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Karatekin YS, Altınayak H, Kehribar L, Yılmaz AK, Korkmaz E, Anıl B. Does Rotation and Anterior Translation Persist as Residual Instability in the Knee after Anterior Cruciate Ligament Reconstruction? (Evaluation of Coronal Lateral Collateral Ligament Sign, Tibial Rotation, and Translation Measurements in Postoperative MRI). MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1930. [PMID: 38003979 PMCID: PMC10672908 DOI: 10.3390/medicina59111930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 10/24/2023] [Accepted: 10/30/2023] [Indexed: 11/26/2023]
Abstract
Purpose: The aim of this study was to evaluate the presence of residual instability in the knee after ACL reconstruction through the analysis of MRI findings. Methods: This study included patients who underwent isolated ACL reconstruction between December 2019 and December 2021, and had preoperative and postoperative MRI, clinical scores, and postoperative isokinetic measurements. The anterior tibial translation (ATT) distance, coronal lateral collateral ligament (LCL) sign, and femorotibial rotation (FTR) angle were compared preoperatively and postoperatively. The correlation between the changes in preoperative-postoperative measurements and postoperative measurements with clinical scores and isokinetic measurements was examined. The clinical outcomes were compared based on the presence of a postoperative coronal LCL sign. Inclusion criteria were set as follows: the time between the ACL rupture and surgery being 6 months, availability of preoperative and postoperative clinical scores, and objective determination of muscle strength using isokinetic dynamometer device measurements. Patients with a history of previous knee surgery, additional ligament injuries other than the ACL, evidence of osteoarthritis on direct radiographs, cartilage injuries lower limb deformities, and contralateral knee injuries were excluded from this study. Results: This study included 32 patients. After ACL reconstruction, there were no significant changes in the ATT distance (preoperatively: 6.5 ± 3.9 mm, postoperatively: 5.7 ± 3.2 mm) and FTR angle (preoperatively: 5.4° ± 2.9, postoperatively: 5.2° ± 3.5) compared to the preoperative measurements (p > 0.05). The clinical measurements were compared based on the presence of a postoperative coronal LCL sign (observed in 17 patients, not observed in 15 patients), and no significant differences were found for all parameters (p > 0.05). There were no observed correlations between postoperative FTR angle, postoperative ATT distance, FTR angle change, and ATT distance change values with postoperative clinical scores (p > 0.05). Significant correlations were observed between the high strength ratios generated at an angular velocity of 60° and a parameters FTR angle and ATT distance (p-values: 0.028, 0.019, and r-values: -0.389, -0.413, respectively). Conclusions: Despite undergoing ACL reconstruction, no significant changes were observed in the indirect MRI findings (ATT distance, coronal LCL sign, and FTR angle). These results suggest that postoperative residual tibiofemoral rotation and tibial anterior translation may persist; however, they do not seem to have a direct impact on clinical scores. Furthermore, the increase in tibial translation and rotation could potentially negatively affect the flexion torque compared to the extension torque in movements requiring high torque at low angular velocities.
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Affiliation(s)
- Yavuz Selim Karatekin
- Department of Orthopaedics and Traumatology, Samsun Education and Research Hospital, 55090 Samsun, Turkey;
| | - Harun Altınayak
- Department of Orthopaedics and Traumatology, Samsun Education and Research Hospital, 55090 Samsun, Turkey;
| | - Lokman Kehribar
- Medical Faculty, Department of Orthopaedics and Traumatology, Samsun University, 55090 Samsun, Turkey;
| | - Ali Kerim Yılmaz
- Faculty of Yasar Doğu Sport Sciences, Ondokuz Mayıs University, 55090 Samsun, Turkey; (A.K.Y.); (E.K.); (B.A.)
| | - Esra Korkmaz
- Faculty of Yasar Doğu Sport Sciences, Ondokuz Mayıs University, 55090 Samsun, Turkey; (A.K.Y.); (E.K.); (B.A.)
| | - Berna Anıl
- Faculty of Yasar Doğu Sport Sciences, Ondokuz Mayıs University, 55090 Samsun, Turkey; (A.K.Y.); (E.K.); (B.A.)
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Zhang ZY, Huang HJ, Maimaitijiang P, Pan XY, Fu XY, Wang C, Wang JQ. Comparisons of diagnostic performance and the reliability in identifying ACL injury between two measuring protocols of anterior tibial subluxation on MR images. Skeletal Radiol 2023; 52:1713-1720. [PMID: 37036469 DOI: 10.1007/s00256-023-04336-1] [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] [Received: 02/07/2023] [Revised: 04/01/2023] [Accepted: 04/02/2023] [Indexed: 04/11/2023]
Abstract
OBJECTIVES To evaluate the diagnostic performance in identifying an anterior cruciate ligament (ACL) injury and the reliability between two measuring protocols of anterior tibial subluxation (ATS). MATERIALS AND METHODS A total of 165 patients with ACL injury and 157 ACL-intact patients were included in this study. Two different measuring protocols of ATS were performed on sagittal MR images, including the modified protocol using the longitudinal tibial axis (axis protocol) and the established protocol using a line perpendicular to the tibial plateau (plateau protocol). Receiver-operating characteristic (ROC) curves were calculated to evaluate the diagnostic performance in identifying an ACL injury, and areas under the curves (AUCs) were compared between the two protocols. Intra- and interobserver reliability tests were performed to evaluate the reliability of the measurements. RESULTS Lateral ATS (P < 0.001) and medial ATS (P < 0.001) were increased in patients with ACL injury under both protocols. To identify an ACL injury, ATS measured under the axis protocol showed higher AUC values than the plateau protocol, including lateral ATS (AUC 0.828 vs. 0.688, P < 0.001), medial ATS (AUC 0.829 vs. 0.789, P = 0.013), and the combined indicator of lateral and medial ATS (AUC 0.885 vs. 0.810, P < 0.001). Reliability tests showed that both protocols were reliable. CONCLUSIONS ATS measured under the modified protocol using the longitudinal tibial axis showed superior diagnostic performance in identifying an ACL injury compared to the established protocol, indicating that the modified protocol may better reflect the characteristics of an ACL-deficient knee.
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Affiliation(s)
- Zhi-Yu Zhang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Hong-Jie Huang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | | | - Xiao-Yu Pan
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Xiao-Yue Fu
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China
- Beijing Key Laboratory of Sports Injuries, Beijing, China
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Cheng Wang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China.
- Beijing Key Laboratory of Sports Injuries, Beijing, China.
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China.
| | - Jian-Quan Wang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China.
- Beijing Key Laboratory of Sports Injuries, Beijing, China.
- Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China.
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Cojean T, Batailler C, Robert H, Cheze L. GNRB® laximeter with magnetic resonance imaging in clinical practice for complete and partial anterior cruciate ligament tears detection: A prospective diagnostic study with arthroscopic validation on 214 patients. Knee 2023; 42:373-381. [PMID: 37172464 DOI: 10.1016/j.knee.2023.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/18/2023] [Accepted: 03/28/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Accurate diagnosis of anterior cruciate ligament (ACL) injury is not always obtained with magnetic resonance imaging (MRI). Other tools, such as the GNRB® arthrometer, help to accurately identify the type of ACL tear. The aim of this study was to show that the GNRB® could be a relevant complementary solution to MRI in ACL injuries detection. METHODS A prospective study performed between 2016 and 2020 included 214 patients who had undergone knee surgery. The study compared sensitivity/specificity pairs of MRI and the GNRB® at 134 N to detect healthy ACL, partial and complete ACL tears. Arthroscopies were the 'gold standard'. Forty-six patients had a healthy ACL with associated knee lesions, 168 patients had ACL tears where 107 were complete tears and 61 were partial tears. RESULTS For healthy ACL, MRI scored 100% for sensitivity (SE) and 95% for specificity (SP), and the GNRB® scored SE 95.65% and SP 97.5% at 134 N. For complete ACL tears, MRI scored 80.81% for sensitivity (SE) and 64.49% for specificity (SP), and the GNRB® scored SE 77.78% and SP 85.98% at 134 N. For partial tears, MRI scored SE 29.51% and SP 88.97%, and the GNRB® scored SE 73.77% and SP 85.52% at 134 N. CONCLUSION GNRB® sensitivity and specificity were equivalent to those of MRI for healthy ACL and complete ACL tear detection. However, MRI had some difficulty in detecting partial ACL tears compared with the GNRB® which showed better sensitivity.
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Affiliation(s)
- Théo Cojean
- Université de Lyon, Université Gustave Eiffel, Université Claude Bernard Lyon 1, Lyon, France.
| | - Cécile Batailler
- Université de Lyon, Université Gustave Eiffel, Université Claude Bernard Lyon 1, Lyon, France; Hôpital de la Croix-Rousse, Lyon, France
| | - Henri Robert
- Centre Hospitalier du Haut Anjou, Château-Gontier-Sur-Mayenne, France
| | - Laurence Cheze
- Université de Lyon, Université Gustave Eiffel, Université Claude Bernard Lyon 1, Lyon, France
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Exploring Anatomo-Morphometric Characteristics of Infrapatellar, Suprapatellar Fat Pad, and Knee Ligaments in Osteoarthritis Compared to Post-Traumatic Lesions. Biomedicines 2022; 10:biomedicines10061369. [PMID: 35740391 PMCID: PMC9220326 DOI: 10.3390/biomedicines10061369] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/06/2022] [Accepted: 06/07/2022] [Indexed: 11/17/2022] Open
Abstract
Several studies have investigated cartilage degeneration and inflammatory subchondral bone and synovial membrane changes using magnetic resonance (MR) in osteoarthritis (OA) patients. Conversely, there is a paucity of data exploring the role of knee ligaments, infrapatellar fat pad (IFP), and suprapatellar fat pad (SFP) in knee OA compared to post-traumatic cohorts of patients. Therefore, the aim of this study was to analyze the volumetric and morphometric characteristics of the following joint tissues: IFP (volume, surface, depth, femoral and tibial arch lengths), SFP (volume, surface, oblique, antero−posterior, and cranio−caudal lengths), anterior (ACL) and posterior cruciate ligament (PCL) (volume, surface, and length), and patellar ligament (PL) (volume, surface, arc, depth, and length). Eighty-nine MR images were collected in the following three groups: (a) 32 patients with meniscal tears, (b) 29 patients with ACL rupture (ACLR), and (c) 28 patients affected by end-stage OA. Volume, surface, and length of both ACL and PCL were determined in groups a and c. A statistical decrease of IFP volume, surface, depth, femoral and tibial arch lengths was found in end-stage OA compared to patients with meniscal tear (p = 0.002, p = 0.008, p < 0.0001, p = 0.028 and p < 0.001, respectively) and patients with ACLR (p < 0.0001, p < 0.0001, p = 0.008 and p = 0.011, respectively). An increment of volume and surface SFP was observed in group b compared to both groups a and c, while no differences were found in oblique, antero−posterior, and cranio−caudal lengths of SFP among the groups. No statistical differences were highlighted comparing volume, surface, arc, and length of PL between the groups, while PL depth was observed to be decreased in end-OA patients compared with meniscal tear patients (p = 0.023). No statistical differences were observed comparing ACL and PCL lengths between patients undergoing meniscectomy and TKR. Our study confirms that IFP MR morphometric characteristics are different between controls and OA, supporting an important role of IFP in OA pathology and progression in accordance with previously published studies. In addition, PL depth changes seem to be associated with OA pathology. Multivariate analysis confirmed that OA patients had a smaller IFP compared to patients with meniscal tears, confirming its involvement in OA.
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Xu Z, Chen Y, Zhu J, Zhang L, Wu P. Comparison of the Use of Magnetic Resonance Imaging of Partial Anterior Cruciate Ligament Tears Using Maximum Knee Flexion in the Lateral Decubitus Position with Routine Knee Positioning. Med Sci Monit 2021; 27:e932228. [PMID: 34593750 PMCID: PMC8491558 DOI: 10.12659/msm.932228] [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] [Indexed: 11/11/2022] Open
Abstract
Background This study assessed magnetic resonance imaging (MRI) of acute and chronic partial anterior cruciate ligament (ACL) tears using maximum knee flexion in the lateral decubitus position compared with routine knee positioning in 204 patients at a single center. Material/Methods Based on the time interval from injury to MRI examination, the 204 patients in this study were divided into 3 groups: subacute (6 weeks to 3 months), intermediate (3 months to 1 year), and chronic (>1 year). All patients received both routine MRI (MRI R) and maximum knee flexion in the lateral decubitus position MRI (MRI S) examination, followed by knee arthroscopy. Three radiologists blinded to patient groups evaluated the MRI scans and made a diagnosis. Results of knee arthroscopy were referenced as the criterion standard. The sensitivity and specificity of MRI R and MRI S groups were calculated and compared. Results The MRI S diagnostic rate was comparable to that of knee arthroscopy. MRI S had significantly higher sensitivity than MRI R for partial ACL tears, especially in the intermediate group (P<0.01). Conclusions MRI of partial ACL tears using maximum knee flexion in the lateral decubitus position improved the diagnostic rate relative to routine MRI examination, particularly in patients in the intermediate group.
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Affiliation(s)
- Zijun Xu
- Department of Radiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Yichao Chen
- Department of Orthopedics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Jianghua Zhu
- Department of Equipment, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Lin Zhang
- Department of Radiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
| | - Peng Wu
- Department of Orthopeadics, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China (mainland)
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Mehier C, Ract I, Metten MA, Najihi N, Guillin R. Primary anterior cruciate ligament repair: magnetic resonance imaging characterisation of reparable lesions and correlation with arthroscopy. Eur Radiol 2021; 32:582-592. [PMID: 34255158 DOI: 10.1007/s00330-021-08155-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 06/05/2021] [Accepted: 06/14/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES A recent treatment algorithm suggests that proximal anterior cruciate ligament (ACL) tears with good-to-excellent tissue quality are amenable to primary repair. Our primary objective was to assess the ability of MRI to determine the exact tear location and tissue quality, using arthroscopy as a reference standard. METHODS In an initial sample of 71 patients with prior ACL surgery (repair or reconstruction), the diagnostic accuracy of MRI was assessed using arthroscopy as a reference standard. Each native ACL tear was graded according to Sherman's arthroscopic classifications during the surgical procedure. MRI scans were retrospectively reviewed for grading, blinded to arthroscopic findings and in consensus by two musculoskeletal radiologists. Tear location and tissue quality were graded using the MRI Sherman tear location (MSTL), MRI Sherman tissue quality (MSTQ) and simplified MRI Sherman tissue quality (S-MSTQ) classifications. Intra- and inter-observer agreement was assessed on a second sample of 77 patients. MRI classification accuracy was compared by McNemar's tests. Intra- and inter-observer agreement was assessed using Cohen's kappa coefficient. RESULTS Regarding tear location, diagnostic accuracy was 70% (50/71) based on the MSTL classification. Diagnostic accuracy for tissue quality was 52% (15/29) based on the MSTQ classification and 90% (26/29) for the S-MSTQ classification (p = 0.003). Inter-observer agreement was good for MSTL (κ = 0.78) and moderate-to-good for the MSTQ and S-MSTQ classifications (κ = 0.44 and 0.63 respectively). CONCLUSIONS MRI seems to be accurate in assessing tear location and tissue quality and may help clinicians to predict the reparability of ACL tears. KEY POINTS • MRI seems to be accurate in assessing tear location and tissue quality and may help clinicians to predict the reparability of ACL tears. • High intra-observer agreement was demonstrated when grading the tear location into one of five types. • The diagnostic accuracy of the simplified MRI tissue quality classification, involving deletion of the ligament stump signal criterion, was better than that observed with the MRI Sherman tissue quality classification, but was moderate to good in terms of inter- and intra-observer agreement.
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Affiliation(s)
- Clement Mehier
- Department of Radiology, Rennes University Hospital, 2 Rue Henri le Guilloux, 35000, Rennes, France.
| | - Isabelle Ract
- Department of Radiology, Rennes University Hospital, 2 Rue Henri le Guilloux, 35000, Rennes, France
| | - Marie-Astrid Metten
- University of Rennes, Rennes University Hospital, Inserm, EHESP, Irset (Research Institute for Environmental and Occupational Health) - UMR_S 1085, F-35000, Rennes, France
| | - Nabil Najihi
- Department of Orthopaedic Surgery, St Laurent Hospital, 320 Av. Général George S. Patton, 35700, Rennes, France
| | - Raphael Guillin
- Department of Radiology, Rennes University Hospital, 2 Rue Henri le Guilloux, 35000, Rennes, France
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Is it worth to perform initial non-operative treatment for patients with acute ACL injury?: a prospective cohort prognostic study. Knee Surg Relat Res 2021; 33:11. [PMID: 33823937 PMCID: PMC8025569 DOI: 10.1186/s43019-021-00094-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 03/10/2021] [Indexed: 01/13/2023] Open
Abstract
Purpose To evaluate the result of implementing an initial non-operative treatment program for an acute ACL injury and to find if the timing of initiating the non-operative treatment is significant. Methods This study included a prospective cohort of 85 consecutive patients with acute ACL injury who were treated according to the above strategy for the initial 3 months with 1-year follow-up. Clinical evaluations were made by Lysholm score, Tegner activity score, Lachman test (LT), pivot-shit test (PST), and the side to side difference (SSD) by KT-2000 arthrometer. The results were analyzed according to the timing of initiating the non-operative treatment. Results Initially, 84% of the patients showed LT and PST ≤ grade 1, and 16% with ≥grade 2. At 1-year follow-up, 77 patients (91%) with LT and PST ≤ grade 1 did not receive reconstruction as copers and 8 patients with LT or PST ≥ grade 2 required reconstruction (six patients received the operation and two refused). The patients with LT and PST ≤ grade 1 showed average Lysholm score 91.2, average SSD 2.5 mm, and mean Tegner score decreased from 6.9 (pre-injury) to 6.2. Patients who started the non-operative treatment within 2 weeks after injury revealed superior rates of grade 0 or 1 instability than those who commenced the treatment later than 2 weeks after injury (P = 0.043). Conclusions Implementing a non-operative treatment with brace in acute phase of ACL injury appears to be an effective and viable option to achieve a reasonable clinical outcome. We recommend earlier initiation of the non-operative treatment to obtain a better result in patients with acute ACL injury. Supplementary Information The online version contains supplementary material available at 10.1186/s43019-021-00094-3.
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Polat AE, Polat B, Gürpınar T, Sarı E, Çarkçı E, Erler K. Tibial tubercle-trochlear groove (TT-TG) distance is a reliable measurement of increased rotational laxity in the knee with an anterior cruciate ligament injury. Knee 2020; 27:1601-1607. [PMID: 33010779 DOI: 10.1016/j.knee.2020.08.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 07/18/2020] [Accepted: 08/12/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND The aims of this study were: 1. To evaluate the use of the tibial tubercle-trochlear groove (TT-TG) distance as a measurement showing rotational instability after anterior cruciate ligament (ACL) injury. 2. To determine the effect of concomitant anterolateral ligament (ALL) injury on TT-TG distance. METHODS Knee magnetic resonance (MR) images of 251 patients were retrospectively evaluated to compare the study group (131 patients) who underwent ACL reconstruction due to acute complete ACL injury and the control group (120 patients) without any trauma and/or patellofemoral instability. The rate of secondary signs of ACL injury (Anterolateral ligament injury, Kissing lesion, Anterior tibial translocation, Buckling of the posterior cruciate ligament (PCL)) in the study group was noted. The relationship between the TT-TG distance and other secondary signs was examined. RESULTS TT-TG distance was measured as 10.83 ± 1.2 mm, 12.88 ± 1.1 mm, 14.17 ± 1.5 mm in control, isolated ACL and ACL + ALL groups, respectively (p < 0.05). TT-TG distance was significantly higher in the patients with ALL injury and kissing lesions than the patients without these lesions (p ˂ 0.05). TT-TG distance did not differ significantly between the patients with and without anterior tibial translocation or buckling of the PCL (p ˃ 0.05). TT-TG distance measurements showed significant interobserver 0.994 (0.992-0.996) and intraobserver 0.997 (0.996-0.998) correlation. CONCLUSIONS TT-TG distance measurement can be used as a reliable quantitative measure of the increased rotational instability after ACL injury. TT-TG distance increases significantly if there is an ALL injury accompanying the ACL injury.
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Affiliation(s)
- Ayşe Esin Polat
- Akçiçek State Hospital, Department of Orthopaedics and Traumatology, Kyrenia, Cyprus
| | - Barış Polat
- Burhan Nalbantoğlu State Hospital, Department of Orthopaedics and Traumatology, Nicosia, Cyprus.
| | - Tahsin Gürpınar
- Istanbul Training and Research Hospital, Department of Orthopaedics and Traumatology, Istanbul, Turkey
| | - Enes Sarı
- Near East University, Medical Faculty, Department of Orthopaedics and Traumatology, Nicosia, Cyprus
| | - Engin Çarkçı
- Istanbul Training and Research Hospital, Department of Orthopaedics and Traumatology, Istanbul, Turkey
| | - Kaan Erler
- Near East University, Medical Faculty, Department of Orthopaedics and Traumatology, Nicosia, Cyprus
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A Retrospective Comparison of ACL Tear and Mucoid Degeneration MRI Findings and an Emphasis on Evaluating of ACL, Blumensaat, and PCL Angles. J Belg Soc Radiol 2020; 104:36. [PMID: 32676546 PMCID: PMC7333554 DOI: 10.5334/jbsr.1654] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective: To determine MRI findings that can differentiate anterior cruciate ligament (ACL) tears from mucoid degeneration. Material and Methods: Thirty-seven patients with complete ACL tears and 43 with ACL mucoid degeneration were included in this study. Discontinuity, the abnormal signal intensity of the ACL on fat-saturated-PD weighted images, contusions, a deep lateral femoral notch, anterior tibial translation, uncovered posterior horn of the lateral meniscus, a celery stalk appearance, thickening, ganglion cysts, intraosseous cysts, the ACL, Blumensaat, and posterior cruciate ligament (PCL) angles were evaluated. Optimum threshold values, sensitivity, specificity, and 95% CIs for the angles were calculated to predict the tear. Results: The prevalence of the significant findings in a tear versus mucoid degeneration, respectively, was as follows: discontinuity (97% vs. 0%, p < 0.001), contusions (65% vs. 2%, p < 0.001), the deep lateral femoral notch (22% vs. 0%, p = 0.001), anterior tibial translation (70% vs. 14%, p < 0.001), uncovered the lateral meniscus (46% vs. 7%, p < 0.001), a celery stalk appearance (0% vs. 66%, p < 0.001), thickening (19% vs. 100%, p < 0.001), ganglion cysts (14% vs. 70%, p < 0.001), and intraosseous cysts (8% vs. 63%, p < 0.001). Threshold values of ACL, Blumensaat, and PCL angles to predict the tear were ≤36° (78% sensitivity, 91% specificity), >11° (84%, 81%), and ≤96° (65%, 91%), respectively. Conclusion: A celery stalk appearance in the mucoid degeneration and discontinuity in an ACL tear are important in the differential diagnosis. ACL, Blumensaat, and PCL angles can be helpful in settings of diagnostic uncertainty.
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Bargagliotti M, Benazzo F, Bellemans J, Truijen J, Pietrobono L, Formagnana M, Zero E, Zanon G. The Role of the Posterolateral Tibial Slope in the Rotational Instability of the Knee in Patients Affected by a Complete Isolated Anterior Cruciate Ligament Injury: Its Value in the Decision-Making Process during the Anterolateral Ligament Reconstruction. JOINTS 2020; 7:78-83. [PMID: 34195534 PMCID: PMC8236326 DOI: 10.1055/s-0040-1710386] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 04/04/2020] [Indexed: 10/29/2022]
Abstract
Purpose The aim of this retrospective, multicenter study was to investigate the correlation between a high degree of rotatory instability, posterolateral tibial slope (PLTS), and anterolateral ligament (ALL) injury. Methods The study population consisted of 76 adults with isolated, complete noncontact anterior cruciate ligament (ACL) tear. The sample was divided into two groups according to the preoperative degree of rotator instability (group A: pivot-shift test grades 2 and 3; group B: pivot-shift test grade 1). Preoperative magnetic resonance imaging (MRI) assessment included angle of PLTS, posterior shift of the lateral femoral condyle (16 mm) on the tibial plateau, and the presence/absence of ALL injury. The two groups were compared for differences. Results There was a statistically significant association between pivot-shift test grades 2 and 3 (group A), PLTS slope angle > 9 degrees, and ALL injury ( p < 0.05). Group A also demonstrated a greater posterior shift of lateral femoral condyle (>11 mm), which was, however, not statistically significant when evaluated as an isolated variable. Conclusion Our study indicates that an increased PLTS is associated with an increased incidence of ALL injury and an increased grade of pivot shift in patients with ACL tear. Assessment of posterolateral tibial slope on MRI can therefore play a key adjunct role in the surgical planning of ALL reconstruction, especially in cases when ALL damage is radiologically difficult to detect or doubtful. Level of Evidence This is a retrospective comparative level III study.
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Affiliation(s)
- Marco Bargagliotti
- Joint Replacement Department, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Francesco Benazzo
- Orthopedic and Sport Traumatology Department, IRCCS Fondazione Policlinico S. Matteo, Pavia, Italy
| | - Johan Bellemans
- Orthopedic and Sport Traumatology Department, Ziejenhuis Oost-Limburg Hospital, Genk, Belgium
| | - Jan Truijen
- Orthopedic and Sport Traumatology Department, Ziejenhuis Oost-Limburg Hospital, Genk, Belgium
| | - Luigi Pietrobono
- Radiology and Neuroradiology Department, IRCCS Fondazione Policlinico S. Matteo, Pavia, Italy
| | | | - Enrico Zero
- Department of Informatics, Bioengineering, Robotics and System Engineering of the University of Genoa, Genoa, Italy
| | - Giacomo Zanon
- Orthopedic and Sport Traumatology Department, IRCCS Fondazione Policlinico S. Matteo, Pavia, Italy
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Sigonney G, Klouche S, Chevance V, Bauer T, Rousselin B, Judet O, Hardy P. Risk factors for passive anterior tibial subluxation on MRI in complete ACL tear. Orthop Traumatol Surg Res 2020; 106:465-468. [PMID: 31983652 DOI: 10.1016/j.otsr.2019.10.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 10/23/2019] [Accepted: 10/24/2019] [Indexed: 02/03/2023]
Abstract
INTRODUCTION In anterior cruciate ligament (ACL) tear, passive spontaneous anterior tibial subluxation (ATS), with respect to the femur, is sometimes observed on MRI. In a case-control study, ATS>3.5mm showed 100% specificity (±3.6, 95% CI) for complete ACL tear. The aim of the present study was to assess the relation between ATS on MRI and associated lesions in complete ACL tear. The study hypothesis was that associated lesions are a risk factor for ATS. MATERIAL AND METHODS A retrospective study included patients operated on for complete ACL tear between 2010 and 2015. Exclusion criteria comprised associated posterior cruciate ligament tear, partial ACL tear, and history of knee surgery. Preoperative MRI was performed with the patient in supine position and the knee in 20° flexion in neutral rotation. ATS was measured by axial superimposition of the bicondylar slice on the slice through the tibial plateau. Associated lesions were assessed: medial and lateral menisci, collateral ligaments, posteromedial and posterolateral corners, tibiofemoral compartment cartilage and cancellous bone. Factors associated with ATS>3.5mm were analyzed. Ninety-one patients were included: mean age, 31.1±10.1 years; 34 female, 57 male. Mean time from injury to MRI was 7.8±11.7 months (range, 0.7-60 months). RESULTS Mean ATS was 4.7±2.3mm. Inter- and intra-observer reproducibility for ATS measurement were excellent. On preoperative MRI, 61.1% of patients showed bone edema, 48.4% medial meniscal tear, and 36.3% lateral meniscal tear. ATS was significantly greater in case of medial meniscal tear (5.4±2.3mm vs. 4±2.1mm; p=0.003). No significant differences were found according to other lesions. Fifty-four patients (59.3%) showed ATS>3.5mm; risk factors comprised medial meniscal tear (OR=2.6, 95%CI [1.1-6.2]; p=0.03) and injury-to-MRI time>9 months (OR=9.8, 95% CI [1.1-85.2]; p=0.04). CONCLUSION Spontaneous anterior tibial subluxation on MRI in complete ACL tear was significantly associated with medial meniscal tear and accident-to-MRI time. LEVEL OF EVIDENCE IV, retrospective cohort study.
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Affiliation(s)
| | | | - Virgile Chevance
- Université Paris Saclay, AP-HP, 92100 Boulogne-Billancourt, France
| | - Thomas Bauer
- Université Paris Saclay, AP-HP, 92100 Boulogne-Billancourt, France
| | - Benoit Rousselin
- Université Paris Saclay, AP-HP, 92100 Boulogne-Billancourt, France
| | - Olivia Judet
- Université Paris Saclay, AP-HP, 92100 Boulogne-Billancourt, France
| | - Philippe Hardy
- Université Paris Saclay, AP-HP, 92100 Boulogne-Billancourt, France
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Hardy A, Klouche S, Szarzynski P, Charpentier E, Beranger JS, Bauer T, Rousselin B, Judet O, Hardy P. A threshold value of 3.5 mm of passive anterior tibial subluxation on MRI is highly specific for complete ACL tears. Knee Surg Sports Traumatol Arthrosc 2019; 27:885-892. [PMID: 30244342 DOI: 10.1007/s00167-018-5159-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 09/17/2018] [Indexed: 02/05/2023]
Abstract
PURPOSE To identify and quantify passive anterior tibial subluxation on MRI using a standardized measurement protocol and determine the diagnostic threshold of subluxation for complete anterior cruciate ligament tears. METHODS A retrospective case-control study was performed. Patients who underwent surgery for a complete isolated ACL tear between 2009 and 2015 were matched for age and gender to controls with an intact ligament on knee MRI. All subjects underwent 1.5 T closed field MR imaging with the same protocol. Measurements were performed on axial sequences to evaluate translation of the medial and lateral condyles compared to the tibial plateau. Each compartment was measured between the vertical tangent to the posterior femoral condyles and the most posterior part of the tibial plateau. The main criterion was global passive subluxation measurements on MRI, corresponding to mean medial and lateral compartment subluxation. The reproducibility and diagnostic value of passive subluxation were calculated. RESULTS Sixty (30/30) subjects were included, mean age 27.1 ± 1.7 years, 20 women and 40 men. Patients had a significantly higher global passive subluxation than controls (3.3 ± 0.6 mm vs 0.6 ± 0.2 mm, respectively p < 0.00001). Reproducibility was excellent and the diagnostic value of passive subluxation for a complete ACL tear was fair. A passive subluxation threshold of 3.5 mm had a sensitivity of 55.2%, a specificity of 100% and 77.6% of well-classified subjects. CONCLUSION The calculated cutoff value for global passive subluxation to identify patients with a complete ACL tear was 3.5 mm, with excellent specificity and a high positive likelihood ratio. Suboptimal clinical results following ACL reconstruction could be partially due to failure to restore an anatomical femorotibial relationship. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Alexandre Hardy
- Hôpital Ambroise Paré, Service de Chirurgie Orthopédique et Traumatologie, Hôpitaux Universitaires Paris Ile de France Ouest, Assistance Publique-Hôpitaux de Paris, 9, avenue Charles de Gaulle, 92100, Boulogne-Billancourt, France
| | - Shahnaz Klouche
- Hôpital Ambroise Paré, Service de Chirurgie Orthopédique et Traumatologie, Hôpitaux Universitaires Paris Ile de France Ouest, Assistance Publique-Hôpitaux de Paris, 9, avenue Charles de Gaulle, 92100, Boulogne-Billancourt, France.
| | - Pierre Szarzynski
- Hôpital Ambroise Paré, Service de Chirurgie Orthopédique et Traumatologie, Hôpitaux Universitaires Paris Ile de France Ouest, Assistance Publique-Hôpitaux de Paris, 9, avenue Charles de Gaulle, 92100, Boulogne-Billancourt, France
| | - Etienne Charpentier
- Hôpital Ambroise Paré, Service de Chirurgie Orthopédique et Traumatologie, Hôpitaux Universitaires Paris Ile de France Ouest, Assistance Publique-Hôpitaux de Paris, 9, avenue Charles de Gaulle, 92100, Boulogne-Billancourt, France
| | - Jean Sebastien Beranger
- Hôpital Ambroise Paré, Service de Chirurgie Orthopédique et Traumatologie, Hôpitaux Universitaires Paris Ile de France Ouest, Assistance Publique-Hôpitaux de Paris, 9, avenue Charles de Gaulle, 92100, Boulogne-Billancourt, France
| | - Thomas Bauer
- Hôpital Ambroise Paré, Service de Chirurgie Orthopédique et Traumatologie, Hôpitaux Universitaires Paris Ile de France Ouest, Assistance Publique-Hôpitaux de Paris, 9, avenue Charles de Gaulle, 92100, Boulogne-Billancourt, France
- Université de Versailles Saint-Quentin-en-Yvelines, UFR des Sciences de la Santé, 78180, Montigny-le-Bretonneux, France
| | - Benoit Rousselin
- Hôpital Ambroise Paré, Service de Chirurgie Orthopédique et Traumatologie, Hôpitaux Universitaires Paris Ile de France Ouest, Assistance Publique-Hôpitaux de Paris, 9, avenue Charles de Gaulle, 92100, Boulogne-Billancourt, France
| | - Olivia Judet
- Hôpital Ambroise Paré, Service de Chirurgie Orthopédique et Traumatologie, Hôpitaux Universitaires Paris Ile de France Ouest, Assistance Publique-Hôpitaux de Paris, 9, avenue Charles de Gaulle, 92100, Boulogne-Billancourt, France
| | - Philippe Hardy
- Hôpital Ambroise Paré, Service de Chirurgie Orthopédique et Traumatologie, Hôpitaux Universitaires Paris Ile de France Ouest, Assistance Publique-Hôpitaux de Paris, 9, avenue Charles de Gaulle, 92100, Boulogne-Billancourt, France
- Université de Versailles Saint-Quentin-en-Yvelines, UFR des Sciences de la Santé, 78180, Montigny-le-Bretonneux, France
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Magnetic Resonance Signal Abnormalities within the Pericruciate Fat Pad: A Possible Secondary Sign for Acute Anterior Cruciate Ligament Tears. Can Assoc Radiol J 2017; 68:438-444. [DOI: 10.1016/j.carj.2017.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Revised: 02/26/2017] [Accepted: 04/10/2017] [Indexed: 11/18/2022] Open
Abstract
Purpose The study sought to investigate the presence of magnetic resonance (MR) signal alterations within the pericruciate fat pad in patients with an acute anterior cruciate ligament (ACL) tear as well as evaluate its diagnostic value in comparison with the main secondary signs of ACL tears. Methods Two musculoskeletal radiologists retrospectively reviewed knee MR examinations performed from May to October 2015. The ACL was considered as torn or intact based on either previous arthroscopic findings or unequivocal MR imaging interpretation if arthroscopic correlation was unavailable. Abnormalities of the pericruciate fat pad were evaluated as increased signal on the fluid-sensitive sequences; the main secondary signs of ACL tears were identified. Sensitivity and specificity were calculated for each sign. Results A total of 182 patients entered this study: 22 with an acute ACL tear, 160 with intact ACL. Signal hyperintensity of the pericruciate fat pad was demonstrated in all patients with an acutely torn ACL, resulting significantly different between individuals with intact ACL and those with ligament tear ( P < .0001). This sign was much more sensitive (100%) but less specific (72.5%-75%) than other secondary signs. Conclusions Signal hyperintensity of the pericruciate fat pad on the fluid-sensitive sequences is associated with acute ACL tears and could be considered as a possible indicator of these injuries.
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Guenoun D, Vaccaro J, Le Corroller T, Barral PA, Lagier A, Pauly V, Coquart B, Coste J, Champsaur P. A dynamic study of the anterior cruciate ligament of the knee using an open MRI. Surg Radiol Anat 2016; 39:307-314. [PMID: 27515305 DOI: 10.1007/s00276-016-1730-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 08/03/2016] [Indexed: 10/21/2022]
Abstract
Recent anatomical and radiological studies of the anterior cruciate ligament (ACL) suggest the ACL length and orientation change during knee flexion, and an open MRI sequencing during knee flexion enables a dynamic ACL analysis. This study's goal is to describe a normal ACL using a 1T open MRI and, in particular, variations in length and insertion angles at different degrees of flexion. Twenty-one volunteers with clinically healthy knees received a dynamic MRI with their knees in hyperextension, neutral position, and flexed at 45° and 90° angles. For each position, two radiologists measured the ACL lengths and angles of the proximal insertion between the ACL's anterior edge and the roof of the inter-condylar notch. Additionally, we measured the ACL's and the tibial plateau's distal angle insertion between their anterior edges and then compared these with the nonparametric Wilcoxon test. The ACL had a significant extension between the 90° flexion and all other positions (hyperextension: 31.75 ± 2.5 mm, neutral position: 32.5 ± 2.6 mm, 45°: 35.6 ± 1.6 mm, 90°: 35.6 ± 1.6 mm). There was also a significant increase of the angle insertion between the proximal 90° flexion and all other positions, as well as between hyperextension and bending to 45° (hyperextension: 2.45° ± 3.7°, neutral: 13.4° ± 9.7°, 45°: 33 25 ± 9.3, 90: 51.85° ± 9.3°). Additionally, there is a significant increase in the distal angle insertion for all positions (hyperextension: 133.2° ± 5.4°, neutral position: 134.95° ± 4.4°, 45°: 138.35° ± 5.9°, 90°: 149.15° ± 8.6°). Our study is the first to exhibit that a dynamic MRI has a significant ACL extension in vivo during bending. This concept opens the way for further studies to improve the diagnosis of traumatic ACL injuries using a dynamic MRI.
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Affiliation(s)
- Daphne Guenoun
- Department of Radiology, Sainte-Marguerite Hospital, Institute for Locomotion, APHM, 13009, Marseille, France.
| | - Julien Vaccaro
- Department of Radiology, Sainte-Marguerite Hospital, Institute for Locomotion, APHM, 13009, Marseille, France
| | - Thomas Le Corroller
- Department of Radiology, Sainte-Marguerite Hospital, Institute for Locomotion, APHM, 13009, Marseille, France
| | - Pierre-Antoine Barral
- Department of Radiology, Sainte-Marguerite Hospital, Institute for Locomotion, APHM, 13009, Marseille, France
| | - Aude Lagier
- Department of Anatomy, Aix Marseille Université, 13005, Marseille, France
| | - Vanessa Pauly
- Unité de Recherche EA3279, Santé Publique et Maladies Chroniques: Qualité de vie Concepts, Usages et Limites, Déterminants, Aix Marseille Université, 13005, Marseille, France
| | - Benjamin Coquart
- Department of Radiology, Sainte-Marguerite Hospital, Institute for Locomotion, APHM, 13009, Marseille, France
| | - Joel Coste
- Department of Rheumatology, Sainte-Marguerite Hospital, Institute for Locomotion, APHM, 13009, Marseille, France
| | - Pierre Champsaur
- Department of Radiology, Sainte-Marguerite Hospital, Institute for Locomotion, APHM, 13009, Marseille, France
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Dual-energy computed tomography of cruciate ligament injuries in acute knee trauma. Skeletal Radiol 2015; 44:1295-301. [PMID: 26025120 DOI: 10.1007/s00256-015-2173-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 05/15/2015] [Accepted: 05/18/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine dual-energy computed tomography (DECT) in evaluating cruciate ligament injuries. More specifically, the purpose was to assess the optimal keV level in DECT gemstone spectral imaging (GSI) images and to examine the usefulness of collagen-specific color mapping and dual-energy bone removal in the evaluation of cruciate ligaments and the popliteus tendon. MATERIALS AND METHODS At a level 1 trauma center, a 29-month period of emergency department DECT examinations for acute knee trauma was reviewed by two radiologists for presence of cruciate ligament injuries, visualization of the popliteus tendon and the optimal keV level in GSI images. Three different evaluating protocols (GSI, bone removal and collagen-specific color mapping) were rated. Subsequent MRI served as a reference standard for intraarticular injuries. RESULTS A total of 18 patients who had an acute knee trauma, DECT and MRI were found. On MRI, six patients had an ACL rupture. DECT's sensitivity and specificity to detect ACL rupture were 79% and 100%, respectively. The DECT vs. MRI intra- and interobserver proportions of agreement for ACL rupture were excellent or good (kappa values 0.72-0.87). Only one patient had a PCL rupture. In GSI images, the optimal keV level was 63 keV. GSI of 40-140 keV was considered to be the best evaluation protocol in the majority of cases. CONCLUSION DECT is a usable method to evaluate ACL in acute knee trauma patients with rather good sensitivity and high specificity. GSI is generally a better evaluation protocol than bone removal or collagen-specific color mapping in the evaluation of cruciate ligaments and popliteus tendon.
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Litscher G, Litscher D, Ofner M, Gaischek I, Malliga DE. Temperature Measurements in Rehabilitation in Patients with Completely Ruptured Anterior Cruciate Ligament before and after RegentK and Physiotherapy. MEDICINES 2014; 1:12-21. [PMID: 28933374 PMCID: PMC5532979 DOI: 10.3390/medicines1010012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 06/30/2014] [Accepted: 07/09/2014] [Indexed: 11/16/2022]
Abstract
Acute skin surface temperature effects on the knee were investigated after a manual therapy developed by Mohamed Khalifa (RegentK) compared to standard physiotherapy in patients with completely ruptured anterior cruciate ligament (ACL). Twenty patients participated in this study. They were randomly assigned to group A (receiving RegentK) or group B (physiotherapy). Each group consisted of 10 patients. Temperature values were registered on four spots (three on the knee, one on the foot) of the injured and the healthy leg (control). Skin temperature increased significantly after RegentK on all sites of the injured leg, but after physiotherapy only the measurement spots on the knee showed significant increases. After RegentK the temperature had also increased significantly on the control leg, whereas in group B, the results were not significant. Experimental and clinical testing of technical equipment, e.g., infrared thermography, for ACL injuries is important for a better understanding of the different physiological/pathophysiological mechanisms underlying different therapy approaches.
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Affiliation(s)
- Gerhard Litscher
- Research Unit for Complementary and Integrative Laser Medicine, Medical University of Graz, Auenbruggerplatz 29, 8036 Graz, Austria.
- Research Unit of Biomedical Engineering in Anesthesia and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 29, 8036 Graz, Austria.
- TCM Research Center Graz, Medical University of Graz, Auenbruggerplatz 29, 8036 Graz, Austria.
| | - Daniela Litscher
- Research Unit for Complementary and Integrative Laser Medicine, Medical University of Graz, Auenbruggerplatz 29, 8036 Graz, Austria.
- Research Unit of Biomedical Engineering in Anesthesia and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 29, 8036 Graz, Austria.
- TCM Research Center Graz, Medical University of Graz, Auenbruggerplatz 29, 8036 Graz, Austria.
| | - Michael Ofner
- Department of Sports Physiology, University of Vienna, Auf der Schmelz 6, 1150 Vienna, Austria.
| | - Ingrid Gaischek
- Research Unit for Complementary and Integrative Laser Medicine, Medical University of Graz, Auenbruggerplatz 29, 8036 Graz, Austria.
- Research Unit of Biomedical Engineering in Anesthesia and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 29, 8036 Graz, Austria.
- TCM Research Center Graz, Medical University of Graz, Auenbruggerplatz 29, 8036 Graz, Austria.
| | - Daniela-Eugenia Malliga
- Division of Cardiac Surgery, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036 Graz, Austria.
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Chang MJ, Chang CB, Choi JY, Je MS, Kim TK. Can magnetic resonance imaging findings predict the degree of knee joint laxity in patients undergoing anterior cruciate ligament reconstruction? BMC Musculoskelet Disord 2014; 15:214. [PMID: 24950603 PMCID: PMC4081463 DOI: 10.1186/1471-2474-15-214] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 06/17/2014] [Indexed: 12/02/2022] Open
Abstract
Background The present study was performed to determine whether MRI findings can predict the degree of knee joint laxity in patients undergoing ACL reconstruction and whether the accuracy of the prediction is affected by the MRI acquisition time. Methods We assessed prospectively collected data of 154 knees with ACL tears. The presence or absence of four primary findings of ACL tears, i.e., nonvisualization, discontinuity, abnormal signal intensity, and abnormal shape of the ACL, and five secondary findings, i.e., anterior translation of the tibia relative to the femur (≥7 mm), posterior cruciate ligament angle (<105°), bone contusion, Segond fracture, and the deep sulcus sign, were determined. Knee joint laxity was assessed using the Lachman and pivot shift tests. The associations between MRI findings and clinically assessed knee joint laxity were analyzed and compared between subgroups (≤3 months from injury to MRI, 89 knees; >3 months, 65 knees). Results Nonvisualization was related to the results of the Lachman test [Odds ratio (OR), 2.6; 95% confidence interval (CI), 1.2–5.5]. Anterior translation of the tibia relative to the femur was related to the results of the pivot shift test (OR, 3.8; 95% CI, 1.6–9.4). In subgroup comparisons of the early and late MRI groups, anterior translation of the tibia relative to the femur was related to the results of the pivot shift test in the early MRI group (OR, 4.5; 95% CI, 1.4–14.4). In contrast, no MRI findings had statistically significant relationships with physical findings in the late MRI group. Conclusions Our study indicates that MRI findings may have some usefulness for predicting the grade of knee laxity in patients with symptomatic ACL injury, but its value is limited, especially in patients with a longer time interval between injury and the performance of MRI.
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Affiliation(s)
| | - Chong Bum Chang
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Boramae Hospital, 5 Gil 20, Boramae-road, Dongjak-gu, Seoul 156-707, Korea.
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Glazebrook KN, Brewerton LJ, Leng S, Carter RE, Rhee PC, Murthy NS, Howe BM, Ringler MD, Dahm DL, Stuart MJ, McCollough CH, Fletcher JG. Case-control study to estimate the performance of dual-energy computed tomography for anterior cruciate ligament tears in patients with history of knee trauma. Skeletal Radiol 2014; 43:297-305. [PMID: 24337491 DOI: 10.1007/s00256-013-1784-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 11/06/2013] [Accepted: 11/10/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Computed tomography (CT) is used to assess for fracture after knee trauma, but identification of ligamentous injuries may also be beneficial. Our purpose is to assess the potential of dual-energy computed tomography (DECT) for the detection of complete anterior cruciate ligament (ACL) disruption. METHODS Sixteen patients with unilateral traumatic ACL disruption (average of 58 days following trauma) confirmed by MRI, and 11 control patients without trauma, underwent DECT of both knees. For each knee, axial, sagittal, and oblique sagittal images (with DECT bone removal, single-energy (SE) bone removal, and DECT tendon-specific color mapping) were reconstructed. Four musculoskeletal radiologists randomly evaluated the 324 DECT reconstructed series (54 knees with 6 displays) separately, to assess for ACL disruption using a five-point scale (1 = definitely not torn, to 5 = definitely torn). ROC analysis was used to compare performance across readers and displays. RESULTS Sagittal oblique displays (mixed kV soft tissue, SE bone removal, and DECT bone removal) demonstrated higher areas under the curve for ACL disruption (AUC = 0.95, 0.93 and 0.95 respectively) without significant differences in performance between readers (p > 0.23). Inter-reader agreement was also better for these display methods (ICC range 0.62-0.69) compared with other techniques (ICC range 0.41-0.57). Mean sensitivity for ACL disruption was worst for DECT tendon-specific color map and axial images (24 % and 63 % respectively). CONCLUSION DECT knee images with oblique sagittal reconstructions using either mixed kV or bone removal displays (either DECT or SE) depict ACL disruption in the subacute or chronic setting with reliable identification by musculoskeletal radiologists.
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Affiliation(s)
- Katrina N Glazebrook
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA,
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Alejandro Orizola M, Álvaro Zamorano C. Reconstrucción de ligamento cruzado anterior de rodilla en mujeres deportistas. REVISTA MÉDICA CLÍNICA LAS CONDES 2012. [DOI: 10.1016/s0716-8640(12)70316-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Guenoun D, Le Corroller T, Amous Z, Pauly V, Sbihi A, Champsaur P. The contribution of MRI to the diagnosis of traumatic tears of the anterior cruciate ligament. Diagn Interv Imaging 2012; 93:331-41. [PMID: 22542209 DOI: 10.1016/j.diii.2012.02.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
When faced with a clinical suspicion of knee ligament injury, MRI nowadays has a central role in the diagnostic strategy. In particular, it is essential for assessing the cruciate ligaments and any associated meniscal tears. The objective of this review is to present the various direct and indirect MRI signs of tearing of the anterior cruciate ligament (ACL) and then describe the lesions associated with it. The anatomical and clinical aspects are also discussed so that the contribution of MRI to the diagnosis and therapeutic management of an ACL tear can be better understood.
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Affiliation(s)
- D Guenoun
- Departement of Radiology, Hôpital Sainte-Marguerite, 270, boulevard Sainte-Marguerite, 13009 Marseille, France.
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Smith TO, Lewis M, Song F, Toms AP, Donell ST, Hing CB. The diagnostic accuracy of anterior cruciate ligament rupture using magnetic resonance imaging: a meta-analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2011. [DOI: 10.1007/s00590-011-0829-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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[Evaluation of anterior knee laxity on MRI]. ACTA ACUST UNITED AC 2011; 92:208-25. [PMID: 21501760 DOI: 10.1016/j.jradio.2011.02.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2010] [Accepted: 02/09/2011] [Indexed: 12/21/2022]
Abstract
PURPOSE Evaluation of the ACL and anterior knee laxity on MR during anterior tibial translation. PATIENTS AND METHODS Three groups were identified based on clinical and arthrometric (KT-1000) data: normal ACL (n=12), complete tear (n=10) and partial tear (n=20). MRI was performed without and with anterior tibial translation (pneumatic device) with morphological and laximetric analysis: drawer tests and dynamic evaluation of ligamentous tension. RESULTS Intra- and inter-observer reproducibility was excellent, correlated to arthrometric data and clinical tests (Lachman, pivot shift). The difference between the drawer signs of normal subjects and patients with ACL tear was significant for a threshold value of 1,1mm for the anterior drawer (sensitivity: 93.33%, specificity: 91.7%) and 2.8 mm for the posterior drawer (sensitivity: 86.7%, specificity: 100%). Dynamic evaluation of ligamentous tension was also reproducible, statistically correlated to the MR drawer tests and reliable for the diagnosis of ACL lesions. In this preliminary study, the distinction between complete and partial ACL tears could not be detected. CONCLUSION Anterior cruciate ligament function can be demonstrated on MR. The predictive value of this morphological and functional association should be determined in the management of patients with partial tears.
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Klass D, Horwitz MD. Orthopaedic one-stop clinics: feasible or fantasy? Br J Hosp Med (Lond) 2010; 71:248-9. [PMID: 20448490 DOI: 10.12968/hmed.2010.71.5.47902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Yoon JP, Chang CB, Yoo JH, Kim SJ, Choi JY, Choi JA, Seong SC, Kim TK. Correlation of magnetic resonance imaging findings with the chronicity of an anterior cruciate ligament tear. J Bone Joint Surg Am 2010; 92:353-60. [PMID: 20124062 DOI: 10.2106/jbjs.i.00031] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Although several findings on magnetic resonance imaging have been demonstrated after anterior cruciate ligament injury, sequential changes on magnetic resonance imaging have not been comprehensively studied. We undertook to correlate four specific findings on magnetic resonance imaging of an anterior cruciate ligament injury over time. METHODS One hundred and forty-five patients with a complete tear of the anterior cruciate ligament confirmed by arthroscopy were divided, according to the time from the injury to the acquisition of the magnetic resonance image, into four groups: acute (within six weeks), subacute (more than six weeks to three months), intermediate (more than three months to one year), and chronic (more than one year). Four findings (anterior cruciate ligament morphology, joint effusion, posterior cruciate ligament angle, and bone bruise) were evaluated for each study group. RESULTS Strong correlations were found between the magnetic resonance imaging findings and the chronicity of the anterior cruciate ligament tear. Anterior cruciate morphology showed sequential changes with time (p < 0.001). Joint effusion decreased with time, with a significant difference occurring between the acute and subacute groups at six weeks (p < 0.001). The posterior cruciate ligament angle decreased gradually over time (p < 0.001). Finally, the signal contrast of bone-bruising decreased with time, with a significant change occurring after three months (p = 0.049). CONCLUSIONS Our study confirmed that these four magnetic resonance imaging variables are closely correlated with the chronicity of an anterior cruciate ligament tear, and estimation of the chronicity of the tear can be facilitated by an integrative interpretation of these findings.
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Affiliation(s)
- Jong Pil Yoon
- Joint Reconstruction Center, Seoul National University Bundang Hospital, Seongnam-si, Gyunggido 463-707, South Korea
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Lam MH, Fong DT, Yung PS, Ho EP, Chan WY, Chan KM. Knee stability assessment on anterior cruciate ligament injury: Clinical and biomechanical approaches. BMC Sports Sci Med Rehabil 2009; 1:20. [PMID: 19712449 PMCID: PMC2744659 DOI: 10.1186/1758-2555-1-20] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2008] [Accepted: 08/27/2009] [Indexed: 01/12/2023]
Abstract
Anterior cruciate ligament (ACL) injury is common in knee joint accounting for 40% of sports injury. ACL injury leads to knee instability, therefore, understanding knee stability assessments would be useful for diagnosis of ACL injury, comparison between operation treatments and establishing return-to-sport standard. This article firstly introduces a management model for ACL injury and the contribution of knee stability assessment to the corresponding stages of the model. Secondly, standard clinical examination, intra-operative stability measurement and motion analysis for functional assessment are reviewed. Orthopaedic surgeons and scientists with related background are encouraged to understand knee biomechanics and stability assessment for ACL injury patients.
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Affiliation(s)
- Mak-Ham Lam
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, PR China.
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