1
|
Sigloch M, Mayr R, Glodny B, Coppola C, Hoermann R, Schmoelz W. Modified Lemaire Tenodesis Forces in Cadaveric Specimens Are Not Affected by Random Small-Scale Variations in the Femoral Insertion Point During Active Knee Joint Flexion-Extension. Arthrosc Sports Med Rehabil 2023; 5:e799-e807. [PMID: 37388897 PMCID: PMC10300583 DOI: 10.1016/j.asmr.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 04/16/2023] [Indexed: 07/01/2023] Open
Abstract
Purpose To directly measure lateral extra-articular tenodesis (LET) forces supporting anterior cruciate ligament reconstruction (ACLR) during dynamic flexion-extension cycles induced by simulated active muscle forces, to investigate the influence of random surgical variation in the femoral LET insertion point around the target insertion position, and to determine potential changes to the extension behavior of the knee joint in a cadaveric model. Methods After iatrogenic anterior cruciate ligament deficiency and simulated anterolateral rotatory instability, 7 fresh-frozen cadaveric knee joints were treated with isolated ACLR followed by combined ACLR-LET. The specimens were tested on a knee joint test bench during active dynamic flexion-extension with simulated muscle forces. LET forces and the degree of knee joint extension were measured. Random variation in the LET insertion point around the target insertion position was postoperatively quantified by computed tomography. Results In extension, the median LET force increased to 39 ± 2 N (95% confidence interval [CI], 36 to 40 N). In flexion over 70°, the LET was offloaded (2 ± 1 N; 95% CI, 0 to 2 N). In this study, small-scale surgical variation in the femoral LET insertion point around the target position had a negligible effect on the graft forces measured. We detected no difference in the degree of knee joint extension after combined ACLR-LET (median, 1.0° ± 3.0°; 95% CI, -6.2° to 5.2°) in comparison with isolated ACLR (median, 1.1° ± 3.3°; 95% CI, -6.7° to 6.1°; P = .62). Conclusions LET forces in combined ACLR-LET increased to a limited extent during active knee joint flexion-extension independent of small-scale variation around 1 specific target insertion point. Combined ACLR-LET did not change knee joint extension in comparison with isolated ACLR under the testing conditions used in this biomechanical study. Clinical Relevance Low LET forces can be expected during flexion-extension of the knee joint. Small-scale deviations in the femoral LET insertion point around the target insertion position in the modified Lemaire technique might have a minor effect on graft forces during active flexion-extension.
Collapse
Affiliation(s)
- Maximilian Sigloch
- Department for Orthopaedics and Traumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Raul Mayr
- Department for Orthopaedics and Traumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Bernhard Glodny
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Christian Coppola
- Department for Orthopaedics and Traumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Romed Hoermann
- Institute for Clinical and Functional Anatomy, Medical University of Innsbruck, Innsbruck, Austria
| | - Werner Schmoelz
- Department for Orthopaedics and Traumatology, Medical University of Innsbruck, Innsbruck, Austria
| |
Collapse
|
2
|
Nagai K, Kamada K, Kay J, Hoshino Y, Matsushita T, Kuroda R, de Sa D. Clinical Outcomes After Anterior Cruciate Ligament Reconstruction in Patients With a Concomitant Segond Fracture: A Systematic Review. Am J Sports Med 2023; 51:525-533. [PMID: 34668790 DOI: 10.1177/03635465211045689] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The Segond fracture can be observed in patients with an anterior cruciate ligament (ACL) tear. It is unclear whether the Segond fracture affects clinical outcomes after ACL reconstruction. PURPOSE To investigate whether the presence of a concomitant Segond fracture affects clinical outcomes after ACL reconstruction and to compare clinical outcomes when a Segond fracture is repaired surgically or left unrepaired. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS Three databases (PubMed, Embase, Cochrane Library) were searched in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines on July 27, 2020. Relevant studies regarding ACL injury with concomitant Segond fracture treated by primary ACL reconstruction were screened in duplicate. Data regarding patient characteristics and clinical outcomes were extracted. Descriptive data are presented, and a random-effects model was used to pool amenable data. RESULTS A total of 5 studies examining 2418 patients (987 female; 40.8%), mean age 25.4 years, were included in this study. There were 304 patients with a Segond fracture (mean age, 28.1 years; 35.9% female) and 2114 patients without a Segond fracture (mean age, 25.1 years; 41.5% female). Four studies directly compared outcomes between patients with an unrepaired Segond fracture and no Segond fracture. One study reported 12 patients who underwent ACL reconstruction and repair of a Segond fracture. Among 4 studies, 11 of 292 (3.8%) graft failures/revision surgeries were reported in the groups that had Segond fracture, whereas 145 of 2114 (6.9%) graft failures/revision surgeries were reported in groups that did not have Segond fracture. No significant difference was observed in the risk of graft failure between the 2 groups, with a pooled risk ratio of 0.59 (95% CI, 0.32-1.07; P = .08; I2 = 0%). No clinically significant differences were observed with regard to International Knee Document Committee score, Lysholm score, Tegner activity scale, and postoperative knee laxity between the group with Segond fracture and those without. CONCLUSION An unrepaired Segond fracture does not appear to have any significant negative effect on postoperative stability or risk of graft failure or revision surgery after ACL reconstruction. Future prospective studies may be warranted to confirm the finding that patients with combined ACL injury and Segond fracture may have outcomes comparable with those of ACL-injured patients without a Segond fracture when isolated ACL reconstruction is performed.
Collapse
Affiliation(s)
- Kanto Nagai
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Kohei Kamada
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Jeffrey Kay
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, Hamilton, Ontario, Canada
| | - Yuichi Hoshino
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Takehiko Matsushita
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Darren de Sa
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, Hamilton, Ontario, Canada
| |
Collapse
|
3
|
The anterolateral capsule is infrequently damaged as evaluated arthroscopically in patients undergoing anatomic ACL reconstruction. J ISAKOS 2022; 7:189-194. [PMID: 35798285 DOI: 10.1016/j.jisako.2022.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 06/21/2022] [Accepted: 06/25/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Concomitant anterolateral complex (ALC) injury may contribute to persistent rotatory knee instability following anterior cruciate ligament (ACL) reconstruction. There is no consensus on how to best identify concomitant ALC injury preoperatively, nor how well ALC injury identified on imaging modalities correlates with clinical examination of knee instability. The purpose of this retrospective study was to determine the incidence of concomitant ALC injury in ACL-injured knees, as determined by arthroscopy to preoperative radiography, ultrasound, and MRI. METHODS A total of 117 patients with a unilateral primary ACL injury who underwent individualized anatomic ACLR between June 2016 and May 2019 were enrolled. Preoperative imaging modalities, including X-ray, ultrasound, and MRI, were evaluated for concomitant ALC injury. Clinical examination under anesthesia, including the anterior drawer, Lachman, and pivot shift tests were performed. Anterolateral capsule injury, as defined by hemorrhage and/or capsular tearing on diagnostic arthroscopy, was also determined. Correlative analyses of ALC injury incidence and severity were performed across imaging modalities and against clinical examination grades. RESULTS ALC injury incidence across imaging modalities was as follows: X-ray (3%), arthroscopy (19%), MRI (53%), and US (63%). The ALC injury rate on arthroscopy was significantly less than MRI (p < 0.001) or ultrasound (p < 0.001). ALC injury incidence and severity were significantly correlated between MRI and US grading scales (p = 0.02), but no correlations among other imaging modalities were found. Similarly, no imaging modality meaningfully correlated with physical examination maneuvers. CONCLUSION The incidence of ALC injury varies across imaging modalities, with lower injury rates found on arthroscopy (19%) compared to MRI (53%) and US (63%). Increasing ALC injury severity grades on imaging does not predict increasing anterolateral knee laxity on clinical examination. LEVEL OF EVIDENCE V, retrospective case series.
Collapse
|
4
|
Naredo E, Rodriguez-Garcia SC, Terslev L, Martinoli C, Klauser A, Hartung W, Hammer HB, Cantisani V, Zaottini F, Vlad V, Uson J, Todorov P, Tesch C, Sudoł-Szopińska I, Simoni P, Serban O, Sconfienza LM, Sala-Blanch X, Plagou A, Picasso R, Özçakar L, Najm A, Möller I, Micu M, Mendoza-Cembranos D, Mandl P, Malattia C, Lenghel M, Kessler J, Iohom G, de la Fuente J, DʼAgostino MA, Collado P, Bueno A, Bong D, Alfageme F, Bilous D, Gutiu R, Marian A, Pelea M, Fodor D. The EFSUMB Guidelines and Recommendations for Musculoskeletal Ultrasound - Part II: Joint Pathologies, Pediatric Applications, and Guided Procedures. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2022; 43:252-273. [PMID: 34734404 DOI: 10.1055/a-1640-9183] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The second part of the Guidelines and Recommendations for Musculoskeletal Ultrasound (MSUS), produced under the auspices of EFSUMB, following the same methodology as for Part 1, provides information and recommendations on the use of this imaging modality for joint pathology, pediatric applications, and musculoskeletal ultrasound-guided procedures. Clinical application, practical points, limitations, and artifacts are described and discussed for every joint or procedure. The document is intended to guide clinical users in their daily practice.
Collapse
Affiliation(s)
- Esperanza Naredo
- Department of Rheumatology, Bone and Joint Research Unit. Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, and Universidad Autónoma de Madrid, Madrid, Spain
| | | | - Lene Terslev
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Carlo Martinoli
- Department of Health Science - DISSAL, University of Genova, Italy
- UO Radiologia, IRCCS Policlinico San Martino, Genova, Italy
| | - Andrea Klauser
- Department of Radiology, Medical University Innsbruck, Section Head Rheumatology and Sports Imaging, Innsbruck, Austria
| | - Wolfgang Hartung
- Clinic for Rheumatology and Clinical Immunology, Asklepios Clinic, Bad Abbach, Germany
| | - Hilde B Hammer
- Department of Rheumatology, Diakonhjemmet Hospital and Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Vito Cantisani
- Department of Radiological, Oncological and Anatomo-pathological Sciences, "Sapienza" University, Rome, Italy
| | - Federico Zaottini
- Department of Health Science - DISSAL, University of Genova, Italy
- UO Radiologia, IRCCS Policlinico San Martino, Genova, Italy
| | - Violeta Vlad
- Sf. Maria Hospital, Rheumatology Department, Bucharest, Romania
| | - Jacqueline Uson
- Department of Rheumatology Hospital Universitario Móstoles, Universidad Rey Juan Carlos, Madrid, Spain
| | - Plamen Todorov
- Department of Internal Disease Propaedeutic and Clinical Rheumatology, Medical University of Plovdiv, Plovdiv, Bulgaria
| | | | - Iwona Sudoł-Szopińska
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Paolo Simoni
- Paediatric Imaging Department, "Reine Fabiola" Children's University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Oana Serban
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Milano Italy
- Department of Biomedical Sciences for Health, University of Milano, Milano, Italy
| | - Xavier Sala-Blanch
- Department of Anaesthesiology, Hospital Clinic, Department of Human Anatomy, Faculty of Medicine, University of Barcelona, Spain
| | - Athena Plagou
- Ultrasound Unit, Private Radiological Institution, Athens, Greece
| | - Riccardo Picasso
- Department of Health Science - DISSAL, University of Genova, Italy
- UO Radiologia, IRCCS Policlinico San Martino, Genova, Italy
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
| | - Aurelie Najm
- Institute of Infection, Immunity and Inflammation, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Ingrid Möller
- Instituto Poal de Reumatologia Barcelona, EULAR Working Group Anatomy for the Image, University of Barcelona, International University of Catalunya, Spain
| | - Mihaela Micu
- Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital Cluj-Napoca, Romania
| | | | - Peter Mandl
- Division of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Clara Malattia
- UOC Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DINOGMI) University of Genoa, Genoa, Italy
| | - Manuela Lenghel
- Radiology Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Jens Kessler
- Department of Anaesthesiology, Division of Pain Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Gabriella Iohom
- Department of Anaesthesiology and Intensive Care Medicine, Cork University Hospital and University College Cork, Cork, Ireland
| | | | - Maria Antonietta DʼAgostino
- Istituto di Reumatologia Università Cattolica del Sacro Cuore, UOC Reumatologia, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Paz Collado
- Rheumatology Department, Transitional Care Clinic, Hospital Universitario Severo Ochoa, Madrid, Spain
| | - Angel Bueno
- Department of Musculoskeletal Radiology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - David Bong
- Instituto Poal de Reumatologia Barcelona, EULAR Working Group Anatomy for the Image, University of Barcelona, International University of Catalunya, Spain
| | - Fernando Alfageme
- Dermatology Department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Diana Bilous
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Roxana Gutiu
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Anamaria Marian
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Michael Pelea
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Daniela Fodor
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| |
Collapse
|
5
|
Mayr R, Sigloch M, Coppola C, Hoermann R, Iltchev A, Schmoelz W. Modified Lemaire tenodesis reduces anterior cruciate ligament graft forces during internal tibial torque loading. J Exp Orthop 2022; 9:45. [PMID: 35583714 PMCID: PMC9117580 DOI: 10.1186/s40634-022-00484-w] [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] [Received: 03/09/2022] [Accepted: 05/06/2022] [Indexed: 11/10/2022] Open
Abstract
PURPOSE The aim of the study was to directly measure graft forces of an anterior cruciate ligament reconstruction (ACLR) and a lateral extra-articular tenodesis (LET) using the modified Lemaire technique in combined anterior cruciate ligament (ACL) deficient and anterolateral rotatory instable knees and to analyse the changes in knee joint motion resulting from combined ACLR + LET. METHODS On a knee joint test bench, six fresh-frozen cadaveric specimens were tested at 0°, 30°, 60°, and 90° of knee flexion in the following states: 1) intact; 2) with resected ACL; 3) with resected ACL combined with anterolateral rotatory instability; 4) with an isolated ACLR; and 5) with combined ACLR + LET. The specimens were examined under various external loads: 1) unloaded; 2) with an anterior tibial translation force (ATF) of 98 N; 3) with an internal tibial torque (IT) of 5 Nm; and 4) with a combined internal tibial torque of 5 Nm and an anterior tibial translation force of 98 N (IT + ATF). The graft forces of the ACLR and LET were recorded by load cells incorporated into custom devices, which were screwed into the femoral tunnels. Motion of the knee joint was analysed using a 3D camera system. RESULTS During IT and IT + ATF, the addition of a LET reduced the ACLR graft forces up to 61% between 0° and 60° of flexion (P = 0.028). During IT + ATF, the LET graft forces reached 112 N. ACLR alone did not restore native internal tibial rotation after combined ACL deficiency and anterolateral rotatory instability. Combined ACLR + LET was able to restore native internal tibial rotation values for 0°, 60° and 90° of knee flexion with decreased internal tibial rotation at 30° of flexion. CONCLUSION The study demonstrates that the addition of a LET decreases the forces seen by the ACLR graft and reduces residual rotational laxity after isolated ACLR during internal tibial torque loading. Due to load sharing, a LET could support the ACLR graft and perhaps be the reason for reduced repeat rupture rates seen in clinical studies. Care must be taken not to limit the internal tibial rotation when performing a LET.
Collapse
Affiliation(s)
- Raul Mayr
- Department for Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Maximilian Sigloch
- Department for Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Christian Coppola
- Department for Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Romed Hoermann
- Institute for Clinical and Functional Anatomy, Medical University of Innsbruck, Innsbruck, Austria
| | - Alessandra Iltchev
- Department for Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Werner Schmoelz
- Department for Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
| |
Collapse
|
6
|
Ahn JH, Koh IJ, McGarry MH, Patel NA, Lin CC, Lee TQ. Synergistic effect of the anterolateral ligament and capsule injuries on the knee laxity in anterior cruciate ligament injured knees: A cadaveric study. Orthop Traumatol Surg Res 2022; 108:103224. [PMID: 35104628 DOI: 10.1016/j.otsr.2022.103224] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 01/03/2021] [Accepted: 11/29/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION There is much controversy about the practical role of the anterolateral ligament (ALL) and its relation to other anterolateral knee structures including the anterolateral capsule (ALC) and iliotibial band (ITB). The purpose of this cadaveric study was to investigate the effect of the ALL and ALC injuries on knee laxity with the iliotibial band (ITB) preserved in the anterior cruciate ligament (ACL)-injured knee. HYPOTHESIS The ALL and ALC would contribute to knee joint stability during anterior translation and internal rotation of the tibia in an ACL-injured knee. MATERIAL AND METHODS For 10 fresh-frozen cadaveric knees, we measured knee laxity with the following state of knee injuries with ITB preserved: (1) intact knee, (2) ACL-sectioned knee (ACL-), (3) additional sectioning of the ALL (ACL-/ALL-), and (4) additional sectioning of the ALC (ACL-/ALL-/ALC-). We did biomechanical measurements in internal-external rotation, anterior-posterior translation, and varus-valgus angulation for each condition at knee flexion angles of 0°, 30°, 60°, and 90°. RESULTS After we sectioned the ALL (ACL-/ALL-), the mean IR at 0°, 30°, 60°, and 90° of knee flexion were significantly increased, compared to the intact knee (p=<0.001, <0.001, <0.001, and 0.002) and ACL- (p=<0.001, <0.001, <0.001, and 0.002). The additional transection of the ALC (ACL-/ALL-/ALC-) significantly increased IR laxity from the ACL-/ALL- at 30°, 60°, and 90° (p=0.005, 0.003, and 0.047). For anterior laxity, ACL-/ALL- resulted in significantly increased anterior laxity from the ACL- at 30° and 60° (p=0.003 and 0.019), and ACL-/ALL-/ALC- significantly increased anterior laxity even from the ACL-/ALL- at 30° and 60° (p=0.007 and 0.011). For varus laxity, ACL-/ALL- resulted in significantly increased varus laxity from both the intact knee and ACL- at 60° (p=0.004 and 0.007) and 90° (p=<0.001 and<0.001). ACL-/ALL-/ALC- resulted in significantly increased varus from ACL-/ALL- at 60° and 90° (p=<0.001 and 0.003). CONCLUSION The anterolateral ligament and anterolateral capsule injuries in ACL-injured knees even with ITB preserved had a synergistic effect on knee laxity in the aspects of internal rotation, anterior translation, and varus angulation. LEVEL OF EVIDENCE II, Controlled laboratory study.
Collapse
Affiliation(s)
- Ji Hyun Ahn
- Department of Orthopaedic Surgery, Dongguk University Ilsan Hospital, 814 Siksadong, Ilsandonggu, Goyangsi, Gyeonggido, 411-773, South Korea.
| | - In Jun Koh
- Department of Orthopaedic Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Michelle H McGarry
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, USA
| | - Nilay A Patel
- Department of Orthopaedic Surgery, University of California, Irvine, CA, USA
| | - Charles C Lin
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Thay Q Lee
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, USA
| |
Collapse
|
7
|
Castoldi M, Cavaignac M, Marot V, Reina N, Mouarbes D, Berard E, Cavaignac E. Femoral Positioning of the Anterolateral Ligament Graft With and Without Ultrasound Location of the Lateral Epicondyle. Am J Sports Med 2022; 50:415-422. [PMID: 34846220 DOI: 10.1177/03635465211061137] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND In anterior cruciate ligament (ACL) reconstruction with anterolateral ligament (ALL) reconstruction, precise positioning of the ALL graft on the femur and tibia is key to achieve rotational control. The lateral femoral epicondyle is often used as a reference point for positioning of the ALL graft and can be located by palpation or with ultrasound guidance. PURPOSE To compare the ALL graft positioning on the femoral side between an ultrasound-guided technique and a palpation technique for the location of the lateral epicondyle. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS A total of 120 patients receiving a primary combined ACL and ALL reconstruction between June and December 2019 were included. The location of the lateral epicondyle was determined by palpation in the palpation group (n = 60) and with preoperative ultrasound guidance in the ultrasound group (n = 60). Groups were comparable in age, sex, body mass index (BMI), and operated side. The planned positioning of the femoral ALL graft was proximal and posterior to the lateral epicondyle. The effective positioning of the femoral ALL graft was evaluated on postoperative lateral radiographs. The primary outcome was location of the graft in a 10-mm quadrant posterior and proximal to the lateral epicondyle. Results were analyzed in 2 subgroups according to BMI. RESULTS All 60 anterolateral grafts (100%) in the ultrasound group were positioned in a 10-mm quadrant posterior and proximal to the lateral epicondyle, as opposed to 52 (87%) in the palpation group (P = .006). Errors in graft positioning with palpation occurred in overweight patients (BMI >25) as well as nonoverweight patients (P = .3). CONCLUSION Femoral positioning of the ALL graft posterior and proximal to the lateral epicondyle is more reproducible with ultrasound guidance when compared with palpation alone, regardless of BMI.
Collapse
Affiliation(s)
- Marie Castoldi
- Institut Universitaire Locomoteur et du Sport, Department of Orthopaedic Surgery, Centre Hospitalo-Universitaire de Nice, Nice, France
| | | | - Vincent Marot
- Department of Orthopedic Surgery and Trauma, Pierre-Paul Riquet Hospital, Toulouse, France
| | - Nicolas Reina
- Department of Orthopedic Surgery and Trauma, Pierre-Paul Riquet Hospital, Toulouse, France.,I2R: Institut de Recherche Riquet, Toulouse, France
| | - Dany Mouarbes
- Department of Orthopedic Surgery and Trauma, Pierre-Paul Riquet Hospital, Toulouse, France
| | - Emilie Berard
- Department of Epidemiology, Health Economics and Public Health, UMR 1027 INSERM-University of Toulouse III, Toulouse University Hospital, Toulouse, France
| | - Etienne Cavaignac
- Department of Orthopedic Surgery and Trauma, Pierre-Paul Riquet Hospital, Toulouse, France.,I2R: Institut de Recherche Riquet, Toulouse, France
| |
Collapse
|
8
|
Murgier J, Thomas P, Reina N, Sylvie R, Bérard E, Cavaignac E. Painful Palpation of the Tibial Insertion of the Anterolateral Ligament Is Concordant With Acute Anterolateral Ligament Injury. Orthop J Sports Med 2020; 8:2325967120930200. [PMID: 32637433 PMCID: PMC7322822 DOI: 10.1177/2325967120930200] [Citation(s) in RCA: 2] [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] [Received: 02/19/2020] [Accepted: 03/04/2020] [Indexed: 01/26/2023] Open
Abstract
Background The anterolateral ligament (ALL) has been shown to contribute to the rotational stability of the knee. However, no clinical sign specific to ALL injury has been described. Purpose/Hypothesis The primary aim of this study was to determine the concordance between pain elicited upon ALL palpation and ALL injury diagnosed by ultrasonography (US). The secondary aim was to look for a relationship between ALL injury and high-grade pivot shift. We hypothesized that an ALL lesion can be diagnosed clinically in an acute knee injury by palpating its tibial insertion. Study Design Cohort study (diagnosis); Level of evidence, 2. Methods A total of 130 patients (89 men, 41 women; mean age, 27.2 ± 8.3 years) with an acute, isolated anterior cruciate ligament injury who were scheduled for ligament reconstruction were enrolled in this study. ALL palpation was carried out a mean 8.8 ± 3.2 days after injury. Preoperatively, ALL integrity was evaluated with US, and the pivot shift was determined under general anesthesia. The agreement between pain upon ALL palpation and ALL injury detected on US was determined by calculating the intraclass correlation coefficient (ICC), along with 95% CIs. Results Distal palpation of the ALL tibial insertion elicited pain in 67 (51.5%) patients, and upon US the ALL was found to be damaged in 64 (49.2%) patients. The agreement between pain over the ALL tibial insertion and the ALL being damaged on US was excellent (ICC, 0.801; 95% CI, 0.730-0.855). Moreover, the clinical test had excellent sensitivity (92%; 95% CI, 88%-97%) and specificity (88%; 95% CI, 82%-93%). The agreement between pain at the ALL distal insertion and the pivot shift was good (ICC, 0.654; 95% CI, 0.543-0.742), and ALL palpation had excellent diagnostic accuracy for identifying rotational instability (sensitivity, 88% [95% CI, 82%-93%]; specificity, 97% [95% CI, 94%-100%]). Conclusion Palpation of the ALL tibial insertion highly correlates with ultrasonographic evidence of an ALL injury in the context of an acute knee injury. This simple test should become part of our standard examination when evaluating patients with acute knee injuries.
Collapse
Affiliation(s)
- Jérôme Murgier
- Aguiléra Private Clinic, Ramsey Santé, Orthopedic Department, Biarritz, France
| | - Pierre Thomas
- Department of Orthopedic Surgery, Hôpital Pierre Paul Riquet, CHU Toulouse, Rue Jean Dausset, Toulouse, France.,SPS Research, Toulouse, France
| | - Nicolas Reina
- Department of Orthopedic Surgery, Hôpital Pierre Paul Riquet, CHU Toulouse, Rue Jean Dausset, Toulouse, France
| | - Rémi Sylvie
- Department of Orthopedic Surgery, Hôpital Pierre Paul Riquet, CHU Toulouse, Rue Jean Dausset, Toulouse, France
| | - Emilie Bérard
- Department of Epidemiology, Health Economics and Public Health, UMR1027 INSERM-University of Toulouse III, Toulouse University Hospital, Toulouse, France
| | - Etienne Cavaignac
- Department of Orthopedic Surgery, Hôpital Pierre Paul Riquet, CHU Toulouse, Rue Jean Dausset, Toulouse, France.,SPS Research, Toulouse, France
| |
Collapse
|
9
|
Shekari I, Shekarchi B, Abbasian M, Minator Sajjadi M, Momeni Moghaddam A, Kazemi SM. Predictive Factors Associated with Anterolateral Ligament Injury in the Patients with Anterior Cruciate Ligament Tear. Indian J Orthop 2020; 54:655-664. [PMID: 32850030 PMCID: PMC7429582 DOI: 10.1007/s43465-020-00159-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 05/27/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND The earlier studies did not assess the associated factors of anterolateral ligament injury, comprehensively. We sought to evaluate the independent predictive factors of anterolateral ligament injury in the patients with anterior cruciate ligament tear. Ultrasound scan has an emerging role in the diagnosis of anterolateral ligament injury. MATERIALS AND METHODS We included 198 patients with anterior cruciate ligament tear in this study. All the patients underwent knee ultrasound scan to diagnose the anterolateral ligament injury. The potential predictive factors of anterolateral ligament injury were compared between the patients with anterolateral ligament injury and the patients with the intact anterolateral ligament. RESULTS In all the patients, the anterolateral ligament was seen in the tibial and femoral portions using the ultrasound scan. One hundred and ten patients (55.6%) had anterolateral ligament injury and the anterolateral ligament was intact in 88 patients (44.4%). The lateral collateral ligament injury was significantly associated with the anterolateral ligament injury (p < 0.001). In addition, the iliotibial band injury had a significant relationship with the anterolateral ligament injury (p = 0.001). An increased lateral tibial slope was significantly associated with the anterolateral ligament injury (p = 0.031). Furthermore, the bone contusion of the lateral femoral condyle had a significant relationship with the anterolateral ligament injury (p = 0.004). CONCLUSION The independent predictors of anterolateral ligament injury included the lateral collateral ligament injury, iliotibial band injury, bone contusion of the lateral femoral condyle, and an increased lateral tibial slope.
Collapse
Affiliation(s)
- Iraj Shekari
- grid.411259.a0000 0000 9286 0323Radiology Research Center, AJA University of Medical Sciences, Tehran, Iran
| | - Babak Shekarchi
- grid.411259.a0000 0000 9286 0323Department of Radiology, AJA University of Medical Sciences, Etemadzadeh Street, Fatemi Avenue, Tehran, 1411718541 Iran
| | - Mohammadreza Abbasian
- grid.411600.2Department of Orthopedic Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Amin Momeni Moghaddam
- grid.411600.2Department of Radiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyyed Morteza Kazemi
- grid.411600.2Department of Orthopedic Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
10
|
Marshall T, Oak SR, Subhas N, Polster J, Winalski C, Spindler KP. Can the Anterolateral Ligament Be Reliably Identified in Anterior Cruciate Ligament-Intact and Anterior Cruciate Ligament-Injured Knees on 3-T Magnetic Resonance Imaging? Orthop J Sports Med 2018; 6:2325967118796452. [PMID: 30263895 PMCID: PMC6153540 DOI: 10.1177/2325967118796452] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Background: The anterolateral ligament (ALL) has been described as an extracapsular
stabilizer of knee rotational stability. Investigators have shown a renewed
interest in the ALL and further evaluated its anatomy and biomechanical role
as a knee stabilizer. The appearance of the ALL on magnetic resonance
imaging (MRI) remains inconsistent across the literature. Purpose: The aims of this study were 2-fold. The first objective was to further
investigate the appearance of the uninjured ALL on MRI and provide data
regarding interrater agreement in identifying the ligament. The second
objective was to describe the incidence of concomitant ALL injuries in
anterior cruciate ligament (ACL)–injured knees and provide data regarding
interrater agreement in identifying and grading these injuries. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Fifty consecutive MRI scans of non–ACL-injured knees (control) and 50
consecutive MRI scans of ACL-injured knees performed at a single sports
medicine center were identified. Three musculoskeletal radiologists
independently reviewed the MRI scans in a randomized and blinded fashion. In
the control group, the reviewers classified the ALL as visualized or not and
did so for the proximal, middle, and distal thirds of the ligament. In the
ACL tear group, the reviewers classified the ALL as visualized or not for
each third of the ligament. They noted whether the ligament was injured and
graded the injury as low, intermediate, or high. Results: All 3 segments of the ALL were visualized in a mean 11% of patients. The ALL
was partially visualized in a mean 68% of patients. The distal third of the
ALL was injured 28% (14/50) of the time in the ACL tear group. The agreement
rate among raters for classifying the injury status was fair to poor. Conclusion: Visualization of the ALL was inconsistent in the current study. Identifying
and grading an injury to the ALL were difficult and had poor interobserver
agreement. Using MRI to aid in the diagnosis of an ALL injury in the setting
of an ACL tear is unreliable according to our study results. Further
research looking at consistent ALL identification and injury patterns should
be undertaken.
Collapse
Affiliation(s)
| | - Sameer R Oak
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Naveen Subhas
- Department of Diagnostic Radiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Joshua Polster
- Department of Diagnostic Radiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Carl Winalski
- Department of Diagnostic Radiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Kurt P Spindler
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| |
Collapse
|
11
|
Imaging Diagnosis of Injury to the Anterolateral Ligament in Patients With Anterior Cruciate Ligaments: Association of Anterolateral Ligament Injury With Other Types of Knee Pathology and Grade of Pivot-Shift Examination: A Systematic Review. Arthroscopy 2018; 34:2728-2738. [PMID: 30037574 DOI: 10.1016/j.arthro.2018.04.025] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 03/08/2018] [Accepted: 04/10/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE The purpose of this study is to systematically review the literature to evaluate the reliability, or the ability of a repeated measurement to yield consistent results, and validity of ultrasound (US) and magnetic resonance imaging (MRI) at evaluating anatomy and pathology of the anterolateral ligament of the knee (ALL) in the setting of anterior cruciate ligament (ACL) injuries. Furthermore, the incidence and association of ALL injury with the pivot-shift examination, and other structural injuries, will be reviewed for additional clinical relevance. METHODS Adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, 2 reviewers independently searched the Medline, Embase, Cochrane, EBSCOhost, OVID, and Web of Science databases for all studies related to imaging of the ALL. All eligible articles and their references were screened by both reviewers. Studies discussing diagnostic imaging of the ALL with regard to identification of injury to the structure in patients with suspected ACL injury were included. No restrictions regarding date of publication, type of publication, or language in the included article were applied. The exclusion criteria included commentaries, case reports, and studies that did not attempt to identify the ALL as a discrete structure. Quality assessment and data extraction was performed for each included study before final analysis was performed. RESULTS A total of 13 articles were included for final analysis. In the included studies, at least 1 portion of the ALL could be visualized on MRI in 76% to 100% of knees, and injury to the ALL was identified in 10.8% to 62.5% of patients. Inter- and intraobserver reliabilities ranged from moderate to almost perfect. There was a consensus among studies that ALL injuries were significantly associated with injuries to the lateral collateral ligament, popliteus tendon, iliotibial band, and bony contusions to the lateral tibia and femur. Most of the included studies found a significant association of injuries to the ALL and a high-grade pivot-shift examination. Only 2 studies used US to evaluate for injury to the ALL, and both studies had almost perfect interobserver reliability. Only 1 study confirmed initial diagnoses at the time of the ACL reconstruction surgery. CONCLUSIONS In patients with ACL injuries, concomitant ALL injuries can be identified on MRI or US with high levels of inter- and intraobserver reliability, and are often associated with a high-grade pivot-shift examination, lateral collateral ligament injury, and lateral femoral condyle and tibial plateau bone bruises. LEVEL OF EVIDENCE Level IV, systematic review of level II-IV studies.
Collapse
|
12
|
Cavaignac E, Laumond G, Reina N, Wytrykowski K, Murgier J, Faruch M, Chiron P. How to Test the Anterolateral Ligament With Ultrasound. Arthrosc Tech 2017; 7:e29-e31. [PMID: 29552465 PMCID: PMC5852247 DOI: 10.1016/j.eats.2017.08.046] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 08/09/2017] [Indexed: 02/03/2023] Open
Abstract
Ultrasonography (US) is a nonirradiating, low-cost, real-time imaging modality that has very good spatial resolution. US can be used to view the anterolateral ligament (ALL) and injuries to the ALL. Several authors have sought to analyze the anterolateral aspect of the knee using US with varying luck. All of them analyzed the ALL statically only. The goal of this Technical Note is to describe in detail the technique that we use to analyze the anterolateral aspect of the knee in patients with an anterior cruciate ligament tear. We use a simple technique that starts by locating the tibial end of the ALL. The lateral inferior genicular artery is a reliable landmark in this context. The analysis is dynamic in addition to being static. To determine if the ALL is injured, we look for a lack of tension on the ALL when the knee is internally rotated and for a Segond fracture. We believe that it is essential to start evaluating the ALL by its tibial end. US analysis of the ALL forms the basis for developing an appropriate "à la carte" treatment for the patient's injury.
Collapse
Affiliation(s)
- Etienne Cavaignac
- Department of Orthopedic Surgery and Trauma, Hôpital Pierre Paul Riquet, Toulouse, France,Address correspondence to Etienne Cavaignac, M.D., Department of Orthopedic Surgery, Hôpital Pierre Paul Riquet, CHU Toulouse, Rue Jean Dausset, 3105 Toulouse, France.Department of Orthopedic SurgeryHôpital Pierre Paul RiquetCHU ToulouseRue Jean Dausset3105 ToulouseFrance
| | - Gregoire Laumond
- Department of Orthopedic Surgery and Trauma, Hôpital Pierre Paul Riquet, Toulouse, France
| | - Nicolas Reina
- Department of Orthopedic Surgery and Trauma, Hôpital Pierre Paul Riquet, Toulouse, France
| | - Karine Wytrykowski
- Department of Orthopedic Surgery and Trauma, Hôpital Pierre Paul Riquet, Toulouse, France
| | - Jérôme Murgier
- Department of Orthopedic Surgery and Trauma, Hôpital Pierre Paul Riquet, Toulouse, France
| | - Marie Faruch
- Department of Radiology, CHU Toulouse, Toulouse, France
| | - Philippe Chiron
- Department of Orthopedic Surgery and Trauma, Hôpital Pierre Paul Riquet, Toulouse, France
| |
Collapse
|