands
| | - Tom M Piscaer
- Department of Orthopaedic Surgery, St. Antonius Hospital, P.O. Box 2500, 3430, EM, Nieuwegein, The Netherlands. .,Department of Orthopaedic Surgery, Erasmus Medical Center, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands.
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Espregueira-Mendes J, Andrade R, Leal A, Pereira H, Skaf A, Rodrigues-Gomes S, Oliveira JM, Reis RL, Pereira R. Global rotation has high sensitivity in ACL lesions within stress MRI. Knee Surg Sports Traumatol Arthrosc 2017; 25:2993-3003. [PMID: 27530386 DOI: 10.1007/s00167-016-4281-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 08/05/2016] [Indexed: 01/14/2023]
Abstract
PURPOSE This study aims to objectively compare side-to-side differences of P-A laxity alone and coupled with rotatory laxity within magnetic resonance imaging, in patients with total anterior cruciate ligament (ACL) rupture. METHODS This prospective study enrolled sixty-one patients with signs and symptoms of unilateral total anterior cruciate ligament rupture, which were referred to magnetic resonance evaluation with simultaneous instrumented laxity measurements. Sixteen of those patients were randomly selected to also have the contralateral healthy knee laxity profile tested. Images were acquired for the medial and lateral tibial plateaus without pressure, with postero-anterior translation, and postero-anterior translation coupled with maximum internal and external rotation, respectively. RESULTS All parameters measured were significantly different between healthy and injured knees (P < 0.05), with exception of lateral plateau without stress. The difference between injured and healthy knees for medial and lateral tibial plateaus anterior displacement (P < 0.05) and rotation (P < 0.001) was statistically significant. It was found a significant correlation between the global rotation of the lateral tibial plateau (lateral plateau with internal + external rotation) with pivot-shift, and between the anterior global translation of both tibial plateaus (medial + lateral tibial plateau) with Lachman. The anterior global translation of both tibial plateaus was the most specific test with a cut-off point of 11.1 mm (93.8 %), and the global rotation of the lateral tibial plateau was the most sensitive test with a correspondent cut-off point of 15.1 mm (92.9 %). CONCLUSION Objective laxity quantification of ACL-injured knees showed increased sagittal laxity, and simultaneously in sagittal and transversal planes, when compared to their healthy contralateral knee. Moreover, when measuring instability from anterior cruciate ligament ruptures, the anterior global translation of both tibial plateaus and global rotation of the lateral tibial plateau add diagnostic specificity and sensitivity. This work strengthens the evidence that the anterior cruciate ligament plays an important biomechanical role in controlling the anterior translation, but also both internal and external rotation. The high sensitivity and specificity of this device in objectively identifying and measuring the multiplanar instability clearly guides stability restoration clinical procedures. Level of evidence Cross-sectional study, Level III.
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Affiliation(s)
- João Espregueira-Mendes
- Orthopaedics Department of Minho University, Braga, Portugal. .,Clínica do Dragão, Espregueira-Mendes Sports Centre - FIFA Medical Centre of Excellence, Porto, Portugal. .,Dom Henrique Research Centre, Porto, Portugal. .,3B's Research Group-Biomaterials, Biodegradables and Biomimetics, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, University of Minho, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, 4805-017, Barco, Guimarães, Portugal. .,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal.
| | - Renato Andrade
- Clínica do Dragão, Espregueira-Mendes Sports Centre - FIFA Medical Centre of Excellence, Porto, Portugal.,Dom Henrique Research Centre, Porto, Portugal.,Faculty of Sports, University of Porto, Porto, Portugal
| | - Ana Leal
- Clínica do Dragão, Espregueira-Mendes Sports Centre - FIFA Medical Centre of Excellence, Porto, Portugal.,Dom Henrique Research Centre, Porto, Portugal.,CMEMS Center for MicroElectroMechanical Systems, Mechanical Engineering Department, University of Minho, Guimarães, Portugal
| | - Hélder Pereira
- Clínica do Dragão, Espregueira-Mendes Sports Centre - FIFA Medical Centre of Excellence, Porto, Portugal.,Dom Henrique Research Centre, Porto, Portugal.,Orthopaedic Department, Centro Hospitalar Póvoa de Varzim, Vila do Conde, Portugal
| | - Abdala Skaf
- Hospital do Coração, São Paulo, Brazil.,Musculoskeletal Department, Clínica Alta Excelência Diagnóstica, São Paulo, Brazil
| | - Sérgio Rodrigues-Gomes
- Clínica do Dragão, Espregueira-Mendes Sports Centre - FIFA Medical Centre of Excellence, Porto, Portugal.,Dom Henrique Research Centre, Porto, Portugal.,SMIC Group, Porto, Portugal
| | - J Miguel Oliveira
- Clínica do Dragão, Espregueira-Mendes Sports Centre - FIFA Medical Centre of Excellence, Porto, Portugal.,3B's Research Group-Biomaterials, Biodegradables and Biomimetics, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, University of Minho, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, 4805-017, Barco, Guimarães, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Rui L Reis
- 3B's Research Group-Biomaterials, Biodegradables and Biomimetics, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, University of Minho, AvePark, Parque de Ciência e Tecnologia, Zona Industrial da Gandra, 4805-017, Barco, Guimarães, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Rogério Pereira
- Clínica do Dragão, Espregueira-Mendes Sports Centre - FIFA Medical Centre of Excellence, Porto, Portugal.,Dom Henrique Research Centre, Porto, Portugal.,Faculty of Health Sciences, University of Fernando Pessoa, Porto, Portugal
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9
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Temponi EF, de Carvalho Júnior LH, Saithna A, Thaunat M, Sonnery-Cottet B. Incidence and MRI characterization of the spectrum of posterolateral corner injuries occurring in association with ACL rupture. Skeletal Radiol 2017; 46:1063-1070. [PMID: 28424850 DOI: 10.1007/s00256-017-2649-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 03/25/2017] [Accepted: 03/30/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the incidence and MRI characteristics of the spectrum of posterolateral corner (PLC) injuries occurring in association with anterior cruciate ligament (ACL) rupture. MATERIALS AND METHODS We carried out a level IV, retrospective case series study. All patients clinically diagnosed with an ACL rupture between July 2015 and June 2016 who underwent MRI of the knee were included in the study. In addition to standard MRI knee reporting, emphasis was placed on identifying injury to the PLC and a description of involvement of these structures by two musculoskeletal radiologists. Association with PLC involvement was sought with concomitant injuries using correlation analysis and logistic regression. RESULTS One hundred sixty-two patients with MRI following ACL rupture were evaluated. Thirty-two patients (19.7%) had an injury to at least one structure of the PLC, including the inferior popliteomeniscal fascicle (n = 28), arcuate ligament (n = 20), popliteus tendon (n = 20), superior popliteomeniscal fascicle (n = 18), lateral collateral ligament (n = 8), popliteofibular ligament (n = 7), biceps tendon (n = 4), iliotibial band (n = 3), and fabellofibular ligament (n = 1). Seventy-five percent of all patients with combined ACL and PLC injuries had bone contusions involving the lateral compartment of the knee. The presence of these contusions strongly correlated with superior popliteomeniscal fascicle lesions (p < 0.05). There was no correlation between injuries to other structures of the PLC and other intra-articular lesions. CONCLUSION Missed injuries of the PLC lead to considerable morbidity. The relevance of this study is to highlight that these injuries occur more frequently than previously described and that an appropriate index of suspicion, clinical examination, and MRI are all required to reduce the risk of missed diagnoses. The results of this study support previous suggestions that the rate of concomitant PLC injury in the ACL-deficient knee is under-reported. The rate of combined injuries in this series was 19.7%. The key message of this paper is that PLC injury is common in the presence of ACL injury and should be sought both clinically and radiologically.
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Affiliation(s)
- Eduardo Frois Temponi
- Hospital Madre Teresa, Avenida Raja Gabáglia, 1002, Belo Horizonte, 30441-070, Minas Gerais, Brazil.
| | - Lúcio Honório de Carvalho Júnior
- Hospital Madre Teresa, Avenida Raja Gabáglia, 1002, Belo Horizonte, 30441-070, Minas Gerais, Brazil.,Departamento do Aparelho Locomotor, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Adnan Saithna
- Southport and Ormskirk Hospitals, Southport, UK.,Department of Clinical Engineering, University of Liverpool, Liverpool, UK
| | - Mathieu Thaunat
- Centre Orthopedic Santy, FIFA Medical Center of Excellence, Ramsay-Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | - Bertrand Sonnery-Cottet
- Centre Orthopedic Santy, FIFA Medical Center of Excellence, Ramsay-Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
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10
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An analysis of normative data on the knee rotatory profile and the usefulness of the Rotatometer, a new instrument for measuring tibiofemoral rotation: the reliability of the knee Rotatometer. Knee Surg Sports Traumatol Arthrosc 2015; 23:2727-33. [PMID: 24817107 DOI: 10.1007/s00167-014-3039-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Accepted: 04/23/2014] [Indexed: 12/22/2022]
Abstract
PURPOSE This study proposes a simple and noninvasive instrument called the "Rotatometer" to measure tibiofemoral rotation and investigates its clinical applicability to the assessment of static rotational knee laxity. METHODS The degree of tibiofemoral rotation was measured for a sample of 94 healthy volunteers with 188 knees by using the Rotatometer. The measurement was made by two independent and blinded examiners in three sessions at one-month intervals. The normative rotational profile and its relationship with gender and age were evaluated, and inter-observer reliability and intra-observer reliability were calculated. RESULTS Males showed 62° ± 5° of external rotation, whereas females, 64° ± 5°. Males showed 44° ± 5° of internal rotation, whereas females, 49° ± 4°. Females showed significantly higher degrees of rotation than males. Tibiofemoral rotation was not correlated with age, and external rotation and internal rotation had a moderate positive relationship. Inter-observer reliability ranged from 0.84 to 0.91 for external rotation and 0.90 to 0.95 for internal rotation, and intra-observer reliability ranged from 0.69 to 0.89 for external rotation and 0.87 to 0.95 for internal rotation. CONCLUSIONS The results suggest the Rotatometer to be a simple and noninvasive device with high inter- and intra-observer reliability. The device can provide a normative rotational profile for reference purposes and thus can be used to determine the preoperative and postoperative rotational status of knees with anterior cruciate ligament injuries and compare results from different reconstruction techniques.
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11
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Theisen D, Mouton C, Seil R. A close look at tibiofemoral rotation measurements. Knee Surg Sports Traumatol Arthrosc 2015; 23:1266-7. [PMID: 25193566 DOI: 10.1007/s00167-014-3263-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 08/22/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Daniel Theisen
- Sports Medicine Research Laboratory, Public Research Centre for Health, Luxembourg, Luxembourg,
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12
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Combined anterior and rotational laxity measurements allow characterizing personal knee laxity profiles in healthy individuals. Knee Surg Sports Traumatol Arthrosc 2015; 23:3571-7. [PMID: 25155050 PMCID: PMC4661198 DOI: 10.1007/s00167-014-3244-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 08/13/2014] [Indexed: 11/19/2022]
Abstract
PURPOSE The aim of this study was to quantify sagittal and rotational knee laxity profiles taking into account individual influencing factors. METHODS Linear regression models were used to determine which individual characteristics (age, height, body mass and sex) influenced the outcome in a group of 104 healthy subjects. The standardized residuals were used as individualized (corrected) laxity scores and were combined to determine knee laxity profiles. RESULTS Anterior knee laxity was not influenced by individual characteristics. Rotational knee laxity was higher in females and inversely related to body mass. The correlation between anterior laxity and internal rotation scores was weak (r = 0.24, p = 0.02). The proportion of knees concerned by increased laxity scores (scores >1) was similar for anterior displacement, internal and external rotation (15 %). Only 32 % of the tested subjects showed a normal profile (score >-1 and <1) for all three directions, 33 % were concerned by hyperlaxity, 40 % by hypolaxity and 5 % by both. CONCLUSIONS The diversity of laxity profiles found here highlights that the interpretation of multidirectional knee laxity is complex and suggests the necessity for individualized care of knee diseases and injuries. These results contribute to the understanding of knee laxity and throw the basis for prevention strategies and improvement of treatment outcomes in injuries and diseases. LEVEL OF EVIDENCE Case series with no comparison groups, Level IV.
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13
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Towards understanding knee joint laxity: Errors in non-invasive assessment of joint rotation can be corrected. Med Eng Phys 2014; 36:889-95. [DOI: 10.1016/j.medengphy.2014.03.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 03/06/2014] [Accepted: 03/24/2014] [Indexed: 12/20/2022]
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Deie M, Nakasa T, Kamei G, Nakamae A, Ochi M. High flexion knee arthroplasty: the relationship between rotational angles and flexion angle after total knee arthroplasty. Curr Rev Musculoskelet Med 2014; 7:103-7. [PMID: 24658882 PMCID: PMC4012152 DOI: 10.1007/s12178-014-9215-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The current patients required high flexion total knee arthroplasty (TKA). We hypothesized the patients who would get the high rotational angle just after TKA could gain high flexion knee 1 year after TKA. Sixty-three patients (average age: 70.6 years) were examined. In order to examine between the intraoperative rotational angles and the gained flexion angles after TKA, the patients were divided into two groups: the H group (more than 120°) and the L groups (less than 120°) by the gained flexion angles. The relationship between the flexion angles at 1 year after surgery and the intraoperative rotational angle had no significant correlation. But the rotational angles in the L group tended to be higher than the ones in the H group, and at only 30°, the L group gained significantly more rotational angle than the H group. These results might show that a tighter rotational stability induces a gain of higher flexion knee after TKA.
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Affiliation(s)
- Masataka Deie
- Institute of Biomechanical and Health Sciences, Laboratory of Musculoskeletal Functional Research and Regeneration, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, Japan, 734-8553,
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15
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Tardy N, Marchand P, Kouyoumdjian P, Blin D, Demattei C, Asencio G. A Preliminary In Vivo Assessment of Anterior Cruciate Ligament-Deficient Knee Kinematics With the KneeM Device: A New Method to Assess Rotatory Laxity Using Open MRI. Orthop J Sports Med 2014; 2:2325967114525583. [PMID: 26535309 PMCID: PMC4555568 DOI: 10.1177/2325967114525583] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Methods of objectively measuring rotational knee laxity are either experimental or difficult to use in daily practice. A new method has been developed to quantitatively assess rotatory laxity using an open MRI system and new tool, the KneeM device. PURPOSE/HYPOTHESIS To perform a preliminary evaluation of a novel knee rotation measurement device to assess knee kinematics during flexion in an MRI field, in both anterior cruciate ligament (ACL)-deficient and healthy contralateral knees. The hypothesis was that the KneeM device would allow in vivo reproduction and analysis of knee kinematics during flexion in healthy and ACL-deficient knees. STUDY DESIGN Controlled laboratory study. METHODS Ten subjects (7 men and 3 women; mean age ± standard deviation, 32.3 ± 9.4 years) with ACL-deficient knees and contralateral uninjured knees participated in the study. An open MRI was performed with the KneeM device at a mean 4.9 months (range, 3.0-7 months) after ACL injury. The device exerted on the knee an anterior drawer force of 100 N, with an internal rotation of 20°, through the range of flexion (0°, 20°, 40°, and 60°). Both ACL-deficient and healthy contralateral knees were analyzed using the Iwaki method. RESULTS There was no statistical difference of anterior translation in the medial compartment between intact and ACL-deficient knees at all degrees of flexion. However, significant differences in the anterior translation of the lateral compartment were observed between ACL-deficient and intact contralateral knees at 0° and 20° of flexion (P = .005 and P = .002, respectively). Between 20° and 40°, the lateral plateau of ACL-deficient knees translated 7.7 mm posteriorly, whereas the medial compartment remained stable, reflecting a sudden external rotation of the lateral plateau under the femoral condyle. CONCLUSION This preliminary study suggests that measurement of tibiofemoral movements in both compartments during flexion using the KneeM device was useful for quantifying rotatory laxity in ACL-deficient knees. Moreover, this device seemed to allow a "mechanized pivot shift" and allowed reproduction of the "pivot" phase in the MRI field between 20° and 40° of flexion. CLINICAL RELEVANCE This device could be used for diagnostic purposes or to investigate the outcomes of ACL reconstructions.
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Affiliation(s)
| | | | | | | | - Christophe Demattei
- Department of Biostatistics, Epidemiology, Public Health and Medical Information, CHU de Nîmes, Nîmes, France
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Arai T, Miaki H. Influence of static alignment of the knee, range of tibial rotation and tibial plateau geometry on the dynamic alignment of "knee-in" and tibial rotation during single limb drop landing. Clin Biomech (Bristol, Avon) 2013; 28:642-8. [PMID: 23725792 DOI: 10.1016/j.clinbiomech.2013.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Revised: 05/07/2013] [Accepted: 05/08/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND Dynamic alignment of "knee-in & toe-out" is a risk factor for anterior cruciate ligament injury and is possibly influenced by static knee alignment, range of tibial rotation and tibial plateau geometry. METHODS Twenty-eight healthy women were classified into valgus, neutral and varus groups based on static alignment of their knees. A 3-dimensional motion analysis was carried out for a single limb drop landing. The range of tibial rotation and posterior tibial slope angle was measured by MRI. Comparison among the 3 groups and correlation between the angles was analyzed during motion. FINDINGS The differences between the medial and lateral posterior tibial slope angles were greater (P=0.019), also range of internal tibial rotation for the valgus group (P=0.017) and, for the varus group, the "knee-in" angle (P=0.048). The "knee-in" angle correlated significantly with the tibial rotation angle (R=-0.39, P=0.038), and the range of tibial rotation correlated with the variations between the medial and lateral posterior tibial slope angles (R=0.90, P=0.003). INTERPRETATION The range of tibial rotation, posterior tibial slope and "knee-in" angle varied according to whether the knee was in valgus or varus with the range of tibial rotation dependent on the posterior tibial slope angle. The greater the "knee-in" angle became, the smaller the internal tibial rotation was, acting in a kinetic chain. The results suggest that static alignment of the knee may be utilized as a predictor for potential problems that occur during motion.
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Affiliation(s)
- Takahiro Arai
- Division of Rehabilitation Science, Department of Health Sciences, Graduate School for Health Studies, University of Kanazawa, Kanazawa, Japan.
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Alam M, Bull AMJ, Thomas RD, Amis AA. A clinical device for measuring internal-external rotational laxity of the knee. Am J Sports Med 2013; 41:87-94. [PMID: 23277467 DOI: 10.1177/0363546512469874] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The dial test can be improved by providing reproducible, accurate measurements to improve diagnosis and treatment comparisons. PURPOSE Validation of a rotational measurement device (RMD) for measuring knee internal-external rotational laxity. STUDY DESIGN Cohort study (diagnosis); Level of evidence, 2. METHODS The RMD consisted of 3 components: a femoral clamp and a tibial splint using paired inclinometers to measure rotations, and a boot to apply tibial internal-external rotation torque. A separate boot inclinometer allowed for foot rotations to be measured independently. The measurements were simultaneously compared with electromagnetic "nest of birds" (NOB) sensors. Sequential paired knee measurements were taken at 4, 6, and 8 N·m of torque at 30° and 90° of flexion in 46 volunteers. RESULTS The correlation coefficient was 0.92 (95% CI, 0.89 to 0.94) and 0.63 (95% CI, 0.54 to 0.70) between the NOB and RMD and between the NOB and boot inclinometer, respectively. Bland-Altman analysis revealed that the RMD was on average within 2° (95% CI, 1° to -4°) of NOB readings, whereas the boot overestimated by 34° (95% CI, -9° to -58°). Maximum side-to-side differences measured by the NOB, RMD, and boot were 1°, 3°, and 21°, respectively. The mean +2× standard deviation data gave a range of side-to-side differences of less than 5° for the RMD. The intraobserver intraclass correlation was 0.9 (95% CI, 0.78 to 0.97) at both 30° and 90° of flexion, and the 95% CI of the differences between readings taken on 2 occasions, the interobserver repeatability, was 1° or less. CONCLUSION The novel clinical RMD for measuring rotational laxity of the knee was portable, easy, and comfortable to use in the clinical setting. The RMD showed significant correlation and accuracy compared with sensors of known high accuracy. Side-to-side differences of less than 5° were found in 95% of normal knees, compared with differences of 13° or more for clinical diagnosis of pathological rotational laxity. Measuring knee rotation at the foot showed poor correlation and accuracy.
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Affiliation(s)
- Mahbub Alam
- Department of Mechanical Engineering, Imperial College London, United Kingdom
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Colombet P, Jenny JY, Menetrey J, Plaweski S, Zaffagnini S. Current concept in rotational laxity control and evaluation in ACL reconstruction. Orthop Traumatol Surg Res 2012; 98:S201-10. [PMID: 23153665 DOI: 10.1016/j.otsr.2012.10.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2012] [Accepted: 09/25/2012] [Indexed: 02/02/2023]
Abstract
Rotation combined with translation; compose the three-dimensional motion of the knee subluxation in anterior cruciate ligament deficient knee. The worldwide scientists were focused initially on the translation part of this complex 3D motion, but since the beginning of the century there was a large interest on knee rotational laxity study. Lot of paper reported new devices and results with an explosion since the beginning of the decade. The purpose of this review is to provide an extensive critical analysis of the literature and clarify the knowledge on this topic. We will start with a dismemberment of different rotational laxities reported: the rotation coupled with translation in 2D tests such as Lachman test and anterior drawer test; the rotational envelope considering the maximum internal external rotation; and the "active rotation" occurring in 3D Pivot-shift (PS) test. Then we will analyze the knee kinematics and the role of different anterior cruciate ligament (ACL) bundle on rotation. A review of different mechanical and radiological devices used to assess the different rotations on ACL deficient knees will be presented. Two groups will be analyzed, dynamic and static conditions of tests. Navigation will be described precisely; it was the starter of this recent interest in rotation studies. Opto electronic and electromagnetic navigation systems will be presented and analyzed. We will conclude with the last generation of rotational laxity assessment devices, using accelerometers, which are very promising.
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Affiliation(s)
- P Colombet
- Clinique du sport, 9, rue Jean-Moulin, 33700 Mérignac, France.
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