1
|
Siboni R, Pioger C, Mouton C, Seil R. The posterior cruciate ligament-posterior femoral cortex angle: a reliable and accurate MRI method to quantify the buckling phenomenon of the PCL in ACL-deficient knees. Knee Surg Sports Traumatol Arthrosc 2023; 31:332-339. [PMID: 36057669 DOI: 10.1007/s00167-022-07145-6] [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: 07/31/2022] [Accepted: 08/26/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE The aim was to validate a new MRI method to measure the buckling phenomenon of the PCL, representative of anterior tibial translation, by comparing its reliability and accuracy to identify anterior cruciate ligament (ACL)-deficient knees with existing methods. METHODS Patients were selected retrospectively and separated into a group of primary ACL injuries and ACL-intact knees. Exclusion criteria were: skeletal immaturity, PCL or a concomitant collateral ligament injury, signs of osteoarthritis (> 1 Kellgren and Lawrence score), tibial plateau fracture, previous ACL reconstruction or displaced meniscal bucket handle tear. The assessment of the curvature of the anterolateral bundle of the PCL was performed on T2 sagittal MRI slices according to 3 methods: (1) the PCL angle (PCLA), (2) the PCL inclination angle (PCLIA) and (3) a new method: the PCL-posterior cortex angle (PCL-PCA), representing the angle between the vertical part of the PCL-ALB and the posterior diaphyseal cortex of the femur. For each method, the inter- and intra-observer reliability was measured. The ability to discriminate both ACL-deficient and ACL-intact knees was evaluated using ROC curves. RESULTS Twenty-four patients were included in each group. Intra-observer reliability was excellent for all 3 methods (ICCs > 0.90). Inter-observer reliability was excellent for the PCL-PCA (ICC > 0.90) and good for the PCLA and the PCLIA (ICCs between 0.75 and 0.90). The PCL-PCA had the highest precision (lowest standard error of measurement: 2.7°). It yielded an excellent discrimination between the ACL and CTL groups (AUC 0.80 [0.67-0.93]) with the highest sensitivity (71% [52.8-89.2]) and specificity (88% [75-100]) for a positive threshold when the angle was ≤ 22.7°. The PCLA and PCLIA methods led to acceptable discrimination and lower sensitivities and specificities (PCLA: AUC 0.71, sensitivity 63%, specificity 79%, threshold ≤ 117.9°; PCLIA: AUC 0.62, sensitivity 50%, specificity 83%, threshold ≤ 21.4°). CONCLUSION In comparison with previously described methods, the PCL-PCA was the most reliable and accurate method to measure the PCL buckling phenomenon on MRI in anterior cruciate ligament (ACL)-deficient knees. It offers an easy and objective method for the follow-up of ACL-injured patients and can therefore be recommended for routine use. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Renaud Siboni
- Department of Orthopaedic Surgery, Centre Hospitalier Luxembourg-Clinique d'Eich, 78 Rue d'Eich, 1460, Luxembourg, Luxembourg.,Department of Orthopaedic Surgery, Reims Teaching Hospital, Hôpital Maison Blanche, 45 Rue Cognacq-Jay, 51092, Reims, France
| | - Charles Pioger
- Department of Orthopaedic Surgery, Centre Hospitalier Luxembourg-Clinique d'Eich, 78 Rue d'Eich, 1460, Luxembourg, Luxembourg.,Department of Orthopaedic Surgery, Ambroise Paré Hospital, Paris Saclay University, 9, avenue Charles de Gaulle, 92100, Boulogne-Billancourt, France
| | - Caroline Mouton
- Department of Orthopaedic Surgery, Centre Hospitalier Luxembourg-Clinique d'Eich, 78 Rue d'Eich, 1460, Luxembourg, Luxembourg.,Luxembourg Institute of Research in Orthopaedics, Sports Medicine and Science, Luxembourg, Luxembourg
| | - Romain Seil
- Department of Orthopaedic Surgery, Centre Hospitalier Luxembourg-Clinique d'Eich, 78 Rue d'Eich, 1460, Luxembourg, Luxembourg. .,Luxembourg Institute of Research in Orthopaedics, Sports Medicine and Science, Luxembourg, Luxembourg. .,Human Motion, Orthopaedics, Sports Medicine and Digital Methods, Luxembourg, Luxembourg.
| |
Collapse
|
2
|
Kim DH, Chai JW, Kang JH, Lee JH, Kim HJ, Seo J, Choi JW. Ensemble deep learning model for predicting anterior cruciate ligament tear from lateral knee radiograph. Skeletal Radiol 2022; 51:2269-2279. [PMID: 35792956 DOI: 10.1007/s00256-022-04081-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/24/2022] [Accepted: 05/24/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To develop an ensemble deep learning model (DLM) predicting anterior cruciate ligament (ACL) tears from lateral knee radiographs and to evaluate its diagnostic performance. MATERIALS AND METHODS In this study, 1433 lateral knee radiographs (661 with ACL tear confirmed on MRI, 772 normal) from two medical centers were split into training (n = 1146) and test sets (n = 287). Three single DLMs respectively classifying radiographs with ACL tears, abnormal lateral femoral notches, and joint effusion were developed. An ensemble DLM predicting ACL tears was developed by combining the three DLMs via stacking method. The sensitivities, specificities, and area under the receiver operating characteristic curves (AUCs) of the DLMs and three radiologists were compared using McNemar test and Delong test. Subgroup analysis was performed to identify the radiologic features associated with the sensitivity. RESULTS The sensitivity, specificity, and AUC of the ensemble DLM were 86.8% (95% confidence interval [CI], 79.9-92.0%), 89.4% (95% CI, 83.4-93.8%), and 0.927 (95% CI, 0.891-0.954), achieving diagnostic performance comparable with that of a musculoskeletal radiologist (P = 0.193, McNemar test; P = 0.131, Delong test). The AUC of the ensemble DLM was significantly higher than those of non-musculoskeletal radiologists (P = 0.043, P < 0.001). The sensitivity of the DLM was higher than that of the radiologists in the absence of an abnormal lateral femoral notch or joint effusion. CONCLUSION The diagnostic performance of the ensemble DLM in predicting lateral knee radiographs with ACL tears was comparable to that of a musculoskeletal radiologist.
Collapse
Affiliation(s)
- Dong Hyun Kim
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jee Won Chai
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ji Hee Kang
- Department of Radiology, Konkuk University Medical Center, 120-1 Neungdong-ro, Gwangjin-gu, Seoul, 05030, Republic of Korea.
| | - Ji Hyun Lee
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyo Jin Kim
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jiwoon Seo
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jae Won Choi
- Armed Forces Yangju Hospital, Yangju, Republic of Korea.,Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| |
Collapse
|
3
|
Seeing Beyond Morphology-Standardized Stress MRI to Assess Human Knee Joint Instability. Diagnostics (Basel) 2021; 11:diagnostics11061035. [PMID: 34199917 PMCID: PMC8226919 DOI: 10.3390/diagnostics11061035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 05/25/2021] [Accepted: 06/01/2021] [Indexed: 12/28/2022] Open
Abstract
While providing the reference imaging modality for joint pathologies, MRI is focused on morphology and static configurations, thereby not fully exploiting the modality’s diagnostic capabilities. This study aimed to assess the diagnostic value of stress MRI combining imaging and loading in differentiating partial versus complete anterior cruciate ligament (ACL)-injury. Ten human cadaveric knee joint specimens were subjected to serial imaging using a 3.0T MRI scanner and a custom-made pressure-controlled loading device. Emulating the anterior-drawer test, joints were imaged before and after arthroscopic partial and complete ACL transection in the unloaded and loaded configurations using morphologic sequences. Following manual segmentations and registration of anatomic landmarks, two 3D vectors were computed between anatomic landmarks and registered coordinates. Loading-induced changes were quantified as vector lengths, angles, and projections on the x-, y-, and z-axis, related to the intact unloaded configuration, and referenced to manual measurements. Vector lengths and projections significantly increased with loading and increasing ACL injury and indicated multidimensional changes. Manual measurements confirmed gradually increasing anterior tibial translation. Beyond imaging of ligament structure and functionality, stress MRI techniques can quantify joint stability to differentiate partial and complete ACL injury and, possibly, compare surgical procedures and monitor treatment outcomes.
Collapse
|
4
|
Ishibashi Y, Adachi N, Koga H, Kondo E, Kuroda R, Mae T, Uchio Y. Japanese Orthopaedic Association (JOA) clinical practice guidelines on the management of anterior cruciate ligament injury - Secondary publication. J Orthop Sci 2020; 25:6-45. [PMID: 31843222 DOI: 10.1016/j.jos.2019.10.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 10/12/2019] [Accepted: 10/16/2019] [Indexed: 02/09/2023]
Abstract
BACKGROUND This clinical guideline presents recommendations for the management of patients with anterior cruciate ligament (ACL) injury, endorsed by the Japanese Orthopaedic Association (JOA) and Japanese Orthopaedic Society of Knee, Arthroscopy and Sports Medicine (JOSKAS). METHODS The JOA ACL guideline committee revised the previous guideline based on "Medical Information Network Distribution Service Handbook for Clinical Practice Guideline Development 2014", which proposed a desirable method for preparing clinical guidelines in Japan. Furthermore, the importance of "the balance of benefit and harm" was also emphasized. This guideline consists of 21 clinical questions (CQ) and 23 background questions (BQ). For each CQ, outcomes from the literature were collected and evaluated systematically according to the adopted study design. RESULTS We evaluated the objectives and results of each study in order to make a decision on the level of evidence so as to integrate the results with our recommendations for each CQ. For BQ, the guideline committee proposed recommendations based on the literature. CONCLUSIONS This guideline is intended to be used by physicians, orthopedic surgeons, physical therapists, and athletic trainers managing ACL injuries. We hope that this guideline is useful for appropriate decision-making and improved management of ACL injuries.
Collapse
Affiliation(s)
- Yasuyuki Ishibashi
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Japan.
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
| | - Hideyuki Koga
- Department of Joint Surgery and Sports Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan
| | - Eiji Kondo
- Centre for Sports Medicine, Hokkaido University Hospital, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Japan
| | - Tatsuo Mae
- Department of Sports Medical Biomechanics, Osaka University Graduate School of Medicine, Japan
| | - Yuji Uchio
- Department of Orthopaedic Surgery, Shimane University School of Medicine, Japan
| |
Collapse
|
5
|
Bone bruise in anterior cruciate ligament rupture entails a more severe joint damage affecting joint degenerative progression. Knee Surg Sports Traumatol Arthrosc 2019; 27:44-59. [PMID: 29869683 PMCID: PMC6510815 DOI: 10.1007/s00167-018-4993-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 05/30/2018] [Indexed: 01/13/2023]
Abstract
PURPOSE During anterior cruciate ligament (ACL) injury, the large external forces responsible for ligament rupture cause a violent impact between tibial and femoral articular cartilage, which is transferred to bone resulting in bone bruise detectable at MRI. Several aspects remain controversial and await evidence on how this MRI finding should be managed while addressing the ligament lesion. Thus, the aim of the present review was to document the evidence of all available literature on the role of bone bruise associated with ACL lesions. METHODS A systematic review of the literature was performed on bone bruise associated with ACL injury. The search was conducted in September 2017 on three medical electronic databases: PubMed, Web of Science, and the Cochrane Collaboration. Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were used. Relevant articles were studied to investigate three main aspects: prevalence and progression of bone bruise associated with ACL lesions, its impact on the knee in terms of lesion severity and joint degeneration progression over time and, finally, the influence of bone bruise on patient prognosis in terms of clinical outcome. RESULTS The search identified 415 records and, after an initial screening according to the inclusion/exclusion criteria, 83 papers were used for analysis, involving a total of 10,047 patients. Bone bruise has a high prevalence (78% in the most recent papers), with distinct patterns related to the mechanism of injury. This MRI finding is detectable only in a minority of cases the first few months after trauma, but its presence and persistence have been correlated to a more severe joint damage that may affect the degenerative progression of the entire joint, with recent evidence suggesting possible effects on long-term clinical outcome. CONCLUSION This systematic review of the literature documented a growing interest on bone bruise associated with ACL injury, highlighting aspects which could provide to orthopaedic surgeons evidence-based suggestions in terms of clinical relevance when dealing with patients affected by bone bruise following ACL injury. However, prospective long-term studies are needed to better understand the natural history of bone bruise, identifying prognostic factors and targets of specific treatments that should be developed in light of the overall joint derangements accompanying ACL lesions. LEVELS OF EVIDENCE IV, Systematic review of level I-IV studies.
Collapse
|
6
|
Kim HJ, Lee JH, Ahn SE, Park MJ, Lee DH. Influence of Anterior Cruciate Ligament Tear on Thigh Muscle Strength and Hamstring-to-Quadriceps Ratio: A Meta-Analysis. PLoS One 2016; 11:e0146234. [PMID: 26745808 PMCID: PMC4706431 DOI: 10.1371/journal.pone.0146234] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 12/15/2015] [Indexed: 01/11/2023] Open
Abstract
Theoretical compensation after anterior cruciate ligament (ACL) tear could cause quadriceps weakness and hamstring activation, preventing anterior tibial subluxation and affecting the expected hamstring-to-quadriceps ratio. Although quadriceps weakness often occurs after ACL tears, it remains unclear whether hamstring strength and hamstring-to-quadriceps ratio increase in ACL deficient knees. This meta-analysis compared the isokinetic muscle strength of quadriceps and hamstring muscles, and the hamstring-to-quadriceps ratio, of the injured and injured limbs of patients with ACL tears. This meta-analysis included all studies comparing isokinetic thigh muscle strengths and hamstring-to-quadriceps ratio in the injured and uninjured legs of patients with ACL tear, without or before surgery. Thirteen studies were included in the meta-analysis. Quadriceps and hamstring strengths were 22.3 N∙m (95% CI: 15.2 to 29.3 N∙m; P<0.001) and 7.4 N∙m (95% CI: 4.3 to 10.5 N∙m; P<0.001) lower, respectively, on the injured than on the uninjured side. The mean hamstring-to-quadriceps ratio was 4% greater in ACL deficient than in uninjured limbs (95% CI: 1.7% to 6.3%; P<0.001). Conclusively, Decreases were observed in both the quadriceps and hamstring muscles of patients with ACL tear, with the decrease in quadriceps strength being 3-fold greater. These uneven reductions slightly increase the hamstring-to-quadriceps ratio in ACL deficient knees.
Collapse
Affiliation(s)
- Hyun-Jung Kim
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, Korea
| | - Jin-Hyuck Lee
- Department of Sports Medical Center, Korea University College of Medicine, Seoul, Korea
| | - Sung-Eun Ahn
- Department of Sports Medical Center, Korea University College of Medicine, Seoul, Korea
| | - Min-Ji Park
- Department of Sports Medical Center, Korea University College of Medicine, Seoul, Korea
| | - Dae-Hee Lee
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- * E-mail:
| |
Collapse
|
7
|
Lee DH, Lee JH, Ahn SE, Park MJ. Effect of Time after Anterior Cruciate Ligament Tears on Proprioception and Postural Stability. PLoS One 2015; 10:e0139038. [PMID: 26422800 PMCID: PMC4589391 DOI: 10.1371/journal.pone.0139038] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Accepted: 09/07/2015] [Indexed: 11/21/2022] Open
Abstract
This study was designed to compare proprioception and postural stability in patients with acute (time from injury ≤ 3 months) and chronic (time from injury > 3 months) ACL tears, and to evaluate the correlation between time interval after ACL injury and proprioception. Thigh muscle strength, postural stability, and joint position sense were compared in 48 patients with acute ACL tears and in 28 with chronic ACL tears. Maximal torque (60°/sec) of the quadriceps and hamstring was evaluated using an isokinetic testing device. Postural stability was determined from the anterior-posterior (APSI), medial-lateral (MLSI), and overall (OSI) stability indices using stabilometry. Joint position sense was also tested by reproduction of passive positioning (RPP). Muscle strengths and stability indices on both the involved and uninvolved sides were similar in the acute and chronic ACL tear groups. RPP on the involved side was significantly greater in the chronic than in the acute ACL tear group (7.8° vs. 5.6°, P = 0.041). Two of three stability indices (APSI, OSI) and RPP were significantly greater on the involved than the uninvolved side in the chronic ACL tear group.
Collapse
Affiliation(s)
- Dae-Hee Lee
- Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- * E-mail:
| | - Jin-Hyuck Lee
- Department of Sports Medical Center, Korea University College of Medicine, Anam Hospital, Seoul, Korea
| | - Sung-Eun Ahn
- Department of Sports Medical Center, Korea University College of Medicine, Anam Hospital, Seoul, Korea
| | - Min-Ji Park
- Department of Sports Medical Center, Korea University College of Medicine, Anam Hospital, Seoul, Korea
| |
Collapse
|