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Tokura T, Nagai K, Hoshino Y, Watanabe S, Kanzaki N, Nishida K, Matsushita T, Kuroda R. Injuries to both anterolateral ligament and Kaplan fiber of the iliotibial band do not increase preoperative pivot-shift phenomenon in ACL injury. Asia Pac J Sports Med Arthrosc Rehabil Technol 2024; 36:40-44. [PMID: 38595931 PMCID: PMC11001600 DOI: 10.1016/j.asmart.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 03/18/2024] [Indexed: 04/11/2024] Open
Abstract
Background To assess the incidence of anterolateral ligament (ALL) and Kaplan fiber of the iliotibial band (KF) injuries in patients with acute anterior cruciate ligament (ACL) injury on magnetic resonance imaging (MRI), and to investigate the association between these injuries and the magnitude of preoperative pivot-shift test. Method One-hundred and five patients with primary ACL injury were retrospectively reviewed. ALL injury and KF injury were assessed by preoperative MRI, and subjects were allocated into four groups: Group A, neither injury; Group B, only ALL injury; Group C, only KF injury; Group D, simultaneous ALL and KF injuries. Before ACL reconstruction, tibial acceleration during the pivot-shift test was measured by an electromagnetic measurement system, and manual grading was recorded according to the International Knee Documentation Committee (IKDC) guideline. Results In MRI, the ALL was identified in 104 patients (99.1%) and KF in 99 patients (94.3%). ALL and KF injuries were observed in 43 patients (43.9%) and 23 patients (23.5%), respectively. Patient distribution to each group was as follows; Group A: 43 patients (43.9%), Group B: 32 patients (32.7%), Group C: 12 patients (12.2%), Group D: 11 patients (11.2%). No significant differences were observed in tibial acceleration, and manual grading among the four groups. Conclusion Simultaneous injury to both ALL and KF was uncommon, and preoperative pivot-shift phenomenon did not increase even in those patients. The finding suggests that the role of ALL and KF in controlling anterolateral rotatory knee laxity may be less evident in the clinical setting compared to a biomechanical test setting.
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Affiliation(s)
- Takeo Tokura
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Kanto Nagai
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Yuichi Hoshino
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Shu Watanabe
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Noriyuki Kanzaki
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Kyohei Nishida
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Takehiko Matsushita
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan
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Guruprasad A, Sinha U, Kumar S, Kumar A, Ahmad S, Kumar P, Agrawal P. Utility of three-dimensional proton density-weighted sequence MRI in knee for the assessment of Anterolateral complex in Anterior cruciate ligament injury. Br J Radiol 2024; 97:583-593. [PMID: 38276884 PMCID: PMC11027298 DOI: 10.1093/bjr/tqae003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 10/09/2023] [Accepted: 01/03/2024] [Indexed: 01/27/2024] Open
Abstract
OBJECTIVES To assess the proportion and pattern of injury of the anterolateral ligament (ALL) and the Kaplan fibre (KF) complex in knees with anterior cruciate ligament (ACL) injuries on MRI using three-dimensional (3D) proton density (PD) sequences. METHODS A total of 88 patients having ACL injury were included in this cross-sectional study. 3D PD sequences were used to assess injury of ALL and the KF complex and were graded on a scale of 0 to 3. MR images were evaluated by two radiologists. Interobserver agreement was determined using Cohen Kappa. RESULTS Femoral, meniscal, and tibial portions of ALL were visualized in 90.9%, 92%, and 94.3% of the study subjects, respectively. Proximal and distal KF were visualized in 92% and 93.2% of patients, respectively. Injury to ALL and KF was seen in 63.6% and 17% of the patients, respectively. Excellent interobserver agreement was noted for the identification and grading of ALL and KF complex injuries. CONCLUSIONS Oblique reformatted 3DPD MRI reliably detect ALC; however, ALL injury is better characterized than KF injury using this sequence. ADVANCES IN KNOWLEDGE Given the potential role of anterolateral complex (ALC) in maintaining the rotational stability of the knee, ALC assessment using the 3D PD sequences and their oblique reformatted images should be incorporated as routine review area of the knee MRI, particularly in the setting of ACL tear.
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Affiliation(s)
- Ankith Guruprasad
- Department of Radiodiagnosis, All India Institute of Medical Sciences Patna, Bihar, 801507, India
| | - Upasna Sinha
- Department of Radiodiagnosis, All India Institute of Medical Sciences Patna, Bihar, 801507, India
| | - Sudeep Kumar
- Department of Orthopedics, All India Institute of Medical Sciences Patna, Bihar, 801507, India
| | - Avinash Kumar
- Department of Orthopedics, All India Institute of Medical Sciences Patna, Bihar, 801507, India
| | - Shamshad Ahmad
- Department of Community and Family Medicine, All India Institute of Medical Sciences Patna, Bihar, 801507, India
| | - Prem Kumar
- Department of Radiodiagnosis, All India Institute of Medical Sciences Patna, Bihar, 801507, India
| | - Prabhat Agrawal
- Department of Orthopedics, All India Institute of Medical Sciences Patna, Bihar, 801507, India
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3
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Farinelli L, Meena A, Sonnery-Cottet B, Vieira TD, Pioger C, Tapasvi S, Abermann E, Hoser C, Fink C. Distal Kaplan fibers and anterolateral ligament injuries are associated with greater intra-articular internal tibial rotation in ACL-deficient knees based on magnetic resonance imaging. J Exp Orthop 2023; 10:113. [PMID: 37943352 PMCID: PMC10635991 DOI: 10.1186/s40634-023-00682-0] [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: 08/24/2023] [Accepted: 10/19/2023] [Indexed: 11/10/2023] Open
Abstract
PURPOSE The purpose of the present study was to assess the internal rotation of the tibia on Magnetic Resonance Imaging (MRI) in a series of consecutive athletes with Anterior cruciate Ligament (ACL) tears. METHODS Retrospective analysis of prospectively collected data was performed to include all consecutive patients who had undergone primary ACL reconstruction between January 2022 and June 2022. The angle between surgical epicondylar axes (SEA) of the knee and posterior tibial condyles (PTC) was measured. A negative value was defined as internal torsion. KFs and ALL injuries were reported. Analysis of covariance (ANCOVA) was performed to examine the independent associations between SEA-PTC angle and injuries of KFs and ALL adjusted for physical variables (age, gender and body mass index [BMI]). Statistical significance was set at a p-value of < 0.05. RESULTS A total of 83 eligible patients were included. The result of multiple linear regression analysis showed that internal tibial rotation was associated with KFs and ALL injuries. The estimated average of SEA-PTC angle in relation to ALL injuries controlling the other variables was -5.49 [95%CI -6.79 - (-4.18)] versus -2.99 [95%CI -4.55 - (-1.44)] without ALL injuries. On the other hand, the estimated average of SEA-PTC angle in relation to KFs lesions controlling the other variables was -5.73 [95%CI -7.04 - (-4.43)] versus -2.75 [95%CI -4.31 - (-1.18)] without KFs injuries. CONCLUSIONS KFs and ALL injuries were associated with an increased intra-articular internal tibial rotation in ACL-deficient knees. The measurement of femorotibial rotation on axial MRI could be useful to detect indirect signs of anterolateral complex (ALC) injuries.
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Affiliation(s)
- Luca Farinelli
- Clinical Orthopaedics, Department of Clinical and Molecular Sciences, Università Politecnica Delle Marche, Ancona, Italy
| | - Amit Meena
- Gelenkpunkt - Sports and Joint Surgery, Olympiastraße 39, Innsbruck, 6020, Austria
- Research Unit for Orthopaedic Sports Medicine and Injury Prevention (OSMI), Private University for Health Sciences, Medical Informatics and Technology, Innsbruck, Austria
| | - Bertrand Sonnery-Cottet
- Centre Orthopedique Santy, FIFA Medical Centre of Excellence, Hôpital Mermoz, Groupe Ramsay, Lyon, France
| | - Thais Dutra Vieira
- Centre Orthopedique Santy, FIFA Medical Centre of Excellence, Hôpital Mermoz, Groupe Ramsay, Lyon, France
| | - Charles Pioger
- Department of Orthopaedic Surgery, Centre Hospitalier de Versailles, 177, Rue de Versailles, Le Chesnay, 78157, France
| | | | - Elisabeth Abermann
- Gelenkpunkt - Sports and Joint Surgery, Olympiastraße 39, Innsbruck, 6020, Austria
- Research Unit for Orthopaedic Sports Medicine and Injury Prevention (OSMI), Private University for Health Sciences, Medical Informatics and Technology, Innsbruck, Austria
| | - Christian Hoser
- Gelenkpunkt - Sports and Joint Surgery, Olympiastraße 39, Innsbruck, 6020, Austria
- Research Unit for Orthopaedic Sports Medicine and Injury Prevention (OSMI), Private University for Health Sciences, Medical Informatics and Technology, Innsbruck, Austria
| | - Christian Fink
- Gelenkpunkt - Sports and Joint Surgery, Olympiastraße 39, Innsbruck, 6020, Austria.
- Research Unit for Orthopaedic Sports Medicine and Injury Prevention (OSMI), Private University for Health Sciences, Medical Informatics and Technology, Innsbruck, Austria.
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Willinger L, Athwal KK, Holthof S, Imhoff AB, Williams A, Amis AA. Role of the Anterior Cruciate Ligament, Anterolateral Complex, and Lateral Meniscus Posterior Root in Anterolateral Rotatory Knee Instability: A Biomechanical Study. Am J Sports Med 2023; 51:1136-1145. [PMID: 36917838 PMCID: PMC10068405 DOI: 10.1177/03635465231161071] [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] [Indexed: 03/16/2023]
Abstract
BACKGROUND Injuries to the anterior cruciate ligament (ACL), Kaplan fibers (KFs), anterolateral capsule/ligament (C/ALL), and lateral meniscus posterior root (LMPR) have been separately linked to anterolateral instability. PURPOSE To investigate the contributions of the ACL, KFs, C/ALL, and LMPR to knee stability and to measure instabilities resulting from their injury. STUDY DESIGN Controlled laboratory study. METHODS Ten fresh-frozen human knees were tested robotically to determine restraints of knee laxity at 0° to 90° of flexion. An 88-N anterior-posterior force (anterior and posterior tibial translation), 5-N·m internal-external rotation, and 8-N·m valgus-varus torque were imposed and intact kinematics recorded. The kinematics were replayed after sequentially cutting the structures (order varied) to calculate their contributions to stability. Another 10 knees were tested in a kinematics rig with optical tracking to measure instabilities after sequentially cutting the structures across 0° to 100° of flexion. One- and 2-way repeated-measures analyses of variance with Bonferroni correction were used to find significance (P < .05) for the robotic and kinematics tests. RESULTS The ACL was the primary restraint for anterior tibial translation; other structures were insignificant (<10% contribution). The KFs and C/ALL resisted internal rotation, reaching 44% ± 23% (mean ± SD; P < .01) and 14% ± 13% (P < .05) at 90°. The LMPR resisted valgus but not internal rotation. Anterior tibial translation increased after ACL transection (P < .001) and after cutting the lateral structures from 70° to 100° (P < .05). Pivot-shift loading increased anterolateral rotational instability after ACL transection from 0° to 40° (P < .05) and further after cutting the lateral structures from 0° to 100° (P < .01). CONCLUSION The anterolateral complex acts as a functional unit to provide rotatory stability. The ACL is the primary stabilizer for anterior tibial translation. The KFs are the most important internal rotation restraint >30° of flexion. Combined KFs + C/ALL injury substantially increased anterolateral rotational instability while isolated injury of either did not. LMPR deficiency did not cause significant instability with the ACL intact. CLINICAL RELEVANCE This study is a comprehensive biomechanical sectioning investigation of the knee stability contributions of the ACL, anterolateral complex, and LMPR and the instability after their transection. The ACL is significant in controlling internal rotation only in extension. In flexion, the KFs are dominant, synergistic with the C/ALL. LMPR tear has an insignificant effect with the ACL intact.
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Affiliation(s)
- Lukas Willinger
- Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | | | | | - Andreas B Imhoff
- Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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Seil R, Pioger C, Siboni R, Amendola A, Mouton C. The anterior cruciate ligament injury severity scale (ACLISS) is an effective tool to document and categorize the magnitude of associated tissue damage in knees after primary ACL injury and reconstruction. Knee Surg Sports Traumatol Arthrosc 2023:10.1007/s00167-023-07311-4. [PMID: 36629888 DOI: 10.1007/s00167-023-07311-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 01/02/2023] [Indexed: 01/12/2023]
Abstract
PURPOSE To develop a tool allowing to classify the magnitude of structural tissue damage occurring in ACL injured knees. The proposed ACL Injury Severity Scale (ACLISS) would provide an easy description and categorization of the wide spectrum of injuries in patients undergoing primary ACL reconstruction, reaching from isolated ACL tears to ACL injuries with a complex association of combined structural damage. METHODS A stepwise approach was used to develop the ACLISS. The eligibility of each item was based on a literature search and a consensus between the authors after considering the diagnostic modalities and clinical importance of associated injuries to the menisci, subchondral bone, articular cartilage or collateral ligaments. Then, a retrospective analysis of associated injuries was performed in 100 patients who underwent a primary ACL reconstruction (ACLR) by a single surgeon. This was based on acute preoperative MRI (within 8 weeks after injury) as well as intraoperative arthroscopic findings. Depending on their prevalence, the number of selected items was reduced. Finally, an analysis of the overall scale distribution was performed to classify the patients according to different injury profiles. RESULTS A final scoring system of 12 points was developed (12 = highest severity). Six points were attributed to the medial and lateral tibiofemoral compartment respectively. The amount of associated injuries increased with ACLISS grading. The median scale value was 4.5 (lower quartile 3.0; higher quartile 7.0). Based on these quartiles, a score < 4 was considered to be an injury of mild severity (grade I), a score between ≥ 4 and ≤ 7 was defined as moderately severe (grade II) and a score > 7 displayed the most severe cases of ACL injuries (grade III). The knees were graded ACLISS I in 35%, ACLISS II in 49% and ACLISS III in 16% of patients. Overall, damage to the lateral tibiofemoral compartment was predominant (p < 0.01), but a proportional increase of tissue damage could be observed in the medial tibiofemoral compartment with the severity of ACLISS grading (p < 0.01). CONCLUSIONS The ACLISS allowed to easily and rapidly identify different injury severity profiles in patients who underwent primary ACLR. Injury severity was associated with an increased involvement of the medial tibiofemoral compartment. The ACLISS is convenient to use in daily clinical practice and represents a feasible grading and documentation tool for a reproducible comparison of clinical data in ACL injured patients. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Romain Seil
- Department of Orthopaedic Surgery, Centre Hospitalier Luxembourg-Clinique d'Eich, 78 Rue d'Eich, L-1460, Luxembourg, Luxembourg. .,Sports Medicine and Science, Luxembourg Institute of Research in Orthopaedics, Luxembourg, Luxembourg. .,Orthopaedics, Sports Medicine and Digital Methods, Human Motion, Luxembourg, Luxembourg.
| | - Charles Pioger
- Department of Orthopaedic Surgery, Centre Hospitalier Luxembourg-Clinique d'Eich, 78 Rue d'Eich, L-1460, Luxembourg, Luxembourg.,Department of Orthopaedic Surgery, Ambroise Paré Hospital, Paris Saclay University, 9, avenue Charles de Gaulle, 92100, Boulogne-Billancourt, France
| | - Renaud Siboni
- Department of Orthopaedic Surgery, Centre Hospitalier Luxembourg-Clinique d'Eich, 78 Rue d'Eich, L-1460, Luxembourg, Luxembourg.,Department of Orthopaedic Surgery, Reims Teaching Hospital, Hôpital Maison Blanche, 45 Rue Cognacq-Jay, 51092, Reims, France
| | | | - Caroline Mouton
- Department of Orthopaedic Surgery, Centre Hospitalier Luxembourg-Clinique d'Eich, 78 Rue d'Eich, L-1460, Luxembourg, Luxembourg.,Sports Medicine and Science, Luxembourg Institute of Research in Orthopaedics, Luxembourg, Luxembourg
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Yi Z, Jiang J, Liu Z, Wang H, Yi Q, Zhan H, Liang X, Niu Y, Xiang D, Geng B, Xia Y, Wu M. The Association Between Bone Bruises and Concomitant Ligaments Injuries in Anterior Cruciate Ligament Injuries: A Systematic Review and Meta-analysis. Indian J Orthop 2023; 57:20-32. [PMID: 36660483 PMCID: PMC9789248 DOI: 10.1007/s43465-022-00774-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 10/21/2022] [Indexed: 11/16/2022]
Abstract
Background Bone bruises and concomitant ligament injuries after anterior cruciate ligament (ACL) injuries have attracted attention, but their correlation and potential clinical significance remain unclear. Purpose To assess the relationship between bone bruises and concomitant ligamentous injuries in ACL injuries. Study design Systematic review. Methods A comprehensive search of PubMed, Embase, Web of Science, and Cochrane Library was completed from inception to October 20, 2021. All articles that evaluated the relationship between bone bruises and related ligaments injuries were included. Methodological Index for Non-Randomized Studies (MINORS) was used for quality assessment as well as Review Manager 5.3 was used for data analysis. Results A total of 19 studies evaluating 3292 patients were included. After meta-analysis, anterolateral ligament (ALL) injuries were associated with bone bruising on the lateral tibial plateau (LTP) (RR = 2.33; 95% CI 1.44-3.77; p = 0.0006), lateral femoral condyle (LFC) (RR = 1.97; 95% CI 1.37-2.85; p = 0.0003) and medial tibial plateau (MTP) (RR = 1.62; 95% CI 1.24-2.11; p = 0.0004); Moreover, medial collateral ligament (MCL) injuries were associated with bone bruising on the femur (RR = 1.49; 95% CI 1.17-1.90; p = 0.001), and no statistical significance was found between bone bruising on the MTP and Kaplan fiber (KF) injuries (RR = 1.58; 95% CI 1.00-2.49; p = 0.05). Nonetheless, the current evidence did not conclude that bone bruises were associated with lateral collateral ligament (LCL) injuries. Conclusion For individuals with an ACL injury, bone bruises of the LTP, LFC, and MTP can assist in the diagnosis of ALL injuries. Furthermore, femoral bruising has potential diagnostic value for MCL injuries. Knowing these associations allows surgeons to be alert to ACL-related ligament injuries on MRI and during operations in future clinical practice.
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Affiliation(s)
- Zhi Yi
- Department of Orthopaedics, Orthopaedic Clinical Research Center of Gansu Province, Intelligent Orthopaedic Industry Technology Center of Gansu Province, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730000 Gansu People’s Republic of China
| | - Jin Jiang
- Department of Orthopaedics, Orthopaedic Clinical Research Center of Gansu Province, Intelligent Orthopaedic Industry Technology Center of Gansu Province, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730000 Gansu People’s Republic of China
| | - Zhongcheng Liu
- Department of Orthopaedics, Orthopaedic Clinical Research Center of Gansu Province, Intelligent Orthopaedic Industry Technology Center of Gansu Province, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730000 Gansu People’s Republic of China
| | - Hong Wang
- Department of Orthopaedics, Orthopaedic Clinical Research Center of Gansu Province, Intelligent Orthopaedic Industry Technology Center of Gansu Province, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730000 Gansu People’s Republic of China
| | - Qiong Yi
- Department of Orthopaedics, Orthopaedic Clinical Research Center of Gansu Province, Intelligent Orthopaedic Industry Technology Center of Gansu Province, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730000 Gansu People’s Republic of China
| | - Hongwei Zhan
- Department of Orthopaedics, Orthopaedic Clinical Research Center of Gansu Province, Intelligent Orthopaedic Industry Technology Center of Gansu Province, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730000 Gansu People’s Republic of China
| | - Xiaoyuan Liang
- Department of Orthopaedics, Orthopaedic Clinical Research Center of Gansu Province, Intelligent Orthopaedic Industry Technology Center of Gansu Province, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730000 Gansu People’s Republic of China
| | - Yongkang Niu
- Department of Orthopaedics, Orthopaedic Clinical Research Center of Gansu Province, Intelligent Orthopaedic Industry Technology Center of Gansu Province, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730000 Gansu People’s Republic of China
| | - Dejian Xiang
- Department of Orthopaedics, Orthopaedic Clinical Research Center of Gansu Province, Intelligent Orthopaedic Industry Technology Center of Gansu Province, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730000 Gansu People’s Republic of China
| | - Bin Geng
- Department of Orthopaedics, Orthopaedic Clinical Research Center of Gansu Province, Intelligent Orthopaedic Industry Technology Center of Gansu Province, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730000 Gansu People’s Republic of China
| | - Yayi Xia
- Department of Orthopaedics, Orthopaedic Clinical Research Center of Gansu Province, Intelligent Orthopaedic Industry Technology Center of Gansu Province, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730000 Gansu People’s Republic of China
| | - Meng Wu
- Department of Orthopaedics, Orthopaedic Clinical Research Center of Gansu Province, Intelligent Orthopaedic Industry Technology Center of Gansu Province, Lanzhou University Second Hospital, No. 82 Cuiyingmen, Chengguan District, Lanzhou, 730000 Gansu People’s Republic of China
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7
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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.
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8
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Devitt BM, Klemm HJ, Kirby J, Batty LM, Webster KE, Whitehead TS, Feller JA. Effect of Radiological Evidence of Kaplan Fiber Injury on the Clinical and Functional Outcomes After Acute Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2022; 50:3557-3564. [PMID: 36178144 DOI: 10.1177/03635465221124249] [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] [Indexed: 01/31/2023]
Abstract
BACKGROUND A paucity of information is available regarding the clinical outcomes of patients with radiological evidence of Kaplan fiber (KF) injury who undergo anterior cruciate ligament (ACL) reconstruction (ACLR). PURPOSE/HYPOTHESIS The purpose was to compare clinical and functional outcomes in patients undergoing acute primary ACLR with and without magnetic resonance imaging (MRI) evidence of KF injury. The hypothesis was that there would be no difference in clinical or functional outcomes in patients with versus those without radiological evidence of KF injury. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS MRI analysis was conducted on patients in a longitudinal prospective study of ACL injury. Only patients who had an MRI scan and had undergone isolated primary ACLR within 60 days of injury were included. MRI was performed using standard knee protocols, and diagnostic criteria were applied to identify KF injury. A total of 32 patients with KF injury (mean age, 24.2 years; 21 male, 11 female) were identified and matched for sex, age, graft type, and preinjury activity with 90 patients who had intact KF. Patients were followed up at 12 months with KT-1000 arthrometer measurements of side-to-side difference in anterior knee laxity, single- and triple-hop limb symmetry index (LSI), Marx activity and International Knee Documentation Committee (IKDC) scores, and return to sport (RTS) rates at 12 months and 24 months. RESULTS No differences were found in anterior knee laxity and single- and triple-hop LSI values between the KF-intact and KF-injured cohorts at 12 months. No differences in Marx and IKDC scores were found between the groups at 12 months and 2 years. The overall rate of RTS within 24 months was 75% (92/122), and 5 patients (2 KF-injured; 3 KF-intact) had a subsequent graft rupture. CONCLUSION We found no difference in clinical or functional outcomes in patients with and without radiological evidence of KF injury who underwent acute primary ACLR. Based on these findings, the radiological presence of KF injury at the time of acute ACL injury should not be regarded as a risk factor for a negative prognosis after ACLR.
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Affiliation(s)
- Brian M Devitt
- OrthoSport Victoria Research Unit, Richmond, Melbourne, Victoria, Australia.,School of Allied Health, La Trobe University, Melbourne, Victoria, Australia
| | - Haydn J Klemm
- OrthoSport Victoria Research Unit, Richmond, Melbourne, Victoria, Australia
| | - Julia Kirby
- OrthoSport Victoria Research Unit, Richmond, Melbourne, Victoria, Australia
| | - Lachlan M Batty
- OrthoSport Victoria Research Unit, Richmond, Melbourne, Victoria, Australia.,School of Allied Health, La Trobe University, Melbourne, Victoria, Australia
| | - Kate E Webster
- School of Allied Health, La Trobe University, Melbourne, Victoria, Australia
| | | | - Julian A Feller
- OrthoSport Victoria Research Unit, Richmond, Melbourne, Victoria, Australia.,School of Allied Health, La Trobe University, Melbourne, Victoria, Australia
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9
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Shi BY, Levine B, Ghazikhanian V, Bugarin A, Schroeder G, Wu S, Kremen T, Jones K. Reliability of MRI Detection of Kaplan Fiber Injury in Pediatric and Adolescent Patients with ACL Tears. Orthop J Sports Med 2022; 10:23259671221128601. [PMID: 36324697 PMCID: PMC9618750 DOI: 10.1177/23259671221128601] [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: 06/20/2022] [Accepted: 08/02/2022] [Indexed: 11/07/2022] Open
Abstract
Background: While studies have described Kaplan fiber (KF) injury in up to 60% of adults with anterior cruciate ligament (ACL) tears, the incidence of KF injury in the pediatric and adolescent population remains unknown. Purpose: To (1) determine the reliability of using magnetic resonance imaging (MRI) to identify KF injury in the pediatric and adolescent population and (2) define the incidence of KF injury in these patients with acute ACL injuries. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: The authors retrospectively identified patients ≤18 years of age who underwent ACL reconstruction for acute tears between 2013 and 2020. All preoperative MRI scans were reviewed independently and in a blinded fashion by 2 musculoskeletal radiologists, who noted the presence of the KF complex and any evidence of injury; interrater reliability was assessed. Patient characteristics, time from injury to MRI, laterality, and concomitant ligamentous or meniscal injuries were recorded, and associations between patient or injury characteristics and KF integrity on MRI were assessed. Results: In total, 51 patients (mean age, 14.9 years) met the inclusion criteria. Of these, 27 patients were female and 31 sustained an injury to the right knee. With respect to KF integrity, radiologist 1 visualized KF injury in 29% of patients, while radiologist 2 visualized KF injury in 35% of patients. In 12% of cases for radiologist 1 and 6% of cases for radiologist 2, KFs were unable to be visualized at all. The overall percentage agreement between the 2 radiologists was 76.5% with a kappa statistic of 0.57 (moderate agreement). There were no significant associations found between the presence of KF injury and patient age, sex, laterality, body mass index, concomitant ligamentous injury, or meniscal injury. However, visualization of KF injury on MRI was associated with a shorter time from index injury to MRI (15 days vs 23 days; P = .044). Conclusion: Approximately one-third of pediatric and adolescent patients who underwent ACL reconstruction were found to have KF injuries. Standard preoperative MRI scans can reliably be used to visualize KF injury in the majority of pediatric and adolescent patients with ACL tears, especially when the MRI is performed in the acute setting.
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Affiliation(s)
- Brendan Y. Shi
- Department of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, California, USA.,Brendan Y. Shi, MD, UCLA Health Orthopaedic Surgery Center, 1225 15th Street, Suite 2100, Santa Monica, CA 90404, USA ()
| | - Benjamin Levine
- Department of Diagnostic Radiology, University of California, Los Angeles, Los Angeles, California, USA
| | - Varand Ghazikhanian
- Department of Diagnostic Radiology, University of California, Los Angeles, Los Angeles, California, USA
| | - Amador Bugarin
- Department of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, California, USA
| | - Grant Schroeder
- Department of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, California, USA
| | - Shannon Wu
- Department of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, California, USA
| | - Thomas Kremen
- Department of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, California, USA
| | - Kristofer Jones
- Department of Orthopaedic Surgery, University of California, Los Angeles, Los Angeles, California, USA
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10
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Watanabe S, Nagai K, Hoshino Y, Kataoka K, Nakanishi Y, Araki D, Kanzaki N, Matsushita T, Kuroda R. Influence of Injury to the Kaplan Fibers of the Iliotibial Band on Anterolateral Rotatory Knee Laxity in Anterior Cruciate Ligament Injury: A Retrospective Cohort Study. Am J Sports Med 2022; 50:3265-3272. [PMID: 35993529 DOI: 10.1177/03635465221116097] [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] [Indexed: 01/31/2023]
Abstract
BACKGROUND Biomechanical cadaveric studies have shown that Kaplan fibers (KFs) of the iliotibial band play a role in controlling anterolateral rotatory knee laxity in anterior cruciate ligament (ACL) injury. However, in the clinical setting, the contribution of injury to KFs on anterolateral rotatory laxity remains unclear. PURPOSE To use magnetic resonance imaging (MRI) scans to detect concomitant KF injury in ACL-injured knees and to then examine the effect of KF injury on anterolateral rotatory laxity as measured by the pivot-shift test in a clinical setting. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS The study enrolled 91 patients with primary ACL tears (mean age 25 ± 11 years; 46 male and 45 female) whose MRI was conducted within 90 days after injury. KF injury was assessed by MRI according to previously reported criteria, and the patients were allocated to a KF injury group and a no-KF injury group. At the time of ACL reconstruction, the pivot-shift test was performed with the patient under anesthesia and quantitatively evaluated by tibial acceleration using an electromagnetic measurement system. Manual grading of the pivot-shift test was assessed according to guidelines of the International Knee Documentation Committee. The data were statistically compared between the 2 groups using Mann-Whitney U test and Fisher exact test (P < .05). RESULTS KFs were identified in 85 patients (93.4%), and KF injury was detected in 20 of the 85 patients (23.5%). No significant differences were observed between the KF injury group (n = 20) and the no-KF injury group (n = 65) in demographic characteristics, the period from injury to MRI (8.0 ± 14.0 days vs 8.9 ± 12.1 days, respectively), the rate of meniscal injury (50.0% vs 53.8%), or the rate of anterolateral ligament injury (45.0% vs 44.6%). Regarding the pivot-shift test, no significant differences were observed in tibial acceleration (1.2 m/s2 [interquartile range, 0.5-2.1 m/s2] vs 1.0 m/s2 [interquartile range, 0.6-1.7 m/s2], respectively) or manual grading between the 2 groups. CONCLUSION Concomitant KF injury did not significantly affect the pivot-shift phenomenon in acute ACL-injured knees. The findings suggest that the contribution of KF injury to anterolateral rotatory knee laxity may be limited in the clinical setting.
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Affiliation(s)
- Shu Watanabe
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kanto Nagai
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yuichi Hoshino
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kiminari Kataoka
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yuta Nakanishi
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Daisuke Araki
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Noriyuki Kanzaki
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takehiko Matsushita
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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11
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E. W, Yu Q, Guo H. Sports Medicine Image Modeling for Injury Prevention in Basketball Training. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:5742543. [PMID: 35992544 PMCID: PMC9356860 DOI: 10.1155/2022/5742543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 07/03/2022] [Accepted: 07/11/2022] [Indexed: 11/21/2022]
Abstract
In order to solve the problem of sports medical image in basketball training, a sports medical image modeling research method based on injury prevention in basketball training was proposed. By the method, the current situation of sports injury in university basketball was investigated. At the same time, the injury factors were analyzed on four occasions, including basketball class, extracurricular activities, competition, and training. In order to reduce the occurrence of injury and enhance the security of basketball sports for nonbasketball students of physical education, combined with the problems and reasons, the corresponding suggestions were put forward. Through the experiment, it was found that the incidence of basketball injury for nonbasketball male university students was as high as 90.7%. The results of the experiment showed that it was necessary to enhance the awareness of self-protection, control emotions and exhibitionism, strengthen physical training, attach importance to basic skills training, do warm-up activities, stay focused, pay attention to exercise load, and prevent excessive fatigue.
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Affiliation(s)
- Wenjie E.
- Physical Education College, Qiqihar University, Qiqihar 161006, Heilongjiang, China
| | - Qiufen Yu
- Physical Education College, Qiqihar University, Qiqihar 161006, Heilongjiang, China
| | - Han Guo
- Physical Education College, Qiqihar University, Qiqihar 161006, Heilongjiang, China
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Murgier J, Bayle-Iniguez X, Clatworthy M. The crevice sign: a new indicator of meniscal instability in ACL reconstructions. Knee Surg Sports Traumatol Arthrosc 2022; 30:1888-1892. [PMID: 34981160 DOI: 10.1007/s00167-021-06823-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 11/25/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE Meniscus preservation is key in knee surgery. The newly documented crevice sign indicates instability of the medial meniscus in ACL-deficient knees. Once the sign is visualised, it is imperative that the stability of the medial meniscus is assessed and potentially treated. It was hypothesized that there would be a strong correlation between the presence of an unstable medial meniscal tear in patients with the crevice sign in ACL-deficient knees. METHODS This was a multicenter prospective study carried out to evaluate the incidence of medial meniscal tears in patients with ACL-deficient knees and their correlation with a crevice sign. All patients (128) who had undergone ACL reconstruction between May 2020 and November 2020 were assessed arthroscopically for meniscal stability and divided in to two groups: stable (n = 84) and unstable (n = 44). Thereafter, the presence of the crevice sign was determined in each case. RESULTS The populations were comparable in terms of sex and age (Table 1). Fisher's exact test showed a significant association between the presence of the crevice sign and the instability of the medial meniscus (p < 0.001). Descriptive statistics suggest that the presence of crevice sign was associated more frequently to MM instability (38.6% vs 1.2%; p < 0.001). The specificity of this test was 98.8% and its sensitivity was 38.6%. The positive predictive value (PPV) was 94.4% and the negative predictive value (NPV) was 75.5%. Table 1 Descriptions and comparisons of internal meniscus instability of patients by presence of crevice sign Internal meniscus instability (N = 44) Internal meniscus stability (N = 84) Total (N = 128) Gender N 44 84 128 Male 33 (75.0) 58 (69.0) 91 (71.1) Female 11 (25.0) 26 (31.0) 37 (28.9) Fisher's exact test (n.s.) Age (years) N 44 84 128 Mean (ET) 28.6 (9.4) 30.1 (10.2) 29.6 (9.9) Median (IIQ) 26.5 (22.0;34.5) 27.0 (22.5;37.0) 27.0 (22.0;36.0) [Min-Max] [14-54] [14-52] [14-54] Wilcoxon test bilateral (n.s.) Crevice sign N 44 84 128 Absent 27 (61.4) 83 (98.8) 110 (85.9) Present 17 (38.6) 1 (1.2) 18 (14.1) Fisher's exact test p < 0.001 CONCLUSION: The hypothesis was confirmed since medial meniscal instability was strongly correlated with the existence of the crevice sign and showed high specificity and PPV. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Jérôme Murgier
- Clinique Aguiléra, Ramsay Santé, Service de chirurgie orthopédique, 21 rue de l'Estagnas, 64200, Biarritz, France.
- South France Knee Association, 66330, Cabestany, France.
| | - Xavier Bayle-Iniguez
- South France Knee Association, 66330, Cabestany, France
- Clinique Médipôle Saint-Roch, Elsan, Service de chirurgie orthopédique, 66330, Cabestany, France
| | - Mark Clatworthy
- Department of Orthopaedics, Middlemore Hospital, 100 Hospital Rd, Otahuhu, Auckland, 2025, New Zealand
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13
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Lynch TB, Bernot JM, Oettel DJ, Byerly D, Musahl V, Chasteen J, Antosh IJ, Patzkowski JC, Sheean AJ. Magnetic resonance imaging does not reliably detect Kaplan fiber injury in the setting of anterior cruciate ligament tear. Knee Surg Sports Traumatol Arthrosc 2022; 30:1769-1775. [PMID: 34522987 DOI: 10.1007/s00167-021-06730-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 08/30/2021] [Indexed: 01/24/2023]
Abstract
PURPOSE There has been a continued effort to better understand the role Kaplan fiber injury plays in persistent instability following ACL tears. However, the prevalence of these injuries remains poorly understood. Therefore, the purpose of this study was to define the prevalence of Kaplan fiber injury in the setting of complete anterior cruciate ligament tear using a commonly used grading system for assessing ligament injuries. The inter-rater reliability of this commonly used grading system and the relationship between Kaplan fiber injury and injury to other structures commonly found in conjunction with ACL tears was also evaluated. METHODS All isolated, complete anterior cruciate ligament tears confirmed on magnetic resonance imaging within 90 days of injury between 2014 and 2020 at a single institution were included for analysis. Each scan was read by two, fellowship-trained musculoskeletal radiologists. Kaplan fiber injury was evaluated using a previously described grading scheme. Kappa, [Formula: see text], of inter-rater agreement was determined for all magnetic resonance image scans. Kruskal Wallis test was performed to assess for associations between Kaplan fiber injury and magnet strength (1.5 T vs. 3.0 T), patient gender, the presence of medial and/or lateral meniscal tears, and/or posterolateral tibial bone bruise. RESULTS Between 2014 and 2020, 131 patients (94 males, 37 females) with a complete anterior cruciate ligament tear were included in the final analysis. The mean age of the cohort was 27.8 ± 6.8 years. Kaplan fiber injuries were identified in 51 of 131 (38.9%, CI 31.0-47.5%) scans with complete anterior cruciate ligament injuries (Grade 1: 28, Grade 2: 18, and Grade 3: 5). Inter-rater agreement for Kaplan fiber injury was fair ([Formula: see text] with 43 (32.8%) scans requiring third reviewer adjudication. There were no significant associations between Kaplan fiber injury and gender, magnet strength, meniscal tears, or posterolateral tibial bone bruise. CONCLUSION The prevalence of Kaplan fiber injuries was comparable to previously described rates; however, the classification system used to report Kaplan fiber injury was associated with low inter-rater reliability. The presence of Kaplan fiber injury was not associated with other injuries commonly observed in conjunction with ACL tear. The previously proposed Kaplan fiber injury classification system is not reproducible nor is it likely to aid surgeons in distinguishing higher grades of rotatory knee instability. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Thomas B Lynch
- San Antonio Military Medical Center, 3551 Roger Brooke Road, San Antonio, TX, 78234, USA.
| | - Jeremy M Bernot
- San Antonio Military Medical Center, 3551 Roger Brooke Road, San Antonio, TX, 78234, USA
| | - David J Oettel
- San Antonio Military Medical Center, 3551 Roger Brooke Road, San Antonio, TX, 78234, USA
| | - Douglas Byerly
- San Antonio Military Medical Center, 3551 Roger Brooke Road, San Antonio, TX, 78234, USA
| | | | | | - Ivan J Antosh
- San Antonio Military Medical Center, 3551 Roger Brooke Road, San Antonio, TX, 78234, USA
| | - Jeanne C Patzkowski
- San Antonio Military Medical Center, 3551 Roger Brooke Road, San Antonio, TX, 78234, USA
| | - Andrew J Sheean
- San Antonio Military Medical Center, 3551 Roger Brooke Road, San Antonio, TX, 78234, USA
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14
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Devitt BM, Batty LM. High Rate of Initially Overlooked Kaplan Fiber Complex Injuries in Patients With Isolated Anterior Cruciate Ligament Injury: Letter to the Editor. Am J Sports Med 2022; 50:NP1-NP3. [PMID: 34984954 DOI: 10.1177/03635465211049385] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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15
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Anterolateral complex injuries occur in the majority of 'isolated' anterior cruciate ligament ruptures. Knee Surg Sports Traumatol Arthrosc 2022; 30:176-183. [PMID: 33796903 DOI: 10.1007/s00167-021-06543-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/18/2021] [Indexed: 01/11/2023]
Abstract
PURPOSE The anterolateral soft tissue envelope of the knee is frequently injured at the time of ACL rupture. This study aims to investigate the MRI injury patterns to the Anterolateral complex and their associations in patients with acute 'isolated ligament' ACL ruptures. METHODS Professional athletes who underwent ACL reconstruction for complete ACL rupture between 2015 and 2019 were included in this study. Patients' characteristics and intraoperative findings were retrieved from clinical and surgical documentation. Preoperative MRIs were evaluated and the injuries to respective structures of the Anterolateral complex and their associations were recorded. RESULTS Anterolateral complex injuries were noted in 63% of cases. The majority of injuries were to Kaplan Fibre (39% isolated injury and 19% combined with Anterolateral ligament injury). There was a very low incidence of isolated Anterolateral ligament injuries (2%). Kaplan Fibre injuries are associated with the presence of lateral femoral condyle bone oedema, and injuries to the superficial MCL, deep MCL, and ramp lesions. High grade pivot shift test was not associated with the presence of Kaplan Fibre or Anterolateral ligament injuries. Patients with an intact Anterolateral complex sustained injury to other knee structures (13% to medial ligament complex, 14% to medial meniscus, and 16% to lateral meniscus). CONCLUSION There is a high incidence of concomitant Anterolateral complex injuries in combination with ACL ruptures, with Kaplan Fibre (and therefore the deep capsulo-osseous layer of the iliotibial band) being the most commonly injured structure. Anterolateral ligament injuries occur much less frequently. These findings reinforce the importance of considering the presence of, and if necessary, treating injuries to structures other than the ACL, as a truly isolated ACL injury is rare.
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16
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Berthold DP, Willinger L, LeVasseur MR, Marrero DE, Bell R, Muench LN, Zenon K, Imhoff AB, Herbst E, Cote MP, Arciero RA, Edgar CM. High Rate of Initially Overlooked Kaplan Fiber Complex Injuries in Patients With Isolated Anterior Cruciate Ligament Injury: Response. Am J Sports Med 2022; 50:NP3-NP5. [PMID: 34984957 DOI: 10.1177/03635465211049388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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17
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Berthold DP, Willinger L, LeVasseur MR, Marrero DE, Bell R, Muench LN, Kane Z, Imhoff AB, Herbst E, Cote MP, Arciero RA, Edgar CM. High Rate of Initially Overlooked Kaplan Fiber Complex Injuries in Patients With Isolated Anterior Cruciate Ligament Injury. Am J Sports Med 2021; 49:2117-2124. [PMID: 34086492 PMCID: PMC8246408 DOI: 10.1177/03635465211015682] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Injuries to the Kaplan fiber complex (KFC) are not routinely assessed for in the anterior cruciate ligament (ACL)-deficient knee during preoperative magnetic resonance imaging (MRI). As injuries to the KFC lead to anterolateral rotatory instability (ALRI) in the ACL-deficient knee, preoperative detection of these injuries on MRI scans may help surgeons to individualize treatment and improve outcomes, as well as to reduce failure rates. PURPOSE To retrospectively determine the rate of initially overlooked KFC injuries on routine MRI in knees with isolated primary ACL deficiency. STUDY DESIGN Case series; Level of evidence, 4. METHODS Patients who underwent isolated ACL reconstruction between August 2013 and December 2019 were identified. No patient had had Kaplan fiber (KF) injury identified on the initial reading of the MRI scan or at the time of surgery. Preoperative knee MRI scans (minimum 1.5 T) were reviewed and injuries to the proximal and distal KFs were recorded by 3 independent reviewers. KF length and distance to nearby anatomic landmarks (the lateral joint line and the lateral femoral epicondyle) were measured. Additional radiological findings, including bleeding, lateral femoral notch sign, and bone marrow edema (BME), were identified to detect correlations with KFC injury. RESULTS The intact KFC could reliably be identified by all 3 reviewers (85.9% agreement; Kappa, 0.716). Also, 53% to 56% of the patients with initially diagnosed isolated ACL ruptures showed initially overlooked injuries to the KFC. Injuries to the distal KFs were more frequent (48.1%, 53.8%, and 43.3% by the first, second, and third reviewers, respectively) than injuries to the proximal KFs (35.6%, 47.1%, and 45.2% by the first, second, and third reviewers, respectively). Bleeding in the lateral supracondylar region was associated with KFC injuries (P = .023). Additionally, there was a positive correlation between distal KF injuries and lateral tibial plateau BME (P = .035), but no associations were found with the lateral femoral notch sign or other patterns of BME, including pivot-shift BME. CONCLUSION KF integrity and injury can be reliably detected on routine knee MRI scans. Also, 53% to 56% of the patients presenting with initially diagnosed isolated ACL ruptures had concomitant injuries to the KFC. This is of clinical relevance, as ACL injuries diagnosed by current routine MRI examination protocols may come with a high number of occult or hidden KFC injuries. As injuries to the KFC contribute to persistent ALRI, which may influence ACL graft failure or reoperation rates, significant improvements in preoperative diagnostic imaging are required to determine the exact injury pattern and to assist in surgical decision making.
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Affiliation(s)
- Daniel P. Berthold
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA,Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany,Daniel P. Berthold, MD, Ismaninger Str. 22, 81675 Munich, Germany ()
| | - Lukas Willinger
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Matthew R. LeVasseur
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - Daniel E. Marrero
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - Ryan Bell
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - Lukas N. Muench
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - Zenon Kane
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Andreas B. Imhoff
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Elmar Herbst
- Department of Trauma, Hand and Reconstructive Surgery University Hospital, Münster, Germany
| | - Mark P. Cote
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Robert A. Arciero
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
| | - Cory M. Edgar
- Department of Orthopaedic Surgery, University of Connecticut, Farmington, Connecticut, USA
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18
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Batty LM, Firth A, Moatshe G, Bryant DM, Heard M, McCormack RG, Rezansoff A, Peterson DC, Bardana D, MacDonald PB, Verdonk PCM, Spalding T, Getgood AMJ, Willits K, Birmingham T, Hewison C, Wanlin S, Firth A, Pinto R, Martindale A, O'Neill L, Jennings M, Daniluk M, Boyer D, Zomar M, Moon K, Pritchett R, Payne K, Fan B, Mohan B, Buchko GM, Hiemstra LA, Kerslake S, Tynedal J, Stranges G, Mcrae S, Gullett L, Brown H, Legary A, Longo A, Christian M, Ferguson C, Mohtadi N, Barber R, Chan D, Campbell C, Garven A, Pulsifer K, Mayer M, Simunovic N, Duong A, Robinson D, Levy D, Skelly M, Shanmugaraj A, Howells F, Tough M, Thompson P, Metcalfe A, Asplin L, Dube A, Clarkson L, Brown J, Bolsover A, Bradshaw C, Belgrove L, Millan F, Turner S, Verdugo S, Lowe J, Dunne D, McGowan K, Suddens CM, Declercq G, Vuylsteke K, Van Haver M. Association of Ligamentous Laxity, Male Sex, Chronicity, Meniscal Injury, and Posterior Tibial Slope With a High-Grade Preoperative Pivot Shift: A Post Hoc Analysis of the STABILITY Study. Orthop J Sports Med 2021; 9:23259671211000038. [PMID: 33889648 PMCID: PMC8033400 DOI: 10.1177/23259671211000038] [Citation(s) in RCA: 6] [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: 01/21/2023] Open
Abstract
Background: A spectrum of anterolateral rotatory laxity exists in anterior cruciate
ligament (ACL)–injured knees. Understanding of the factors contributing to a
high-grade pivot shift continues to be refined. Purpose: To investigate factors associated with a high-grade preoperative pivot shift
and to evaluate the relationship between this condition and baseline
patient-reported outcome measures (PROMs). Study Design: Cross-sectional study; Level of evidence, 3. Methods: A post hoc analysis was performed of 618 patients with ACL deficiency deemed
high risk for reinjury. A binary logistic regression model was developed,
with high-grade pivot shift as the dependent variable. Age, sex, Beighton
score, chronicity of the ACL injury, posterior third medial or lateral
meniscal injury, and tibial slope were selected as independent variables.
The importance of knee hyperextension as a component of the Beighton score
was assessed using receiver operator characteristic curves. Baseline PROMs
were compared between patients with and without a high-grade pivot. Results: Six factors were associated with a high-grade pivot shift: Beighton score
(each additional point; odds ratio [OR], 1.17; 95% CI, 1.06-1.30;
P = .002), male sex (OR, 2.30; 95% CI, 1.28-4.13;
P = .005), presence of a posterior third medial (OR,
2.55; 95% CI, 1.11-5.84; P = .03) or lateral (OR, 1.76; 95%
CI, 1.01-3.08; P = .048) meniscal injury, tibial slope
>9° (OR, 2.35; 95% CI, 1.09-5.07; P = .03), and
chronicity >6 months (OR, 1.70; 95% CI, 1.00-2.88; P =
.049). The presence of knee hyperextension improved the diagnostic utility
of the Beighton score as a predictor of a high-grade pivot shift. Tibial
slope <9° was associated with only a high-grade pivot in the presence of
a posterior third medial meniscal injury. Patients with a high-grade pivot
shift had higher baseline 4-Item Pain Intensity Measure scores than did
those without a high-grade pivot shift (mean ± SD, 11 ± 13 vs 8 ± 14;
P = .04); however, there was no difference between
groups in baseline International Knee Documentation Committee, ACL Quality
of Life, Knee injury and Osteoarthritis Outcome Score, or Knee injury and
Osteoarthritis Outcome Score subscale scores. Conclusion: Ligamentous laxity, male sex, posterior third medial or lateral meniscal
injury, increased posterior tibial slope, and chronicity were associated
with a high-grade pivot shift in this population deemed high risk for repeat
ACL injury. The effect of tibial slope may be accentuated by the presence of
meniscal injury, supporting the need for meniscal preservation. Baseline
PROMs were similar between patients with and without a high-grade pivot
shift.
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Affiliation(s)
- Lachlan M Batty
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Andrew Firth
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Gilbert Moatshe
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Dianne M Bryant
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Mark Heard
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Robert G McCormack
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Alex Rezansoff
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Devin C Peterson
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Davide Bardana
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Peter B MacDonald
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Peter C M Verdonk
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Tim Spalding
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Alan M J Getgood
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | | | - Kevin Willits
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Trevor Birmingham
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Chris Hewison
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Stacey Wanlin
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Andrew Firth
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Ryan Pinto
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Ashley Martindale
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Lindsey O'Neill
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Morgan Jennings
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Michal Daniluk
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Dory Boyer
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Mauri Zomar
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Karyn Moon
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Raely Pritchett
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Krystan Payne
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Brenda Fan
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Bindu Mohan
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Gregory M Buchko
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Laurie A Hiemstra
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Sarah Kerslake
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Jeremy Tynedal
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Greg Stranges
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Sheila Mcrae
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - LeeAnne Gullett
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Holly Brown
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Alexandra Legary
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Alison Longo
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Mat Christian
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Celeste Ferguson
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Nick Mohtadi
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Rhamona Barber
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Denise Chan
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Caitlin Campbell
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Alexandra Garven
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Karen Pulsifer
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Michelle Mayer
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Nicole Simunovic
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Andrew Duong
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - David Robinson
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - David Levy
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Matt Skelly
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Ajaykumar Shanmugaraj
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Fiona Howells
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Murray Tough
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Pete Thompson
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Andrew Metcalfe
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Laura Asplin
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Alisen Dube
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Louise Clarkson
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Jaclyn Brown
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Alison Bolsover
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Carolyn Bradshaw
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Larissa Belgrove
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Francis Millan
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Sylvia Turner
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Sarah Verdugo
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Janet Lowe
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Debra Dunne
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Kerri McGowan
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Charlie-Marie Suddens
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Geert Declercq
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Kristien Vuylsteke
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
| | - Mieke Van Haver
- Investigation performed at the Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
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19
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Devitt BM, Al'khafaji I, Blucher N, Batty LM, Murgier J, Webster KE, Feller JA. Association Between Radiological Evidence of Kaplan Fiber Injury, Intraoperative Findings, and Pivot-Shift Grade in the Setting of Acute Anterior Cruciate Ligament Injury. Am J Sports Med 2021; 49:1262-1269. [PMID: 33719594 DOI: 10.1177/0363546521994467] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Biomechanical studies have suggested that the Kaplan fibers (KFs) of the iliotibial band play a role in controlling anterolateral rotation of the knee. There is a paucity of clinical information on whether injury to the KF in the setting of anterior cruciate ligament (ACL) rupture contributes to increased rotatory laxity of the knee. PURPOSE/HYPOTHESIS The purpose was to evaluate the association among radiological evidence of KF injury, intraoperative arthroscopic findings, and grade of pivot shift at the time of ACL reconstruction (ACLR). It was hypothesized that KF injury would be associated with increased injury to the lateral compartment of the knee and a higher grade of pivot shift. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A retrospective magnetic resonance imaging (MRI) analysis was conducted on 267 patients with ACL-injured knees who underwent primary ACLR. Patients who had MRI and surgery within 60 days of injury were included (mean age, 23.6 years); there were 158 (59.2%) male patients. MRI was performed using standard knee protocols, and diagnostic criteria were applied to identify KF injury. Associations were made among MRI findings, intraoperative findings, and grade of pivot shift with the patient examined under anesthesia at the time of ACLR. A comparison was made between patients with and without radiological evidence of KF injury. RESULTS The prevalence of KF injury was 17.6% (47/267 patients). Arthroscopic evidence of lateral meniscal injury was associated with KF injury (KF intact, 31%; KF injured, 55%; P = .010). The majority of patients in the intact and injured KF groups had a grade 2 pivot shift (75% and 70%, respectively). A minority had grade 3 pivot shift: 5% in the intact group versus 6.4% in the injured group. There was no association between radiological evidence of KF injury and pivot-shift grade (P = .600). CONCLUSION In acute ACL injury, KF injuries were not very common (17.6%), and the rate of grade 3 pivot shift was low (5.2%). When present, KF injuries were not associated with a higher-grade pivot shift. However, there was an association between KF injury and lateral meniscal tears identified at the time of ACLR. The role of KFS in controlling anterolateral rotatory laxity in the acute ACL injury in the clinical setting may be less evident when compared with the biomechanical setting.
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Affiliation(s)
- Brian M Devitt
- OrthoSport Victoria, Richmond, Australia.,School of Allied Health, Human Services and Sport, LaTrobe University, Melbourne, Australia
| | | | | | | | | | - Kate E Webster
- School of Allied Health, Human Services and Sport, LaTrobe University, Melbourne, Australia
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