1
|
Chen C, Liu X, Wu P, Liang Q, Peng S, Hu P, Liao Y. High-resolution oblique coronal MRI at optimal flexed-knee angle: a novel imaging method for enhanced anterior cruciate ligament tear diagnosis. J Orthop Surg Res 2024; 19:456. [PMID: 39090629 PMCID: PMC11293168 DOI: 10.1186/s13018-024-04956-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Accepted: 07/28/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND The accuracy of traditional knee MR imaging in diagnosing anterior cruciate ligament tears, especially partial tears, is relatively low, which may lead to misdiagnosis and missed diagnosis. This study aimed to assess the diagnostic performance of a novel imaging method, high-resolution oblique coronal MRI at an optimal flexed-knee Angle, for ACL tears. METHODS 50 healthy volunteers were scanned with a scan-assisted device for the optimal flexion angle of ACL. For 92 knee trauma patients selected strictly according to inclusion and exclusion criteria, conventional extended-knee scans (control group) and high-resolution oblique coronal scans based on the optimal flexed-knee angle (experimental group) were conducted. Two observers rated ACL visibility blindly on a 5-point scale. Arthroscopy-defined outcomes determined diagnostic metrics for each method and sensitivity, specificity, positive predictive value, negative predictive value and accuracy were calculated. RESULTS The average optimal flexion angle for healthy volunteers was approximately 30° (30.3° ± 5.0°). Imaging demonstrated complete visualization of the ACL in 96.7% of images in the experimental group versus 12.0% in the control group. The diagnostic indicators of the experimental group surpassed those of the control group: sensitivity (94.9% vs. 76.3%), specificity (97.0% vs. 81.8%), positive predictive value (98.2% vs. 88.2%), negative predictive value(91.4% vs. 65.9%), and accuracy (95.7% vs. 78.3%). ROC analysis indicated superior diagnostic performance in the experimental group, with an AUC of 0.945 compared with 0.776 for the control group (p < 0.0001). CONCLUSIONS High-resolution oblique coronal imaging at the optimal 30° flexed-knee angle improved ACL visualization and diagnostic performance compared with conventional techniques.
Collapse
Affiliation(s)
- Can Chen
- Department of Radiology, The Third Xiangya Hospital, Central South University, No. 138 Tongzipo Road, Yuelu District, Changsha, 410013, Hunan, China
| | - Xiao Liu
- Department of Radiology, The Third Xiangya Hospital, Central South University, No. 138 Tongzipo Road, Yuelu District, Changsha, 410013, Hunan, China
| | - Peng Wu
- Clinical and Technical Support, Philips Healthcare, Shanghai, China
| | - Qi Liang
- Department of Radiology, The Third Xiangya Hospital, Central South University, No. 138 Tongzipo Road, Yuelu District, Changsha, 410013, Hunan, China
| | - Song Peng
- Department of Radiology, The Third Xiangya Hospital, Central South University, No. 138 Tongzipo Road, Yuelu District, Changsha, 410013, Hunan, China
| | - Pengzhi Hu
- Department of Radiology, The Third Xiangya Hospital, Central South University, No. 138 Tongzipo Road, Yuelu District, Changsha, 410013, Hunan, China
| | - Yunjie Liao
- Department of Radiology, The Third Xiangya Hospital, Central South University, No. 138 Tongzipo Road, Yuelu District, Changsha, 410013, Hunan, China.
| |
Collapse
|
2
|
Voinea ȘV, Gheonea IA, Teică RV, Florescu LM, Roman M, Selișteanu D. Refined Detection and Classification of Knee Ligament Injury Based on ResNet Convolutional Neural Networks. Life (Basel) 2024; 14:478. [PMID: 38672749 PMCID: PMC11051415 DOI: 10.3390/life14040478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/20/2024] [Accepted: 04/03/2024] [Indexed: 04/28/2024] Open
Abstract
Currently, medical imaging has largely supplanted traditional methods in the realm of diagnosis and treatment planning. This shift is primarily attributable to the non-invasive nature, rapidity, and user-friendliness of medical-imaging techniques. The widespread adoption of medical imaging, however, has shifted the bottleneck to healthcare professionals who must analyze each case post-image acquisition. This process is characterized by its sluggishness and subjectivity, making it susceptible to errors. The anterior cruciate ligament (ACL), a frequently injured knee ligament, predominantly affects a youthful and sports-active demographic. ACL injuries often leave patients with substantial disabilities and alter knee mechanics. Since some of these cases necessitate surgery, it is crucial to accurately classify and detect ACL injury. This paper investigates the utilization of pre-trained convolutional neural networks featuring residual connections (ResNet) along with image-processing methods to identify ACL injury and differentiate between various tear levels. The ResNet employed in this study is not the standard ResNet but rather an adapted version capable of processing 3D volumes constructed from 2D image slices. Achieving a peak accuracy of 97.15% with a custom split, 96.32% through Monte-Carlo cross-validation, and 93.22% via five-fold cross-validation, our approach enhances the performance of three-class classifiers by over 7% in terms of raw accuracy. Moreover, we achieved an improvement of more than 1% across all types of evaluation. It is quite clear that the model's output can effectively serve as an initial diagnostic baseline for radiologists with minimal effort and nearly instantaneous results. This advancement underscores the paper's focus on harnessing deep learning for the nuanced detection and classification of ACL tears, demonstrating a significant leap toward automating and refining diagnostic accuracy in sports medicine and orthopedics.
Collapse
Affiliation(s)
- Ștefan-Vlad Voinea
- Department of Automatic Control and Electronics, University of Craiova, 200585 Craiova, Romania; (Ș.-V.V.); (M.R.)
| | - Ioana Andreea Gheonea
- Department of Radiology and Medical Imaging, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (I.A.G.); (L.M.F.)
| | - Rossy Vlăduț Teică
- Doctoral School, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Lucian Mihai Florescu
- Department of Radiology and Medical Imaging, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (I.A.G.); (L.M.F.)
| | - Monica Roman
- Department of Automatic Control and Electronics, University of Craiova, 200585 Craiova, Romania; (Ș.-V.V.); (M.R.)
| | - Dan Selișteanu
- Department of Automatic Control and Electronics, University of Craiova, 200585 Craiova, Romania; (Ș.-V.V.); (M.R.)
| |
Collapse
|
3
|
Bamania P, Osmani HT, Robinson P, McDonnell S, Ahmed N. The patient with a painful knee. Br J Hosp Med (Lond) 2024; 85:1-10. [PMID: 38416527 DOI: 10.12968/hmed.2023.0408] [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] [Indexed: 02/29/2024]
Abstract
Knee pain encompasses a wide array of differential diagnoses and can often pose a diagnostic challenge, as it can have traumatic or non-traumatic causes. A good clinical history, assessment and anatomical knowledge gives a strong foundation to narrow down the diagnosis, and understanding the correct imaging modality and findings further informs correct and timely management. This article reviews various disease processes including fractures, inflammatory, infective and neoplastic causes, and discusses the assessment and various imaging modalities to aid diagnosis in both primary and secondary care.
Collapse
Affiliation(s)
- Prashant Bamania
- Department of Radiology, Chelsea and Westminster Hospital, London, UK
| | - Humza T Osmani
- Department of Trauma and Orthopaedics, Addenbrooke's Hospital, Cambridge, UK
| | - Philip Robinson
- University of Leeds and Biochemical Research Centre, Musculoskeletal Centre, Department of Radiology, Chapel Allerton Hospital, Leeds Teaching Hospitals, Leeds, UK
| | - Stephen McDonnell
- Department of Trauma and Orthopaedics, Addenbrooke's Hospital, Cambridge, UK
| | - Naeem Ahmed
- Department of Radiology, Chelsea and Westminster Hospital, London, UK
| |
Collapse
|
4
|
Yalın M, Key S, Yıldırım M, Agar A. Examining Postoperative Posterior Cruciate Ligament Index: A Structural Paradigm in Anterior Cruciate Ligament (ACL) Reconstructions With Hamstring Tendon Autograft. Cureus 2024; 16:e53089. [PMID: 38414686 PMCID: PMC10897742 DOI: 10.7759/cureus.53089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND The current study aimed to compare the posterior cruciate ligament (PCL) index values of patients who underwent hamstring tendon (HT) autograft reconstruction due to an anterior cruciate ligament (ACL) tear. The comparison involved assessing these values in a similar cohort and evaluating the association between the alteration in the PCL index and functional results. METHODS Patients who were clinically diagnosed with a complete, unilateral ACL tear and underwent ACL reconstruction (ACLR) using HT autograft between January 2018 and January 2021 constituted the operated group (Group 1) of the study. The control group (Group 2) consisted of patients selected from a convenience sample without ACL rupture, meniscal lesion, or cartilage damage who underwent an MRI during an outpatient orthopaedic consultation for knee pain. The operated group was submitted for an MRI of the knee one year after the operation for any reason such as pain, graft healing, the presence of tunnel widening, or suspicion of re-rupture. The International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form and the Lysholm Scoring System were applied to the patients in the operated group in the preoperative and postoperative periods to evaluate their complaints, function, and participation in sports and to assess functional ability and functional capacity. A radiologist with five years of experience measured the PCL index in the sagittal section of an MRI. In the operated group, changes in PCL index, IKDC, and Lysholm values during the postoperative period were assessed, along with their correlation. Additionally, a comparison was made between the values of the operated group and the non-operated group. RESULTS No statistically significant correlation was found between the PCL index alteration and the functional score alteration (IKDC and Lysholm) in the operated group (p>0.05). In comparison to the non-operated group, the preoperative PCL index measures of the operated group were significantly lower (p: 0.000; p<0.05). The increase in the postoperative PCL index measurements of the operated group was similarly statistically significant (p: 0.000; p<0.05). CONCLUSION Although the PCL index appears to be a strong anatomical structural parameter in ACLR patients performing HT autograft in the postoperative period, its correlation with functional results is weak.
Collapse
Affiliation(s)
- Mustafa Yalın
- Department of Orthopedics and Traumatology, Elazığ Fethi Sekin City Hospital, Elazığ, TUR
| | - Sefa Key
- Department of Orthopedics and Traumatology, Fırat University, Elazığ, TUR
| | | | - Anıl Agar
- Department of Orthopedics and Traumatology, Fırat University, Elazığ, TUR
| |
Collapse
|
5
|
Vasiliadis AV, Giovanoulis V. "Hippokampos" sign of posterior cruciate ligament: an indirect sign of anterior cruciate ligament injury on magnetic resonance imaging. J Sports Med Phys Fitness 2023; 63:1366-1368. [PMID: 37695566 DOI: 10.23736/s0022-4707.23.15320-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Affiliation(s)
- Angelo V Vasiliadis
- Department of Orthopedic Surgery, Sports Trauma Unit, St. Luke's Hospital, Thessaloniki, Greece -
- Department of Orthopedic Surgery and Sports Medicine, Croix-Rousse Hospital, Lyon, France -
| | - Vasileios Giovanoulis
- Department of Orthopedic Surgery, Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France
| |
Collapse
|
6
|
Shrestha R, Khadka SK, Chaudhary A, Acharya SP, Malla M, Gautam P, Maharjan S, Basi A, Thapa S, Karki S. Anterior Cruciate Ligament Tear Using Magnetic Resonance Imaging among Patients Undergoing Arthroscopy in a Tertiary Care Centre: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc 2023; 61:451-454. [PMID: 37203907 PMCID: PMC10896444 DOI: 10.31729/jnma.7989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 04/29/2023] [Indexed: 05/20/2023] Open
Abstract
Introduction Magnetic Resonance Imaging is the preferred imaging modality in patients having anterior cruciate ligament tears. The aim of this study was to find out the prevalence of anterior cruciate ligament tears using magnetic resonance imaging among patients undergoing arthroscopy in a tertiary care centre. Methods A descriptive cross-sectional study was conducted in the Department of Orthopaedics and Traumatology of a tertiary care centre. Data from 17 November 2017 to 17 October 2022 were collected between 26 December 2022 and 30 December 2022 from the hospital records. Ethical approval was obtained from Institutinal Review Committee of the same institute (Reference number: 233/22). All patients with a knee injury who received arthroscopy were included in the study. Magnetic resonance imaging reports, arthroscopic findings and relevant data of each case were retrieved from the medical case records of patients. Convenience sampling method was used. Point estimate and 95% Confidence Interval were calculated. Results Among patients with arthroscopy confirmed anterior cruciate ligament tear, 138 (91.39%) (86.92 to 95.86, 95% Confidence Interval) had anterior cruciate ligament tear diagnosed with magnetic resonance imaging. The mean age of the patients who had anterior cruciate ligament tear in the magnetic resonance imaging was 32.35±11.31 years. Out of them, 87 (63%) were males and 51 (37%) were females. The mean duration of the injury was 11.60±18.47 months. Conclusions The prevalence of anterior cruciate ligament tear using magnetic resonance imaging among patients undergoing arthroscopy in tertiary care centres was similar when compared to other similar studies when conducted in similar settings. Keywords anterior cruciate ligament tears; arthroscopy; cross-sectional studies; MRI.
Collapse
Affiliation(s)
- Rohit Shrestha
- Department of Orthopedics, Dhulikhal Hospital, Dhulikhel, Kavre, Nepal
| | | | | | | | - Manasil Malla
- Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal
| | - Prabesh Gautam
- Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - Sagar Maharjan
- Department of Orthopedics, Dhulikhal Hospital, Dhulikhel, Kavre, Nepal
| | - Ashkal Basi
- Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - Sangharsha Thapa
- Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - Subindra Karki
- Department of Radiology, Dhulikhel Hospital, Dhulikhel, Kavre, Nepal
| |
Collapse
|
7
|
Batista JP, Maestu R, Barbier J, Chahla J, Kunze KN. Propensity for Clinically Meaningful Improvement and Surgical Failure After Anterior Cruciate Ligament Repair. Orthop J Sports Med 2023; 11:23259671221146815. [PMID: 37065184 PMCID: PMC10102942 DOI: 10.1177/23259671221146815] [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: 09/03/2022] [Accepted: 10/11/2022] [Indexed: 04/18/2023] Open
Abstract
Background Primary repair of the anterior cruciate ligament (ACL) confers an alternative to ACL reconstruction in appropriately selected patients. Purpose To prospectively assess survivorship and to define the clinically meaningful outcomes after ACL repair. Study Design Case series; Level of evidence, 4. Methods Included were consecutive patients with Sherman grade 1-2 tears who underwent primary ACL repair with or without suture augmentation between 2017 and 2019. Patient-reported outcomes (Lysholm, Tegner, International Knee Documentation Committee, Western Ontario and McMaster Universities Osteoarthritis Index, and Knee injury and Osteoarthritis Outcome Score [KOOS] subscales) were collected preoperatively and at 6 months, 1 year, and 2 years postoperatively. The minimal clinically important difference (MCID) was calculated using a distribution-based method, whereas the Patient Acceptable Symptom State (PASS) and substantial clinical benefit (SCB) were calculated using an anchor-based method. Plain radiographs and magnetic resonance imaging (MRI) were obtained at 6 months, 1 year, and 2 years postoperatively. Results A total of 120 patients were included. The overall failure rate was 11.3% at 2 years postoperatively. Changes in outcome scores required to achieve the MCID ranged between 5.1 and 14.3 at 6 months, 4.6 and 8.4 at 1 year, and 4.7 and 11.9 at 2 years postoperatively. Thresholds for PASS achievement ranged between 62.5 and 89 at 6 months, 75 and 89 at 1 year, and 78.6 and 93.2 at 2 years postoperatively. Threshold scores (absolute/change based) for achieving the SCB ranged between 82.8 and 96.4/17.7 and 40.1 at 6 months, between 94.7 and 100/23 and 45 at 1 year, and between 95.3 and 100/29.4 and 45 at 2 years. More patients achieved the MCID and PASS at 1 year compared with 6 months and 2 years. For SCB, this trend was also observed for non-KOOS outcomes, while for KOOS subdomains, more patients achieved the SCB at 2 years. High-intensity signal of the ACL repair (odds ratio [OR], 31.7 [95% CI, 1.5-73.4]; P = .030) and bone contusions on MRI (OR, 4.2 [95% CI, 1.7-25.2]; P = .041) at 1 year postoperatively were independently associated with increased risk of ACL repair failure. Conclusion The rate of clinically meaningful outcome improvement was high early after ACL repair, with the greatest proportion of patients achieving the MCID, PASS, and SCB at 1 year postoperatively. Bone contusions involving the posterolateral tibia and lateral femoral condyle as well as high repair signal intensity at 1 year postoperatively were independent predictors of failure at 2 years postoperatively.
Collapse
Affiliation(s)
| | - Rodrigo Maestu
- Centro de Tratamiento de Enfermedades
Articulares, Buenoa Aires, Argentina
| | - Jose Barbier
- Centro Artroscópico Jorge Batista SA,
Buenos Aires, Argentina
| | - Jorge Chahla
- Division of Sports Medicine, Department
of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois,
USA
| | - Kyle N. Kunze
- Department of Orthopedic Surgery,
Hospital for Special Surgery, New York, New York, USA
- Kyle N. Kunze, M.D,
Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 E. 70th
Street, New York, NY 10021, USA ()
(Twitter: @kylekunzemd)
| |
Collapse
|
8
|
Skeletally Immature Patients With Classic Anterior Cruciate Ligament Bone Bruise Patterns Have a Higher Likelihood of Having an Intact Anterior Cruciate Ligament Compared With Skeletally Mature Patients. J Pediatr Orthop 2023; 43:13-17. [PMID: 36129350 DOI: 10.1097/bpo.0000000000002268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The incidence of anterior cruciate ligament (ACL) tears in skeletally immature patients with an ACL bone contusion pattern has been sparsely investigated. The purpose of this study is to investigate whether physeal status has an influence on the likelihood of sustaining an ACL tear when classic bipolar ACL bone bruising pattern is present. METHODS Magnetic resonance imaging reports were queried for "contusion" on all patients between 6 and 22 years between 2015 and 2019. Images were reviewed to denote all intra-articular pathology and the physeal status of the femur and tibia. The primary outcome was the incidence of ACL tears in patients with the presence of bipolar bone contusions. Fischer exact testing was used to determine associations. RESULTS Of 499 patients included, 269 of those had bipolar bone contusions. Patients with bipolar bone contusions and ACL tears had a shorter duration between injury and imaging date compared with patients with ACL tears without bipolar bone contusions (6.9 vs. 38.6 d, P =0.05). Patients with an open femoral physis had a higher likelihood of having an intact ACL despite the presence of bipolar bone contusions than patients with a closed femoral physis (10.8% vs. 1.0%, P <0.001). Of patients with bipolar bone contusions, those with an intact ACL were younger than patients with an ACL tear (14.6 vs. 16.4, P =0.017). CONCLUSIONS Although bipolar bone contusions of the central lateral femoral condyle and posterior lateral tibial plateau are typically found after ACL injury, these bipolar contusions can be found concomitantly with an intact ACL and were more often found in relatively younger patients. Patients who have an open femoral physis have a higher likelihood to have an intact ACL despite the presence of bipolar bone contusions compared with patients who have a closed femoral physis. LEVEL OF EVIDENCE Level IV-cross-sectional.
Collapse
|
9
|
The coronal lateral collateral ligament sign in the anterior cruciate ligament-injured knees was observed regardless of the knee laxity based on the quantitative measurements. Knee Surg Sports Traumatol Arthrosc 2022; 30:3508-3514. [PMID: 35412065 DOI: 10.1007/s00167-022-06970-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 03/29/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE The coronal lateral collateral ligament (LCL) sign has been reported to be associated with deviated position of the tibia on MRI due to anterior cruciate ligament (ACL) injuries. However, the relationships between LCL sign and clinical knee laxity evaluations are still unclear. The purpose of the study was to investigate the relationship between the coronal LCL sign and knee laxity measurements. METHODS A retrospective review of unilateral ACL injured patients who underwent ACL reconstruction was performed. The coronal LCL sign was determined using magnetic resonance imaging (MRI). Clinical grading of the pivot-shift test, KT-1000 measurements, and quantitative measurements of the Lachman test and the pivot-shift test using an electromagnetic system, were compared between patients with positive and negative coronal LCL sign. A subgroup analysis of different age groups was then performed, dividing patients to adolescent (age ≤ 18 years) and adult (age > 18 years) groups. RESULTS A total of 85 patients were enrolled, of which 45 patients had coronal LCL signs. The coronal LCL sign was not associated with the pivot-shift test clinical grading (n.s), KT-1000 measurement (n.s), the tibial translation during the Lachman test (n.s), or with tibia acceleration (n.s) and translation (n.s) during the pivot-shift test. The subgroup analysis also showed that the aforementioned parameters were not associated with the coronal LCL sign in either adolescent or adult subgroups. CONCLUSION The occurrence of coronal LCL sign in MRI did not imply greater clinical knee laxity evaluations in patients with ACL tears. The knee laxity should routinely be evaluated regardless the coronal LCL sign. LEVEL OF EVIDENCE Level III.
Collapse
|
10
|
Chen KH, Yang CY, Wang HY, Ma HL, Lee OKS. Artificial Intelligence-Assisted Diagnosis of Anterior Cruciate Ligament Tears From Magnetic Resonance Images: Algorithm Development and Validation Study. JMIR AI 2022; 1:e37508. [PMID: 38875555 PMCID: PMC11135221 DOI: 10.2196/37508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 06/15/2022] [Accepted: 07/05/2022] [Indexed: 06/16/2024]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) injuries are common in sports and are critical knee injuries that require prompt diagnosis. Magnetic resonance imaging (MRI) is a strong, noninvasive tool for detecting ACL tears, which requires training to read accurately. Clinicians with different experiences in reading MR images require different information for the diagnosis of ACL tears. Artificial intelligence (AI) image processing could be a promising approach in the diagnosis of ACL tears. OBJECTIVE This study sought to use AI to (1) diagnose ACL tears from complete MR images, (2) identify torn-ACL images from complete MR images with a diagnosis of ACL tears, and (3) differentiate intact-ACL and torn-ACL MR images from the selected MR images. METHODS The sagittal MR images of torn ACL (n=1205) and intact ACL (n=1018) from 800 cases and the complete knee MR images of 200 cases (100 torn ACL and 100 intact ACL) from patients aged 20-40 years were retrospectively collected. An AI approach using a convolutional neural network was applied to build models for the objective. The MR images of 200 independent cases (100 torn ACL and 100 intact ACL) were used as the test set for the models. The MR images of 40 randomly selected cases from the test set were used to compare the reading accuracy of ACL tears between the trained model and clinicians with different levels of experience. RESULTS The first model differentiated between torn-ACL, intact-ACL, and other images from complete MR images with an accuracy of 0.9946, and the sensitivity, specificity, precision, and F1-score were 0.9344, 0.9743, 0.8659, and 0.8980, respectively. The final accuracy for ACL-tear diagnosis was 0.96. The model showed a significantly higher reading accuracy than less experienced clinicians. The second model identified torn-ACL images from complete MR images with a diagnosis of ACL tear with an accuracy of 0.9943, and the sensitivity, specificity, precision, and F1-score were 0.9154, 0.9660, 0.8167, and 0.8632, respectively. The third model differentiated torn- and intact-ACL images with an accuracy of 0.9691, and the sensitivity, specificity, precision, and F1-score were 0.9827, 0.9519, 0.9632, and 0.9728, respectively. CONCLUSIONS This study demonstrates the feasibility of using an AI approach to provide information to clinicians who need different information from MRI to diagnose ACL tears.
Collapse
Affiliation(s)
- Kun-Hui Chen
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Surgery, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chih-Yu Yang
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hsin-Yi Wang
- Department of Surgery, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Anaesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hsiao-Li Ma
- Department of Surgery, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Oscar Kuang-Sheng Lee
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- China Medical University Hospital, Taichung, Taiwan
| |
Collapse
|
11
|
Minamoto Y, Akagi R, Maki S, Shiko Y, Tozawa R, Kimura S, Yamaguchi S, Kawasaki Y, Ohtori S, Sasho T. Automated detection of anterior cruciate ligament tears using a deep convolutional neural network. BMC Musculoskelet Disord 2022; 23:577. [PMID: 35705930 PMCID: PMC9199233 DOI: 10.1186/s12891-022-05524-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 06/03/2022] [Indexed: 11/12/2022] Open
Abstract
Background The development of computer-assisted technologies to diagnose anterior cruciate ligament (ACL) injury by analyzing knee magnetic resonance images (MRI) would be beneficial, and convolutional neural network (CNN)-based deep learning approaches may offer a solution. This study aimed to evaluate the accuracy of a CNN system in diagnosing ACL ruptures by a single slice from a knee MRI and to compare the results with that of experienced human readers. Methods One hundred sagittal MR images from patients with and without ACL injuries, confirmed by arthroscopy, were cropped and used for the CNN training. The final decision by the CNN for intact or torn ACL was based on the probability of ACL tear on a single MRI slice. Twelve board-certified physicians reviewed the same images used by CNN. Results The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of the CNN classification was 91.0%, 86.0%, 88.5%, 87.0%, and 91.0%, respectively. The overall values of the physicians’ readings were similar, but the specificity was lower than the CNN classification for some of the physicians, thus resulting in lower accuracy for the human readers. Conclusions The trained CNN automatically detected the ACL tears with acceptable accuracy comparable to that of human readers.
Collapse
Affiliation(s)
- Yusuke Minamoto
- Center for Preventive Medical Sciences, Chiba University, Chiba, Japan.,Department of Physical Therapy, Faculty of Health Science, Ryotokuji University, Urayasu, Japan
| | - Ryuichiro Akagi
- Center for Preventive Medical Sciences, Chiba University, Chiba, Japan. .,Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan. .,Sportsmedics Center, Chiba University Hospital, Chiba, Japan.
| | - Satoshi Maki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Yuki Shiko
- Biostatistics Section, Clinical Research Center, Chiba University Hospital, Chiba, Japan
| | - Ryosuke Tozawa
- Center for Preventive Medical Sciences, Chiba University, Chiba, Japan.,Department of Physical Therapy, Faculty of Health Science, Ryotokuji University, Urayasu, Japan
| | - Seiji Kimura
- Center for Preventive Medical Sciences, Chiba University, Chiba, Japan.,Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.,Sportsmedics Center, Chiba University Hospital, Chiba, Japan
| | - Satoshi Yamaguchi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.,Graduate School of Global and Transdisciplinary Studies, Chiba University, Chiba, Japan
| | - Yohei Kawasaki
- Faculty of Nursing, Japanese Red Cross College of Nursing, Tokyo, Japan
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.,Sportsmedics Center, Chiba University Hospital, Chiba, Japan
| | - Takahisa Sasho
- Center for Preventive Medical Sciences, Chiba University, Chiba, Japan.,Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| |
Collapse
|
12
|
Sridhar S, Amutharaj J, Valsalan P, Arthi B, Ramkumar S, Mathupriya S, Rajendran T, Waji YA. A Torn ACL Mapping in Knee MRI Images Using Deep Convolution Neural Network with Inception-v3. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:7872500. [PMID: 35178233 PMCID: PMC8846973 DOI: 10.1155/2022/7872500] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/07/2022] [Accepted: 01/17/2022] [Indexed: 11/17/2022]
Abstract
The anterior cruciate ligaments (ACL) are the fundamental structures in preserving the common biomechanics of the knees and most frequently damaged knee ligaments. An ACL injury is a tear or sprain of the ACL, one of the fundamental ligaments in the knee. ACL damage most generally happens during sports, for example, soccer, ball, football, and downhill skiing, which include sudden stops or changes in direction, jumping, and landings. Magnetic resonance imaging (MRI) has a major role in the field of diagnosis these days. Specifically, it is effective for diagnosing the cruciate ligaments and any related meniscal tears. The primary objective of this research is to detect the ACL tear from MRI knee images, which can be useful to determine the knee abnormality. In this research, a Deep Convolution Neural Network (DCNN) based Inception-v3 deep transfer learning (DTL) model was proposed for classifying the ACL tear MRI images. Preprocessing, feature extraction, and classification are the main processes performed in this research. The dataset utilized in this work was collected from the MRNet database. A total of 1,370 knee MRI images are used for evaluation. 70% of data (959 images) are used for training and testing, and 30% of data (411 images) are used in this model for performance analysis. The proposed DCNN with the Inception-v3 DTL model is evaluated and compared with existing deep learning models like VGG16, VGG19, Xception, and Inception ResNet-v28. The performance metrics like accuracy, precision, recall, specificity, and F-measure are evaluated to estimate the performance analysis of the model. The model has obtained 99.04% training accuracy and 95.42% testing accuracy in performance analysis.
Collapse
Affiliation(s)
- S. Sridhar
- Department of Computer Science and Engineering, Saveetha School of Engineering, Saveetha Institute of Medical and Technical Sciences, Chennai, India
| | - J. Amutharaj
- Department of ISE, RajaRajeswari College of Engineering,Mysore Road, Bangalore, Karnataka, India
| | | | - B. Arthi
- Department of Computer Science and Engineering, College of Engineering and Technology, SRM Institute of Science and Technology (Deemed to Be University), Kattankulathur, Chennai, Tamilnadu, India
| | - S. Ramkumar
- Department of Computer Applications, Kalasalingam Academy of Research and Education (Deemed to Be University), Srivilliputhur, Tamilnadu, India
| | - S. Mathupriya
- Department of Computer Science and Engineering, Sri Sairam Institute of Technology (Autonomous), Chennai, Tamilnadu, India
| | - T. Rajendran
- Makeit Technologies (Center for Industrial Research), Coimbatore, Tamilnadu, India
| | - Yosef Asrat Waji
- Department of Chemical Engineering, College of Biological and Chemical Engineering, Addis Ababa Science and Technology University, Addis Ababa, Ethiopia
| |
Collapse
|
13
|
Pai SN, Ayyadurai P, Perumal S, Sivaraman A. Anterior cruciate ligament haemangioma. BMJ Case Rep 2022; 15:e248058. [PMID: 35039381 PMCID: PMC8768924 DOI: 10.1136/bcr-2021-248058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2021] [Indexed: 11/04/2022] Open
Affiliation(s)
- Satvik N Pai
- Orthopaedic Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Prakash Ayyadurai
- Arthroscopy and Sports Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Suresh Perumal
- Arthroscopy and Sports Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Arumugam Sivaraman
- Arthroscopy and Sports Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| |
Collapse
|
14
|
Gali JC, Almeida TA, de Moraes Miguel DC, Nassar SA, Filho JCG, Drain NP, Fu FF. The posterior cruciate ligament inclination angle is higher in anterior cruciate ligament insufficiency. Knee Surg Sports Traumatol Arthrosc 2022; 30:124-130. [PMID: 34787689 DOI: 10.1007/s00167-021-06789-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 10/25/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE Magnetic resonance imaging (MRI) is the gold standard image examination for anterior cruciate ligament (ACL) lesion diagnosis. Our hypothesis was that measuring the posterior cruciate ligament inclination angle (PCLIA) using MRI images may be an auxiliary tool to aid the recognition of ACL insufficiency. The purpose of this study was to compare the PCLIA measurement in MRIs of individuals with and without ACL injury. METHODS The PCLIA was measured by two radiologists in 65 knee MRIs of patients with intact ACL (control group) and in 65 knee MRIs of people with ACL injury (study group). In both groups, the posterior cruciate ligament was intact. The control group was included 35 men (53.8%) and 30 women (46.1%). The patients' average age was 38.7 years (range 15-75; SD ± 14.8 years). In this group, 31 (47.6%) MRIs were from right knees and 34 (52.3%) were from left knees. The study group consisted of 45 men (69.2%) and 20 women (30.7%). The patients' average age was 36.8 years (range 14-55; SD ± 10.3 years). In this group, 33 (50.7%) were right knees and 32 (49.2%) were left knees. PCLIA was formed by the intersection of two lines drawn in MRI sagittal images. The first passed tangentially to the articular surface of the tibial condyle and the second was drawn over the fraction of the ligament that originated where the first crossed the PCL, outlined proximally. RESULTS The average PCLIA was 44.2 ± 3.8° in the control group and 78.9 ± 8.6° in the study group. Statistical analyses showed that the PCLIA was higher in the group with ACL injury (p < 0.05). Conclusion The PCLIA was significantly higher in individuals with ACL injuries. The measurement of this angle using MRI images may allow for detection of ACL insufficiency and thus assist in an individualized and precise approach to the treatment of injuries to the ACL. CLINICAL RELEVANCE PCLIA may be a way to detect ACL insufficiency and thus help surgeons to decide which patient might need ACL reconstruction. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Julio Cesar Gali
- Department of Surgery, Faculty of Medical Science and Health, Catholic University of Sao Paulo, Rua Joubert Wey, 290, Sorocaba, SP, 18030-070, Brazil.
| | | | | | | | | | - Nicholas P Drain
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Freddie F Fu
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| |
Collapse
|
15
|
Jeon Y, Yoshino K, Hagiwara S, Watanabe A, Quek ST, Yoshioka H, Feng M. Interpretable and Lightweight 3-D Deep Learning Model for Automated ACL Diagnosis. IEEE J Biomed Health Inform 2021; 25:2388-2397. [PMID: 34003757 DOI: 10.1109/jbhi.2021.3081355] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We propose an interpretable and lightweight 3D deep neural network model that diagnoses anterior cruciate ligament (ACL) tears from a knee MRI exam. Previous works focused primarily on achieving better diagnostic accuracy but paid less attention to practical aspects such as explainability and model size. They mainly relied on ImageNet pre-trained 2D deep neural network backbones, such as AlexNet or ResNet, which are computationally expensive. Some of them tried to interpret the models using post-inference visualization tools, such as CAM or Grad-CAM, which lack in generating accurate heatmaps. Our work addresses the two limitations by understanding the characteristics of ACL tear diagnosis. We argue that the semantic features required for classifying ACL tears are locally confined and highly homogeneous. We harness the unique characteristics of the task by incorporating: 1) attention modules and Gaussian positional encoding to reinforce the seeking of local features; 2) squeeze modules and fewer convolutional filters to reflect the homogeneity of the features. As a result, our model is interpretable: our attention modules can precisely highlight the ACL region without any location information given to them. Our model is extremely lightweight: consisting of only 43 K trainable parameters and 7.1 G of Floating-point operations per second (FLOPs), that is 225 times smaller and 91 times lesser than the previous state-of-the-art, respectively. Our model is accurate: our model outperforms the previous state-of-the-art with the average ROC-AUC of 0.983 and 0.980 on the Chiba and Stanford knee datasets, respectively.
Collapse
|
16
|
Lynch TB, Siu R, Bates T, Antosh IJ. Primary ACL Repair of a Chronic ACL Femoral Avulsion with 2-Year Clinical and Radiographic Outcomes: A Case Report. JBJS Case Connect 2021; 11:01709767-202106000-00099. [PMID: 34101625 DOI: 10.2106/jbjs.cc.20.00923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE There has been a reemergence of anterior cruciate ligament (ACL) repair. We present the unique case of an ACL repair in a service member with a chronic tear. The patient went on to have a successful outcome with return to full activities without symptoms and functional outcomes scores equal to preinjury levels. CONCLUSION This case demonstrates a preserved ACL remnant after an ACL femoral avulsion secondary to scarring to the posterior cruciate ligament. ACL repair can produce excellent outcomes in the right population, and injury chronicity may not necessarily preclude successful repair in the setting of good-quality ACL remnant.
Collapse
Affiliation(s)
- Thomas B Lynch
- San Antonio Military Medical Center, Fort Sam Houston, Texas
| | - Ryan Siu
- California Northstate University College of Medicine, Elk Grove, California
| | - Taylor Bates
- San Antonio Military Medical Center, Fort Sam Houston, Texas
| | - Ivan J Antosh
- San Antonio Military Medical Center, Fort Sam Houston, Texas
| |
Collapse
|
17
|
Yao S, Fu BSC, Yung PSH. Graft healing after anterior cruciate ligament reconstruction (ACLR). ASIA-PACIFIC JOURNAL OF SPORT MEDICINE ARTHROSCOPY REHABILITATION AND TECHNOLOGY 2021; 25:8-15. [PMID: 34094881 PMCID: PMC8134949 DOI: 10.1016/j.asmart.2021.03.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 02/05/2021] [Accepted: 03/21/2021] [Indexed: 01/11/2023]
Abstract
Anterior cruciate ligament reconstruction (ACLR) is a commonly performed procedure in Orthopaedic sports medicine. With advances in surgical techniques providing better positioning and fixation of the graft, subsequent graft failure to certain extent should be accounted by poor graft healing. Although different biological modulations for enhancement of graft healing have been tried in different clinical and animal studies, complete graft incorporation into bone tunnels and the “ligamentization” of the intra-articular part have not been fully achieved yet. Based on the understanding of graft healing process and its failure mechanism, the purpose of this review is to combine both the known basic science & clinical evidence, to provide a much clearer picture of the obstacle encountered in graft healing, so as to facilitate researchers on subsequent work on the enhancement of ACL graft healing.
Collapse
Affiliation(s)
- Shiyi Yao
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong
| | - Bruma Sai-Chuen Fu
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong
| | - Patrick Shu-Hang Yung
- Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong
| |
Collapse
|
18
|
Alves TAFDA, Braun MAA, Duarte ML, Santosc LRD. Anteromedial meniscofemoral ligament-A rare finding. Morphologie 2021; 106:124-127. [PMID: 33867244 DOI: 10.1016/j.morpho.2021.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 03/09/2021] [Accepted: 03/10/2021] [Indexed: 10/21/2022]
Abstract
We report a case of a 49-year-old patient presenting an anteromedial meniscofemoral ligament (AMMFL) on both knees with a tear of this ligament in the left knee associated to a normal anterior cruciate ligament (ACL). The AMMFL is a relatively rare anatomic structure that may correspond to a variant of the ACL type anterior root insertion of the medial meniscus. The findings reported in the literature were in most part results of incidental situations. AMMFL can be visualized through magnetic resonance imaging (MRI) and arthroscopy.
Collapse
Affiliation(s)
| | | | - Márcio Luís Duarte
- Department of Radiology, WEBIMAGEM Telerradiologia, São Paulo - SP, Brazil.
| | | |
Collapse
|
19
|
Hoogeslag RAG, Buitenhuis MB, Brouwer RW, Derks RPH, van Raak SM, Veld RHI'. Standard MRI May Not Predict Specific Acute Anterior Cruciate Ligament Rupture Characteristics. Orthop J Sports Med 2021; 9:2325967121992472. [PMID: 33855093 PMCID: PMC8010830 DOI: 10.1177/2325967121992472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 11/03/2020] [Indexed: 11/16/2022] Open
Abstract
Background There has been renewed interest in the concept of anterior cruciate ligament (ACL) suture repair (ACLSR). Morphologic characteristics of the ruptured ACL remnant play a role in deciding whether a patient is eligible for ACLSR. However, no classification of these characteristics of ACL rupture on magnetic resonance imaging (MRI) scans has yet been compared with intraoperative findings in the context of ACLSR. Purpose To investigate the value of using preoperative MRI to predict specific characteristics of acute complete ACL rupture. Study Design Cohort study (diagnostic); Level of evidence, 2. Methods A total of 25 patients were included. Two radiologists classified ACL rupture location and pattern on preoperative 1.5-T MRI scans with a standard sequence; the results were compared with the corresponding findings at arthroscopy conducted by a single surgeon. The agreement between the MRI and surgical findings was calculated using Cohen κ values. Furthermore, the reliability coefficients of the MRI classifications within and between radiologists were calculated. Results The agreement between MRI classification and arthroscopic findings for ACL rupture location was slight (Cohen κ, 0.016 [radiologist 1] and 0.087 [radiologist 2]), and for ACL rupture pattern, this was poor to slight (Cohen κ, <0 and 0.074). The intraobserver reliability of MRI classification for ACL rupture location was moderate for radiologist 1 and slight for radiologist 2 (Cohen κ, 0.526 and 0.061, respectively), and for ACL rupture pattern, this was slight for radiologist 1 and 2 (Cohen κ, 0.051 and 0.093, respectively). The interobserver reliability of MRI classification for ACL rupture location and pattern was slight between radiologists (Cohen κ, 0.172 and 0.040, respectively). Conclusion In the current study, we found poor to slight agreement between MRI classification and arthroscopic findings of specific ACL rupture characteristics. In addition, the intra- and interobserver reliability for MRI classification of the ACL rupture characteristics was slight to moderate.
Collapse
Affiliation(s)
| | | | - Reinoud W Brouwer
- Department of Orthopaedic Surgery, Martini Hospital, Groningen, the Netherlands
| | - Rosalie P H Derks
- Department of Musculoskeletal Radiology ZGT, Hengelo, the Netherlands
| | - Sjoerd M van Raak
- Department of Musculoskeletal Radiology ZGT, Hengelo, the Netherlands
| | | |
Collapse
|
20
|
Mitchell BC, Siow MY, Bastrom T, Bomar JD, Pennock AT, Parvaresh K, Edmonds EW. Coronal Lateral Collateral Ligament Sign: A Novel Magnetic Resonance Imaging Sign for Identifying Anterior Cruciate Ligament-Deficient Knees in Adolescents and Summarizing the Extent of Anterior Tibial Translation and Femorotibial Internal Rotation. Am J Sports Med 2021; 49:928-934. [PMID: 33617287 DOI: 10.1177/0363546521988938] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Incompetence of the anterior cruciate ligament (ACL) confers knee laxity in the sagittal and axial planes that is measurable with clinical examination and diagnostic imaging. HYPOTHESIS An ACL-deficient knee will produce a more vertical orientation of the lateral collateral ligament (LCL), allowing for the entire length of the LCL to be visualized on a single coronal slice (coronal LCL sign) on magnetic resonance imaging. STUDY DESIGN Cohort study (diagnosis); Level of evidence, 3. METHODS Charts were retrospectively reviewed from April 2009 to December 2017 for all patients treated with ACL reconstruction (constituting the ACL-deficient cohort). A control cohort was separately identified consisting of patients with a normal ACL and no pathology involving the collateral ligaments or posterior cruciate ligament. Patients were excluded for follow-up <2 years, incomplete imaging, and age >19 years. Tibial translation and femorotibial rotation were measured on magnetic resonance images, and posterior tibial slope was measured on a lateral radiograph of the knee. Imaging was reviewed for the presence of the coronal LCL sign. RESULTS The 153 patients included in the ACL-deficient cohort had significantly greater displacement than the 70 control patients regarding anterior translation (5.8 vs 0.3 mm, respectively; P < .001) and internal rotation (5.2° vs -2.4°, P < .001). Posterior tibial slope was not significantly different. The coronal LCL sign was present in a greater percentage of ACL-deficient knees than intact ACL controls (68.6% vs 18.6%, P < .001). The presence of the coronal LCL sign was associated with greater anterior tibial translation (7.2 vs 0.2 mm, P < .001) and internal tibial rotation (7.5° vs -2.4°, P = .074) but not posterior tibial slope (7.9° vs 7.9°, P = .973) as compared with its absence. Multivariate analysis revealed that the coronal LCL sign was significantly associated with an ACL tear (odds ratio, 12.8; P < .001). CONCLUSION Our study provides further evidence that there is significantly more anterior translation and internal rotation of the tibia in the ACL-deficient knee and proves our hypothesis that the coronal LCL sign correlates with the presence of an ACL tear. This coronal LCL sign may be of utility for identifying ACL tears and anticipating the extent of axial and sagittal deformity.
Collapse
Affiliation(s)
- Brendon C Mitchell
- Department of Orthopaedic Surgery, University of California-San Diego, San Diego, California, USA
| | - Matthew Y Siow
- Department of Orthopaedic Surgery, University of California-San Diego, San Diego, California, USA
| | - Tracey Bastrom
- Division of Orthopaedic Surgery, Rady Children's Hospital, San Diego, California, USA
| | - James D Bomar
- Division of Orthopaedic Surgery, Rady Children's Hospital, San Diego, California, USA
| | - Andrew T Pennock
- Division of Orthopaedic Surgery, Rady Children's Hospital, San Diego, California, USA
| | - Kevin Parvaresh
- Department of Orthopaedic Surgery, Rush Medical Center, Chicago, Illinois, USA
| | - Eric W Edmonds
- Division of Orthopaedic Surgery, Rady Children's Hospital, San Diego, California, USA
| |
Collapse
|
21
|
Mitchell BC, Siow MY, Bastrom T, Bomar JD, Pennock AT, Parvaresh K, Edmonds EW. Predictive Value of the Magnetic Resonance Imaging-Based Coronal Lateral Collateral Ligament Sign on Adolescent Anterior Cruciate Ligament Reconstruction Graft Failure. Am J Sports Med 2021; 49:935-940. [PMID: 33617286 DOI: 10.1177/0363546521988939] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The coronal lateral collateral ligament (LCL) sign is the presence of the full length of the LCL visualized on a single coronal magnetic resonance imaging (MRI) slice at the posterolateral corner of the knee. The coronal LCL sign has been shown to be associated with elevated measures of anterior tibial translation and internal rotation in the setting of anterior cruciate ligament (ACL) tear. HYPOTHESIS The coronal LCL sign (with greater anterior translation, internal rotation, and posterior slope of the tibia) will indicate a greater risk for graft failure after ACL reconstructive surgery. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Retrospective review was performed of adolescent patients with ACL reconstruction: a cohort without graft failure and a cohort with graft failure. MRI was utilized to measure tibial translation and femorotibial rotation and to identify the coronal LCL sign. The posterior tibial slope was measured on lateral radiographs. Patient-reported outcomes were collected. RESULTS We identified 114 patients with no graft failure and 39 patients with graft failure who met all criteria, with a mean follow-up time of 3.5 years (range, 2-9.4 years). Anterior tibial translation was associated with anterolateral complex injury (P < .001) but not graft failure (P = .06). Internal tibial rotation was associated with anterolateral complex injury (P < .001) and graft failure (P = .042). Posterior tibial slope was associated with graft failure (P = .044). The coronal LCL sign was associated with anterolateral complex injury (P < .001) and graft failure (P = .013), with an odds ratio of 4.3 for graft failure (95% CI, 1.6-11.6; P = .003). Subjective patient-reported outcomes and return to previous level of sport were not associated with failure. Comparison of MRI before and after ACL reconstruction in the graft failure cohort demonstrated a reduced value in internal rotation (P = .003) but no change in coronal LCL sign (P = .922). CONCLUSION Our study demonstrates that tibial internal rotation and posterior slope are independent predictors of ACL graft failure in adolescents. Although the value of internal rotation could be improved with ACL reconstruction, the presence of the coronal LCL sign persisted over time and was predictive of graft rupture (without the need to make measurements or memorize values of significant risk). Together, these factors indicate that greater initial knee deformity after initial ACL tear predicts greater risk for future graft failure.
Collapse
Affiliation(s)
- Brendon C Mitchell
- Department of Orthopaedic Surgery, University of California-San Diego, San Diego, California, USA
| | - Matthew Y Siow
- Department of Orthopaedic Surgery, University of California-San Diego, San Diego, California, USA
| | - Tracey Bastrom
- Division of Orthopaedic Surgery, Rady Children's Hospital, San Diego, California, USA
| | - James D Bomar
- Division of Orthopaedic Surgery, Rady Children's Hospital, San Diego, California, USA
| | - Andrew T Pennock
- Division of Orthopaedic Surgery, Rady Children's Hospital, San Diego, California, USA
| | - Kevin Parvaresh
- Department of Orthopaedic Surgery, Rush Medical Center, Chicago, Illinois, USA
| | - Eric W Edmonds
- Division of Orthopaedic Surgery, Rady Children's Hospital, San Diego, California, USA
| |
Collapse
|
22
|
Ogrodzka-Ciechanowicz K, Stolarz M, Gła̧b G, Ślusarski J, Ga̧dek A. Biomechanical image of the knee motion in patients with chronic anterior instability of the knee joint before and after Kinesio Taping. J Back Musculoskelet Rehabil 2020; 33:169-177. [PMID: 31524135 DOI: 10.3233/bmr-160770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVE In the available literature there are no reports on the effectiveness of Kinesio Taping (KT) in the conservative treatment of patients with anterior instability of the knee. The purpose of the present research was to evaluate the influence of the selected KT technique in limiting the anterior translation of the tibia by performing a biomechanical analysis of the gait cycle of patients with anterior instability of the knee. METHODS A total of 31 patients qualified for the single group study. In all patients, a total tear of the anterior cruciate ligament was diagnosed. The research tool was a three-dimensional motion analysis BTS SMART system. The effectiveness of KT of the knee with an anterior cruciate ligament tear was assessed based on angular changes in the movement of the knee in three planes of motion during specific phases of the gait cycle. RESULTS The results show that KT does not significantly affect angular values of the knee joint in the sagittal and transverse planes of the affected and healthy limb during selected phases of the gait cycle. CONCLUSIONS Due to only observed changes in the frontal plane, the KT method should be modified to also improve knee function in other planes.
Collapse
Affiliation(s)
| | - Maciej Stolarz
- Vichy-Clermont Ferrand Institut de Formation Supérieure en Ostéopathie, Vichy, France
| | - Grzegorz Gła̧b
- Department of Physiotherapy, Faculty of Motor Rehabilitation, University of Physical Education, Krakow, Poland
| | - Jakub Ślusarski
- Department of Orthopaedics and Rehabilitation, University Hospital, Krakow, Poland
| | - Artur Ga̧dek
- Department of Orthopaedics and Rehabilitation, University Hospital, Krakow, Poland.,Department of Orthopaedics and Physiotherapy, Jagiellonian University Collegium Medicum, Krakow, Poland
| |
Collapse
|
23
|
Saad A, Waldron D, Iqbal A, Evans S, Panchal H, James S, Davies M, Botchu R. Anterior translation of the tibia in relation to femur in mucoid degeneration of ACL - An observational study. J Orthop 2020; 18:240-243. [PMID: 32071511 DOI: 10.1016/j.jor.2020.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 02/02/2020] [Indexed: 11/27/2022] Open
Abstract
Background Mucoid degeneration (MD) of the anterior cruciate ligament (ACL) are a well-known pathological entity.We have encountered several patients with MD of the ACL, found to have a anterior translation of tibia a exceeding 5 mm with an intact ACL. We studied this cohort and investigated the likely cause of this. Methods A retrospective search of our department's radiology system to identify all patients referred from the knee orthopaedic clinic for MR imaging over a span of 10 years. All patients had MD within the substance of the ACL and an intact ACL. We evaluated the degree of anterior translation of the tibia (ATT) in relation to the femur in mucoid degeneration of ACL. Results We identified 464 consecutive cases. The mean age was 52 years. There was a male predominance of 261 to 203 female. The average PTF measurement was 2.4 mm with a range of 0-20mm. Of the 464 cases, 3 397 patients had an insignificant ATT of < 5 mm. (0mm. 67. 67 67 patients had a ATT >5 mm. Of them, 32.8% had a ATT of 6 mm, 53.7% had a ATT range between 7 and 9 mm, with the remaining 13.4% above 9 mm in length. Conclusion It is essential to look for other secondary signs of ACL tears and not only focus on ATT as well as correlate this with clinical findings.
Collapse
Affiliation(s)
- A Saad
- The Royal Orthopaedic Hospital, The Woodlands, Bristol Rd S, Birmingham, B31 2AP, United Kingdom
| | - D Waldron
- The Royal Orthopaedic Hospital, The Woodlands, Bristol Rd S, Birmingham, B31 2AP, United Kingdom
| | - A Iqbal
- The Royal Orthopaedic Hospital, The Woodlands, Bristol Rd S, Birmingham, B31 2AP, United Kingdom
| | - S Evans
- The Royal Orthopaedic Hospital, The Woodlands, Bristol Rd S, Birmingham, B31 2AP, United Kingdom
| | - H Panchal
- Sanya Pixel Diagnostics, Ahmedabad, India
| | - S James
- The Royal Orthopaedic Hospital, The Woodlands, Bristol Rd S, Birmingham, B31 2AP, United Kingdom
| | - M Davies
- The Royal Orthopaedic Hospital, The Woodlands, Bristol Rd S, Birmingham, B31 2AP, United Kingdom
| | - R Botchu
- The Royal Orthopaedic Hospital, The Woodlands, Bristol Rd S, Birmingham, B31 2AP, United Kingdom
| |
Collapse
|
24
|
Avulsion fractures of the knee: a review of the pathophysiology, radiographic, and cross-sectional imaging features. Emerg Radiol 2019; 26:683-689. [PMID: 31410608 DOI: 10.1007/s10140-019-01711-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 07/22/2019] [Indexed: 10/26/2022]
Abstract
Knee trauma is a common presenting symptom in the emergency setting. Avulsive knee injuries are important to diagnose timely and accurately to avoid unnecessary patient morbidity. Many of these avulsive knee injuries have characteristic appearances on imaging. This article presents a comprehensive review of some of the most common types with real cases used for imaging correlation.
Collapse
|
25
|
Chen J, Kim J, Shao W, Schlecht SH, Baek SY, Jones AK, Ahn T, Ashton-Miller JA, Banaszak Holl MM, Wojtys EM. An Anterior Cruciate Ligament Failure Mechanism. Am J Sports Med 2019; 47:2067-2076. [PMID: 31307223 PMCID: PMC6905051 DOI: 10.1177/0363546519854450] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Nearly three-quarters of anterior cruciate ligament (ACL) injuries occur as "noncontact" failures from routine athletic maneuvers. Recent in vitro studies revealed that repetitive strenuous submaximal knee loading known to especially strain the ACL can lead to its fatigue failure, often at the ACL femoral enthesis. HYPOTHESIS ACL failure can be caused by accumulated tissue fatigue damage: specifically, chemical and structural evidence of this fatigue process will be found at the femoral enthesis of ACLs from tested cadaveric knees, as well as in ACL explants removed from patients undergoing ACL reconstruction. STUDY DESIGN Controlled laboratory study. METHODS One knee from each of 7 pairs of adult cadaveric knees were repetitively loaded under 4 times-body weight simulated pivot landings known to strain the ACL submaximally while the contralateral, unloaded knee was used as a comparison. The chemical and structural changes associated with this repetitive loading were characterized at the ACL femoral enthesis at multiple hierarchical collagen levels by employing atomic force microscopy (AFM), AFM-infrared spectroscopy, molecular targeting with a fluorescently labeled collagen hybridizing peptide, and second harmonic imaging microscopy. Explants from ACL femoral entheses from the injured knee of 5 patients with noncontact ACL failure were also characterized via similar methods. RESULTS AFM-infrared spectroscopy and collagen hybridizing peptide binding indicate that the characteristic molecular damage was an unraveling of the collagen molecular triple helix. AFM detected disruption of collagen fibrils in the forms of reduced topographical surface thickness and the induction of ~30- to 100-nm voids in the collagen fibril matrix for mechanically tested samples. Second harmonic imaging microscopy detected the induction of ~10- to 100-µm regions where the noncentrosymmetric structure of collagen had been disrupted. These mechanically induced changes, ranging from molecular to microscale disruption of normal collagen structure, represent a previously unreported aspect of tissue fatigue damage in noncontact ACL failure. Confirmatory evidence came from the explants of 5 patients undergoing ACL reconstruction, which exhibited the same pattern of molecular, nanoscale, and microscale structural damage detected in the mechanically tested cadaveric samples. CONCLUSION The authors found evidence of accumulated damage to collagen fibrils and fibers at the ACL femoral enthesis at the time of surgery for noncontact ACL failure. This tissue damage was similar to that found in donor knees subjected in vitro to repetitive 4 times-body weight impulsive 3-dimensional loading known to cause a fatigue failure of the ACL. CLINICAL RELEVANCE These findings suggest that some ACL injuries may be due to an exacerbation of preexisting hierarchical tissue damage from activities known to place larger-than-normal loads on the ACL. Too rapid an increase in these activities could cause ACL tissue damage to accumulate across length scales, thereby affecting ACL structural integrity before it has time to repair. Prevention necessitates an understanding of how ACL loading magnitude and frequency are anabolic, neutral, or catabolic to the ligament.
Collapse
Affiliation(s)
- Junjie Chen
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
- Department of Chemistry, University of Michigan, Ann Arbor, MI, USA
| | - Jinhee Kim
- Department of Chemistry, University of Michigan, Ann Arbor, MI, USA
| | - Wenhao Shao
- Department of Chemistry, University of Michigan, Ann Arbor, MI, USA
| | - Stephen H. Schlecht
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - So Young Baek
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Alexis K. Jones
- Department of Chemistry, University of Michigan, Ann Arbor, MI, USA
| | - Taeyong Ahn
- Macromolecular Science and Engineering, University of Michigan, Ann Arbor, MI, USA
| | | | | | - Edward M. Wojtys
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
26
|
Pauvert A, Robert H, Gicquel P, Graveleau N, Pujol N, Chotel F, Lefevre N. MRI study of the ligamentization of ACL grafts in children with open growth plates. Orthop Traumatol Surg Res 2018; 104:S161-S167. [PMID: 30314939 DOI: 10.1016/j.otsr.2018.09.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 09/06/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION There is little published information on the ligamentization of pediatric anterior cruciate ligament (ACL) grafts. The aims of our study were to compare the MRI appearance of ACL grafts performed in a population with open growth plates to normal ACLs in adolescents and to determine whether the MRI signal in the grafts at 6 months could predict a retear. We hypothesized that ligamentization was a slow, gradual process. MATERIAL AND METHODS This was a prospective multicenter study of 100 ACL grafts (quadriceps tendon, hamstring tendon, fascia lata) in children 7 to 16 years of age. Of these, 65 intact grafts underwent one or more MRI examinations between 6 months and 2 years postoperative. MRI images were also analyzed in 7 patients who suffered a retear and in the intact ACL of 20 adolescents (15 to 18 years of age). The other 28 patients did not undergo an MRI during the postoperative phase. For each MRI, the signal-to-noise quotient (SNQ) was calculated in three different areas in the ACL (proximal, middle, distal) along with the Howell intra-articular and intra-tibial grades from I to IV. The Mantel-Haenszel Chi-square, Wilcoxon signed-rank test and Student's t-test were used to compare groups. The Lin concordance correlation coefficients were calculated for inter-rater consistency. RESULTS There was a difference in the SNQ between the three zones of a normal ACL. Most were Howell grade III (55% Howell III, 25% Howell II and 20% Howell I). For intact grafts, the SNQ improved significantly between 6 and 12 months and between 6 and 24 months. There was no difference in the SNQ between the three zones independent of the postoperative time point. The intra-articular Howell grade improved significantly between 6 and 24 months and between 12 and 24 months. The intra-tibial Howell grade improved significantly between 12 and 24 months. There were no significant differences between patients with intact grafts and those who suffered a retear. There were no differences between the various types of grafts used. CONCLUSION Normal ACLs in adolescents have inhomogeneous SNQ and Howell grades. The SNQ and Howell grades in ACL grafts are more homogeneous and continue to improve out to 2 years, but do not reach that of a normal ACL. The signal and appearance of an ACL graft and normal ACL are very different, and the MRI signal at 6 months postoperative is not predictive of retear. LEVEL OF EVIDENCE III, prospective study.
Collapse
Affiliation(s)
- Adrien Pauvert
- Department of Orthopaedic Surgery, Centre hospitalier Nord Mayenne, 229 boulevard Paul-Lintier, 53100 Mayenne, France.
| | - Henri Robert
- Department of Orthopaedic Surgery, Centre hospitalier Nord Mayenne, 229 boulevard Paul-Lintier, 53100 Mayenne, France
| | - Philippe Gicquel
- Pediatric orthopedics department, Strasbourg university hospital center, Hautepierre hospital, avevue Molière, 67098 Strasbourg, France
| | - Nicolas Graveleau
- CCOS & Sport clinic of Bordeaux-Mérignac, 2, avenue Georges-de-Negrevergne, 33700 Mérignac, France
| | - Nicolas Pujol
- Department Orthopaedic Surgery, Centre Hospitalier de Versailles, 177, rue de Versailles, 78150 Le Chesnay, France
| | - Franck Chotel
- Pediatric orthopedics department, Hôpital Femme Mere Enfant, 59, boulevard Pinel, 69677, Lyon, France
| | - Nicolas Lefevre
- Department Orthopaedic Sport Surgery, Clinique du sport, Groupe Ramsay-Générale de Santé, 36 boulevard St Marcel, 75005 Paris, France; Orthopaedic Institut, Clinique Nollet, 23, rue Brochant, 75017 Paris, France
| | -
- 15 rue Ampère, 92500 Rueil Malmaison, France
| |
Collapse
|
27
|
Centeno C, Markle J, Dodson E, Stemper I, Williams C, Hyzy M, Ichim T, Freeman M. Symptomatic anterior cruciate ligament tears treated with percutaneous injection of autologous bone marrow concentrate and platelet products: a non-controlled registry study. J Transl Med 2018; 16:246. [PMID: 30176875 PMCID: PMC6122476 DOI: 10.1186/s12967-018-1623-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 08/29/2018] [Indexed: 12/13/2022] Open
Abstract
Background Bone marrow concentrate (BMC) has shown promise in the treatment of several orthopedic conditions. This registry study investigated the use of autologous BMC and platelet products for percutaneous anterior cruciate ligament (ACL) treatment. Methods Twenty-nine patients presenting to a single outpatient interventional musculoskeletal and pain practice with symptomatic grade 1, 2, or 3 ACL tears with less than 1 cm retraction were enrolled. Patients were treated with a percutaneous ACL injection of autologous BMC and platelet products using fluoroscopic guidance. Pre- and post-treatment magnetic resonance imaging analysis was completed for 23 patients using ImageJ software for an objective quantitative analysis of pixel density as a proxy for ACL integrity. Subjective clinical outcome measures collected pre-treatment and at 1, 3, 6, 12, 18, 24, and 36 months post-treatment include the Numerical Pain Scale (NPS), the Lower Extremity Functional Scale (LEFS), the International Knee Documentation Committee (IKDC) form, and a modified version of the Single Assessment Numeric Evaluation. Results Seventy-seven percent of patients treated with BMC injections into the ACL showed significant improvement (p < 0.01) in objective measures of ACL integrity at an average of 8.8 months (median 4.7 months). The mean of last patient-reported improvement was 72% (SD = 35) at an average of 23 (SD = 10) months post-treatment. Mean scores were found to be significantly different (p < 0.05) for the NPS at 6, 18, and 24 months, and LEFS and IKDC at all time points (i.e. 1, 3, 6, 12, 18, 24, and 36 months) relative to baseline. Conclusion In symptomatic patients with grade 1, 2, or even grade 3 tears with minimal retraction, ACL treatment with percutaneous injection of BMC and platelet products shows promise as a non-surgical alternative. However, a larger randomized controlled trial is warranted to confirm these findings. Trial registration NCT03011398. A Clinical Registry of Orthobiologics Procedures. https://clinicaltrials.gov/ct2/show/NCT03011398?term=orthobiologics&rank=1. Registered 29 December 2016. Enrollment 1 December 2011-retrospectively registered
Collapse
Affiliation(s)
- Christopher Centeno
- Centeno-Schultz Clinic, 403 Summit Blvd Suite 201, Broomfield, CO, 80021, USA.,Regenexx, LLC, Des Moines, IA, 50321, USA
| | - Jason Markle
- Centeno-Schultz Clinic, 403 Summit Blvd Suite 201, Broomfield, CO, 80021, USA
| | | | | | | | - Matthew Hyzy
- Centeno-Schultz Clinic, 403 Summit Blvd Suite 201, Broomfield, CO, 80021, USA
| | | | - Michael Freeman
- CAPHRI School of Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
28
|
The clinical relevance of PCL index on the reconstruction of anterior cruciate ligament with hamstring tendon autograft. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2018; 29:111-117. [PMID: 30101360 DOI: 10.1007/s00590-018-2292-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 08/05/2018] [Indexed: 10/28/2022]
Abstract
The posterior cruciate ligament index (PCL index) has been reported as a diagnostic and prognostic marker for anterior cruciate ligament (ACL) reconstruction. The clinical relevance of PCL index on the reconstruction of ACL with hamstring tendon autograft has not been described in the literature. The objective of this study is to evaluate the importance of the PCL index as a marker of anatomic reconstruction and of functional improvement of patients undergoing ACL reconstruction with HT autograft. Twenty-four patients were submitted to ACL reconstruction with HT autograft. The PCL index was assessed by magnetic resonance imaging before and after surgery. The functional evaluation was performed through the International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form© and Knee Society Knee Scoring System© (IKS). Patients presented a significant positive variation of the PCL index, IKDC and IKS scores. There is no significant correlation between PCL index variation and IKDC and IKS scores (p > 0.05). Unlike other studies reporting a relationship between the PCL index, control of rotational kinematics, and functional improvement in patients undergoing ACL reconstruction with bone-patellar tendon-bone autograft, this study does not demonstrate this association. There is evidence in this study to show that the PCL index may be used as an anatomic reconstructive marker of ACL but not to predict the clinical outcome in this type of reconstruction.
Collapse
|
29
|
Analysis of the risk factors for anterior cruciate ligament injury: an investigation of structural tendencies. Clin Imaging 2018; 50:20-30. [DOI: 10.1016/j.clinimag.2017.12.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 10/27/2017] [Accepted: 12/08/2017] [Indexed: 01/12/2023]
|
30
|
van der Bruggen W, Hirschmann MT, Strobel K, Kampen WU, Kuwert T, Gnanasegaran G, Van den Wyngaert T, Paycha F. SPECT/CT in the Postoperative Painful Knee. Semin Nucl Med 2018; 48:439-453. [PMID: 30193650 DOI: 10.1053/j.semnuclmed.2018.05.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
This review summarizes the role of SPECT/CT in patients with a painful postoperative knee and describes typical diagnostic criteria in these patients. Pain after knee surgery is common and is influenced by the underlying pathology, the type of surgery, and the patient. Knee joint-preserving surgery includes osteotomy, ligament reconstruction, meniscus surgery, and cartilage repair procedures, often used in combination. Knee arthroplasty procedures consist of unicondylar, patellofemoral, and primary or revision total knee prosthesis. In patients with pain after knee joint-preserving surgery, MRI remains the reference standard. After ligament reconstruction, CT can evaluate postoperative tunnel positioning, and bone SPECT/CT can contribute by assessing overloading or biodegradation problems. After meniscal or cartilage surgery, SPECT/CT can be particularly helpful to identify compartment overloading or nonhealing chondral or osteochondral lesions as cause of pain. SPECT/CT arthrography can assess cartilage damage at an early stage due to altered biomechanical forces. After corrective osteotomy of the knee, SPECT/CT can reveal complications such as overloading, nonunion, or patellofemoral problems. After arthroplasty, conventional radiographs lack both sensitivity to detect aseptic loosening and specificity in differentiating aseptic from infectious loosening. Secondly, hardware-induced artifacts still hamper CT and MRI, despite improving and increasingly available metal artifact reduction techniques. Bone scintigraphy is a proven useful adjunct to conventional radiography and MRI to reveal the pain generator and is less hampered by artifacts from metallic implants compared with CT and MRI. Nevertheless, the optimal imaging strategy in evaluating complications after knee arthroplasty is still a matter of debate. Although the evidence of the use of BS SPECT/CT is still limited, it is growing steadily. In particular, recent data on specific uptake patterns in tibial and femoral zones after total knee arthroplasty and the impact of integrating biomechanics into the assessment of SPECT/CT appear promising, but more research is needed.
Collapse
Affiliation(s)
- Wouter van der Bruggen
- Department of Radiology and Nuclear Medicine, Slingeland Hospital, Doetinchem, The Netherlands..
| | - Michael T Hirschmann
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), Bruderholz, Switzerland
| | - Klaus Strobel
- Department of Radiology and Nuclear Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | | | - Torsten Kuwert
- Clinic of Nuclear Medicine, University Hospital Erlangen, Erlangen, Germany
| | - Gopinath Gnanasegaran
- Department of Nuclear Medicine, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Tim Van den Wyngaert
- Department of Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium.; Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Frédéric Paycha
- Department of Nuclear Medicine, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France
| |
Collapse
|
31
|
Daniels SP, van der List JP, Kazam JJ, DiFelice GS. Arthroscopic primary repair of the anterior cruciate ligament: what the radiologist needs to know. Skeletal Radiol 2018; 47:619-629. [PMID: 29285553 DOI: 10.1007/s00256-017-2857-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 11/18/2017] [Accepted: 12/12/2017] [Indexed: 02/02/2023]
Abstract
Recently, there has been a renewed interest in primary repair of proximal anterior cruciate ligament (ACL) tears. Magnetic resonance imaging (MRI) plays an important role in preoperative patient selection and in postoperative ligament assessment. Knowledge of the imaging factors that make patients candidates for primary ACL repair, namely proximal tear location and good tissue quality, can help radiologists provide information that is meaningful for surgical decision making. Furthermore, an understanding of the surgical techniques can prevent misinterpretation of the postoperative MRI. This article reviews preoperative MRI characterization of ACL injuries, techniques of arthroscopic primary ACL repair surgery and examples of postoperative MRI findings.
Collapse
Affiliation(s)
- Steven P Daniels
- Department of Radiology, New York Presbyterian Hospital-Weill Cornell Medical Center, 525 East 68th Street, Box 141, New York, NY, 10065, USA.
| | - Jelle P van der List
- Orthopedic Trauma and Sports Medicine Services, Hospital for Special Surgery, 535 E. 70th St, New York, NY, 10021, USA
| | - J Jacob Kazam
- Department of Radiology, New York Presbyterian Hospital-Weill Cornell Medical Center, 525 East 68th Street, Box 141, New York, NY, 10065, USA
| | - Gregory S DiFelice
- Orthopedic Trauma and Sports Medicine Services, Hospital for Special Surgery, 535 E. 70th St, New York, NY, 10021, USA
| |
Collapse
|
32
|
Kwee RM, Hafezi-Nejad N, Roemer FW, Zikria BA, Hunter DJ, Guermazi A, Demehri S. Association of Mucoid Degeneration of the Anterior Cruciate Ligament at MR Imaging with Medial Tibiofemoral Osteoarthritis Progression at Radiography: Data from the Osteoarthritis Initiative. Radiology 2018; 287:912-921. [PMID: 29465334 DOI: 10.1148/radiol.2018171565] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Purpose To determine whether anterior cruciate ligament (ACL) mucoid degeneration in participants with or at risk for osteoarthritis is associated with longitudinal risk of radiographic progression of medial tibiofemoral compartment joint space loss (JSL). Materials and Methods Baseline demographic, clinical, radiographic, and Magnetic Resonance (MR) Imaging Osteoarthritis Knee Score (MOAKS) data were evaluated in 600 participants from the Osteoarthritis Initiative database. Two blinded musculoskeletal radiologists independently evaluated baseline MR images for ACL mucoid degeneration. Multiple logistic regression was used to investigate the association between ACL mucoid degeneration at MR imaging and JSL progression at radiography, defined as a minimum joint space width decrease greater than 0.7 mm (48 months; cutoff according to mean and standard deviation of 1-year minimum joint space width changes in 90 knees of reference group). Stratified analysis was performed based on baseline cartilage surface damage. Results Knees with ACL mucoid degeneration showed a greater proportion of JSL progression compared with knees with a normal ACL (64% vs 47%; P = .004). After adjustment for all demographic, clinical, radiographic, and MOAKS variables, ACL mucoid degeneration was not statistically significantly associated with JSL progression in the entire cohort (adjusted odds ratio, 1.66; 95% confidence interval: 1.00, 2.77; P = .051). In subgroup analysis, ACL mucoid degeneration was statistically significantly associated with JSL progression in participants with less baseline cartilage surface damage (maximum cartilage surface loss of ≤75% in all subregions [P = .015] and ≤4 of involved subregions with cartilage surface loss [P = .028]). Conclusion ACL mucoid degeneration in participants with or at risk for osteoarthritis is associated with progression of medial tibiofemoral compartment JSL in knees with less baseline cartilage surface area damage. © RSNA, 2018 Online supplemental material is available for this article.
Collapse
Affiliation(s)
- Robert M Kwee
- From the Russell H. Morgan Department of Radiology and Radiological Science (R.M.K., N.H.N., S.D.) and Department of Orthopaedic Surgery (B.A.Z.), Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC 5165, Baltimore, Md 21287; Department of Radiology, Zuyderland Medical Center, Heerlen, the Netherlands (R.M.K.); Department of Radiology, Boston University School of Medicine, Boston, Mass (F.W.R., A.G.); Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany (F.W.K.); and Department of Rheumatology, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, Australia (D.J.H.)
| | - Nima Hafezi-Nejad
- From the Russell H. Morgan Department of Radiology and Radiological Science (R.M.K., N.H.N., S.D.) and Department of Orthopaedic Surgery (B.A.Z.), Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC 5165, Baltimore, Md 21287; Department of Radiology, Zuyderland Medical Center, Heerlen, the Netherlands (R.M.K.); Department of Radiology, Boston University School of Medicine, Boston, Mass (F.W.R., A.G.); Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany (F.W.K.); and Department of Rheumatology, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, Australia (D.J.H.)
| | - Frank W Roemer
- From the Russell H. Morgan Department of Radiology and Radiological Science (R.M.K., N.H.N., S.D.) and Department of Orthopaedic Surgery (B.A.Z.), Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC 5165, Baltimore, Md 21287; Department of Radiology, Zuyderland Medical Center, Heerlen, the Netherlands (R.M.K.); Department of Radiology, Boston University School of Medicine, Boston, Mass (F.W.R., A.G.); Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany (F.W.K.); and Department of Rheumatology, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, Australia (D.J.H.)
| | - Bashir A Zikria
- From the Russell H. Morgan Department of Radiology and Radiological Science (R.M.K., N.H.N., S.D.) and Department of Orthopaedic Surgery (B.A.Z.), Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC 5165, Baltimore, Md 21287; Department of Radiology, Zuyderland Medical Center, Heerlen, the Netherlands (R.M.K.); Department of Radiology, Boston University School of Medicine, Boston, Mass (F.W.R., A.G.); Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany (F.W.K.); and Department of Rheumatology, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, Australia (D.J.H.)
| | - David J Hunter
- From the Russell H. Morgan Department of Radiology and Radiological Science (R.M.K., N.H.N., S.D.) and Department of Orthopaedic Surgery (B.A.Z.), Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC 5165, Baltimore, Md 21287; Department of Radiology, Zuyderland Medical Center, Heerlen, the Netherlands (R.M.K.); Department of Radiology, Boston University School of Medicine, Boston, Mass (F.W.R., A.G.); Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany (F.W.K.); and Department of Rheumatology, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, Australia (D.J.H.)
| | - Ali Guermazi
- From the Russell H. Morgan Department of Radiology and Radiological Science (R.M.K., N.H.N., S.D.) and Department of Orthopaedic Surgery (B.A.Z.), Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC 5165, Baltimore, Md 21287; Department of Radiology, Zuyderland Medical Center, Heerlen, the Netherlands (R.M.K.); Department of Radiology, Boston University School of Medicine, Boston, Mass (F.W.R., A.G.); Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany (F.W.K.); and Department of Rheumatology, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, Australia (D.J.H.)
| | - Shadpour Demehri
- From the Russell H. Morgan Department of Radiology and Radiological Science (R.M.K., N.H.N., S.D.) and Department of Orthopaedic Surgery (B.A.Z.), Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC 5165, Baltimore, Md 21287; Department of Radiology, Zuyderland Medical Center, Heerlen, the Netherlands (R.M.K.); Department of Radiology, Boston University School of Medicine, Boston, Mass (F.W.R., A.G.); Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany (F.W.K.); and Department of Rheumatology, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, Australia (D.J.H.)
| |
Collapse
|
33
|
Anterior cruciate ligament fixation devices: Expected imaging appearance and common complications. Eur J Radiol 2018; 99:17-27. [DOI: 10.1016/j.ejrad.2017.12.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 10/23/2017] [Accepted: 12/08/2017] [Indexed: 11/21/2022]
|
34
|
Parkar AP, Bleskestad K, Løken S, Adriaensen MEAPM, Solheim E. Protruding anterior medial meniscus-An indirect sign of posterior cruciate ligament deficiency. Eur J Radiol 2018; 99:146-153. [PMID: 29362146 DOI: 10.1016/j.ejrad.2017.12.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 10/24/2017] [Accepted: 12/31/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND to examine if PROTruding of the Anterior Medial Meniscus (PROTAMM) could be an indirect sign of PCL deficiency by comparing PROTAMM to passive posterior tibial sagging (PSS) for chronic PCL rupture on routine MRI. METHODS Patients with PCL reconstruction between 2011 and 2016 were included in a case control study. Primarily cases with combined ACL/PCL injury were excluded. Secondary exclusion criteria were bony fractures, medial meniscus pathology and poor quality MRIs. Three (blinded) observers reviewed the pre-operative MRIs according to a pre-defined protocol. RESULTS After applying the inclusion and primary exclusion criteria 16 patients were identified in the PCL rupture group. The control group consisted of 15 patients. After reviewing the MRIs, 6 were excluded due to secondary exclusion criteria. Mean PPS measured 4.8 mm (± 4.4 mm) in the PCL rupture group and 1.8 mm (±2.9 mm) in the control group, p = 0.05. Mean PROTAMM was 3.6 mm (±0.6 mm) in the PCL rupture group and 0.7 mm (±0.9 mm) in the control group, p = 0.004. CONCLUSION We found a mean PROTAMM of 3.6 mm in patients with PCL rupture. We suggest that this sign, after knee injury in an otherwise normal medial meniscus, is a promising indirect sign of PCL deficiency compared to PPS. Implementation of this sign in clinical practice may improve the sensitivity of routine non-weight bearing MRI in identifying PCL deficient knees.
Collapse
Affiliation(s)
- Anagha P Parkar
- Radiology Department, Haraldsplass Deaconess Hospital, Ulriksdal 8, N-5009 Bergen, Norway; Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Postboks 7804, N-5020, Bergen, Norway.
| | - Kristiane Bleskestad
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Postboks 7804, N-5020, Bergen, Norway.
| | - Susanne Løken
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Postboks 7804, N-5020, Bergen, Norway.
| | - Miraude E A P M Adriaensen
- Department of Radiology, Zuyderland Medical Center, Henri Dunantstraat 5, 6419 PC Heerlen, The Netherlands.
| | - Eirik Solheim
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Postboks 7804, N-5020, Bergen, Norway.
| |
Collapse
|
35
|
Achtnich A, Beitzel K, Imhoff AB, Petersen W. Arthroskopische Refixation proximaler Ausrisse des vorderen Kreuzbands. ARTHROSKOPIE 2017. [DOI: 10.1007/s00142-017-0182-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
36
|
|
37
|
Acute Proximal Anterior Cruciate Ligament Tears: Outcomes After Arthroscopic Suture Anchor Repair Versus Anatomic Single-Bundle Reconstruction. Arthroscopy 2016; 32:2562-2569. [PMID: 27324969 DOI: 10.1016/j.arthro.2016.04.031] [Citation(s) in RCA: 122] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 04/23/2016] [Accepted: 04/26/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare clinical and radiologic results of primary anterior cruciate ligament (ACL) suture anchor repair and microfracturing with anatomic ACL single-bundle reconstruction in patients with acute proximal ACL avulsion tears. METHODS Between January 2010 and December 2013, 420 patients underwent ACL treatment. Forty-one patients were included in this study. The inclusion criteria were as follows: unilateral acute proximal ACL rupture, concomitant meniscus lesions, no previous knee ligament surgery, and no additional ligament injuries or absence of ligament injury of the contralateral knee. Preoperative magnetic resonance imaging confirming a proximal avulsion tear of the ACL was required. Patients had to undergo surgical treatment within 6 weeks after injury. Follow-up examination included Lachman and pivot-shift testing, KT-1000 measurement, and the International Knee Documentation Committee score. RESULTS At a mean follow-up of 28 months (range, 24 to 31 month), 20 patients in each group were available. A mean KT-1000 arthrometer result of less than 3 mm indicated stability in all patients (P = .269). Three patients had a 1+ Lachman test (P = .072) and 4 patients had a 1+ pivot-shift test in the ACL repair group (P = .342). The International Knee Documentation Committee score results did not differ significantly (P > .99), but there was a significant correlation between poor results and failure rate (P = .001) in the refixation group. The failure rate was 15% in the ACL refixation group and 0% in the reconstruction group (P = .231). Magnetic resonance imaging confirmed homogeneous signal and proper ACL position in 100% of patients in the control group and 86% in the ACL repair group. CONCLUSIONS Proximal refixation of the ACL using knotless suture anchors and microfracturing restores knee stability and results in comparable functional outcomes to a control group treated with single-bundle ACL reconstruction. The results suggest that refixation of the ACL is a feasible treatment option in selected patients. LEVEL OF EVIDENCE Level III, case-control study.
Collapse
|
38
|
Abstract
The anterior and posterior cruciate ligaments are important stabilizers of the knee joint function. Although they are both similar in their native appearance, they possess slightly different properties and complement each other's function. The imaging findings differ between the anterior and posterior cruciate ligaments. While MRI is the main imaging modality, radiographs and CT have a role in pre- and post-operative imaging. The aim of this review is to present pre-and post-operative imaging findings of injured cruciate ligaments. A special emphasis will be placed on the potential pitfalls in cruciate ligament imaging.
Collapse
|
39
|
[Arthroscopic refixation of acute proximal anterior cruciate ligament rupture using suture anchors]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2016; 29:173-179. [PMID: 27770156 DOI: 10.1007/s00064-016-0470-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 08/03/2016] [Accepted: 08/04/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Arthroscopic assisted suture anchor refixation combined with microfracturing of the femoral ACL insertion zone in cases of acute proximal anterior cruciate ligament (ACL) rupture to restore anatomical and biomechanical properties of the native ACL. INDICATIONS Acute proximal ACL rupture/avulsion, multiligament injury of the knee CONTRAINDICATIONS: Chronic (>6 weeks) proximal ACL rupture, intraligamentary rupture, as well as previous ACL surgery. SURGICAL TECHNIQUE Arthroscopic examination of the knee joint, debridement of the femoral insertion zone, examination of the ligament quality by a probe, insertion of a curved lasso through the ACL to place the sutures and use of a drill guide to place the anchor in the middle of the femoral ACL insertion. Microfracturing holes around the femoral footprint were made by an awl to enhance healing properties of the ACL. POSTOPERATIVE MANAGEMENT Partial weight bearing was permitted and crutches were used for 6 weeks, knee brace limited for the first 2 weeks 0‑0-0°, then 0‑0-90° for the following 4 weeks. RESULTS A total of 20 patients who underwent acute proximal ACL suture anchor refixation were evaluated after a mean follow-up of 28 months. Regarding stability, mean values of the KT-1000 arthrometer indicated stable results (<3 mm), 3 patients had a 1+ Lachman and 4 patients had a 1+ pivot shift. IKDC (International Knee Documentation Committee) score indicated that 17 cases were very good to good (12A, 4B) and in 3 cases the results were satisfactory (3C). Magnetic resonance imaging showed that the ALC was found to be intact in 17 cases. The total rate of revision was 15 % (3/20) because of recurrent instability.
Collapse
|
40
|
Primary repair of the anterior cruciate ligament: A paradigm shift. Surgeon 2016; 15:161-168. [PMID: 27720666 DOI: 10.1016/j.surge.2016.09.006] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 08/31/2016] [Accepted: 09/10/2016] [Indexed: 01/14/2023]
Abstract
Over the last century, many surgical treatments have been developed in the orthopedic field, including treatments of anterior cruciate ligament (ACL) injuries. These treatments ideally evolve in a process of trial and error with prospective comparison of new treatments to the current treatment standard. However, these evolutions are sometimes not linear and periodically undergo paradigm shifts. In this article, we review the evolution of ACL treatment and explain how it underwent a paradigm shift. Open primary ACL repair was the most common treatment in the 1970s and 1980s, but because multiple studies noted deterioration of outcomes at mid-term follow-up, in addition to several randomized clinical trials (RCTs) that noted better outcomes following ACL reconstruction, the open primary repair technique was abandoned. At the end of the primary repair era, however, several studies showed that outcomes of open primary repair were good to excellent and did not deteriorate when this technique was selectively performed in patients with proximal ACL tears, whereas primary repair led to disappointing and unpredictable results in patients with mid-substance tears. Unfortunately, enrollment of patients in the aforementioned RCTs was already finished, ultimately leading to abandoning of open primary repair, despite the advantages of ligament preservation. In this review, we discuss (I) why the evolution of ACL treatment underwent a paradigm shift, (II) which factors may have played a role in this and (III) what the future role of arthroscopic primary ACL repair is in the evolution of ACL treatments.
Collapse
|
41
|
Evaluation of Knee Pain in Athletes: A Radiologist's Perspective. Can Assoc Radiol J 2016; 68:27-40. [PMID: 27681849 DOI: 10.1016/j.carj.2016.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Revised: 08/23/2015] [Accepted: 04/27/2016] [Indexed: 01/03/2023] Open
Abstract
Lower limb injuries account for most of all injuries suffered by athletes and the knee joint accounts for over half of these. The etiology of knee pain is multifactorial; a good history focusing on the mechanism of injury and the chronicity of pain is extremely useful in correlating with radiologic findings and establishing a clinically meaningful diagnosis. This review article will discuss several important and common causes of acute and chronic knee pain in athletes, focusing on their mechanism of injury and site of pain as well as their salient imaging findings.
Collapse
|
42
|
Kwee RM, Ahlawat S, Kompel AJ, Morelli JN, Fayad LM, Zikria BA, Demehri S. Association of mucoid degeneration of anterior cruciate ligament with knee meniscal and cartilage damage. Osteoarthritis Cartilage 2015; 23:1543-50. [PMID: 25907861 DOI: 10.1016/j.joca.2015.04.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 04/06/2015] [Accepted: 04/14/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess the prevalence of anterior cruciate ligament (ACL) mucoid degeneration in patients referred for routine knee magnetic resonance (MR) imaging, and its association with age and structural joint damage. METHOD Four independent radiologists assessed 413 consecutive knee MR examinations for the presence of a normal or ruptured ACL, or ACL mucoid degeneration. Knees with ACL mucoid degeneration were frequency matched by age, sex, and MR field strength with consecutive control knees with a normal ACL (1:2 ratio). Differences in meniscal and cartilage damage of the tibiofemoral compartments, as determined by the Whole-Organ MR Imaging Score (WORMS) system, were compared by Mann-Whitney U tests. Multivariable logistic regression analysis identified the association of ACL mucoid degeneration with severe MTFC cartilage damage (WORMS≥5). RESULTS Patients with ACL mucoid degeneration (n = 36; 36% males; median age 55.5 years, range: 26-81) were older than patients with a normal (P < 0.001) or ruptured ACL (P < 0.001), without sex predilection (P = 0.76), and were more frequently diagnosed at 3 T (12%) compared to 1.5 T (2%). Knees with ACL mucoid degeneration had statistically significantly more medial meniscal (P < 0.001) and central and posterior medial tibiofemoral compartment (MTFC) cartilage (P < 0.001) damage compared with control knees (n = 72), but there were no differences in patients ≤50 years (P = 0.09 and 0.32, respectively). In multivariable logistic regression, severe MTFC cartilage damage (WORMS≥5) was significantly associated with ACL mucoid degeneration (odds ratio 4.09, 95% confidence interval 1.29-12.94, P = 0.016). CONCLUSION There is a strong association between ACL mucoid degeneration and cartilage damage in the central and posterior MTFC, especially in patients >50 years.
Collapse
Affiliation(s)
- R M Kwee
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - S Ahlawat
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - A J Kompel
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - J N Morelli
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - L M Fayad
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - B A Zikria
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - S Demehri
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
| |
Collapse
|
43
|
Salzler M, Nwachukwu BU, Rosas S, Nguyen C, Law TY, Eberle T, McCormick F. State-of-the-art anterior cruciate ligament tears: A primer for primary care physicians. PHYSICIAN SPORTSMED 2015; 43:169-77. [PMID: 25703144 DOI: 10.1080/00913847.2015.1016865] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The purpose of this article is to provide primary care physicians and other members of the medical community with an updated, general review on the subject of anterior cruciate ligament (ACL) tears. We aim to enhance awareness of these injuries and to prepare those practicing in the primary care setting to address these injuries. Because ACL injuries are quite common, it is very likely that a primary care physician will encounter these injuries and need to address them acutely. The current literature is replete with new concepts and controversies regarding ACL injuries, and this article provides a concise review for our target audience in regard to the care of a patient with an ACL injury. This article is composed of an overview with current epidemiologic data, basic anatomy and physiology, clinical presentation, physical examination findings, imaging modalities, and treatment options. After reading this short article, a medical care provider should understand ACL injuries and their appropriate management.
Collapse
Affiliation(s)
- Matt Salzler
- Tufts Medical Center, Department of Orthopedic Surgery , Boston, MA , USA
| | | | | | | | | | | | | |
Collapse
|
44
|
Tan K, Yoong P, Toms AP. Normal anatomical variants of the menisci and cruciate ligaments that may mimic disease. Clin Radiol 2014; 69:1178-85. [PMID: 25060935 DOI: 10.1016/j.crad.2014.06.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2014] [Revised: 06/06/2014] [Accepted: 06/16/2014] [Indexed: 11/30/2022]
Abstract
There are many normal anatomical variants of the knee joint. Some are common and others are rare. With continuing improvements in the spatial resolution of MRI, smaller variants are more clearly demonstrated and can be mistaken for disease. They can all be differentiated from pathological conditions by understanding their anatomy and key differentiating features. This review compares normal variants of the menisci and cruciate ligaments with the pathological disorders that can mimic them.
Collapse
Affiliation(s)
- K Tan
- Department of Radiology, Norfolk and Norwich University Hospital, Colney Lane, Norwich NR4 7UY, UK.
| | - P Yoong
- Department of Radiology, Royal Berkshire Hospital, London Road, Reading RG1 5AN, UK
| | - A P Toms
- Department of Radiology, Norfolk and Norwich University Hospital, Colney Lane, Norwich NR4 7UY, UK
| |
Collapse
|
45
|
Zampeli F, Ntoulia A, Giotis D, Stavros R, Mitsionis G, Pappas E, Georgoulis AD. The PCL index is correlated with the control of rotational kinematics that is achieved after anatomic anterior cruciate ligament reconstruction. Am J Sports Med 2014; 42:665-74. [PMID: 24335494 DOI: 10.1177/0363546513512780] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The posterior cruciate ligament (PCL) index quantifies the curvature of the PCL seen on magnetic resonance imaging (MRI) that is caused by a change in tibiofemoral alignment in the anterior cruciate ligament (ACL)-deficient knee. It has been proposed that the PCL index may be useful in assessing the success of ACL reconstruction (ACLR). Hypothesis/ PURPOSE The purpose of this study was to test if the PCL index is predictive of in vivo rotational kinematics and joint laxity measures in knees of patients after single-bundle ACLR. The hypothesis was that the PCL index is predictive of rotational knee kinematics and objective laxity scores. STUDY DESIGN Controlled laboratory study. METHODS At a mean of 18.1 months postoperatively, the PCL index was defined on MRI in 16 patients prospectively followed up after anatomic single-bundle ACLR and in 16 matched controls. The patients were evaluated with 3-dimensional motion analysis during (1) descending and pivoting as well as (2) landing and pivoting tasks. The side-to-side difference in tibial rotation range of motion between the reconstructed knee and the contralateral intact knee was calculated. The side-to-side difference in anterior tibial translation was measured with a KT-1000 arthrometer. Linear regression models were used with the PCL index as a predictor of the side-to-side difference in tibial rotation for each task and the side-to-side difference in anterior tibial translation. RESULTS The PCL index of the reconstructed knees was significantly lower compared with that of the control knees (P < .001). The index was predictive of the side-to-side difference in tibial rotation during both tasks (R (2) = 0.472 and 0.477, P = .003), with a lower index being indicative of increased rotational laxity. It was not predictive of anterior tibial translation (at 134 N: R (2) = 0.13, P = .17; at maximum force: R (2) = 0.009, P = .726). CONCLUSION The PCL index after anatomic single-bundle ACLR using a bone-patellar tendon-bone graft is predictive of rotational kinematics during in vivo dynamic pivoting activities. The results show that the PCL index is correlated with the postoperative ability to control rotational kinematics of the knee joint. CLINICAL RELEVANCE This study provides evidence regarding the interplay between restoration of the native ACL's anatomy and the PCL's appearance and suggests that the effective restoration of tibiofemoral alignment after ACLR that is reflected in the PCL index translates into better functional outcomes as measured by tibial rotation during pivoting activities.
Collapse
Affiliation(s)
- Franceska Zampeli
- Franceska Zampeli, Orthopaedic Sports Medicine Center, Department of Orthopaedic Surgery, University of Ioannina, Papanastasiou, Arta, 47100, Greece.
| | | | | | | | | | | | | |
Collapse
|