A new method for diagnosis of anterior cruciate ligament tear: MRI with maximum flexion of knee in the prone position: A case control study

Günaydın, Burak; Şahin, Gülcan Gücer; Sari, Abdulkadir; Kara, Adnan; Dinçel, Yaşar Mahsut; Çetin, Murat; Tekin, Cagatay; Kabukçuoğlu, Yavuz

doi:10.1016/j.ijsu.2019.06.017

Cited by 8 publications

(8 citation statements)

References 26 publications

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“…Burak et al [ 18 ] and Muhle et al [ 25 ] described why MRI with knee flexion enabled better visualization of ACL lesions. They found that as knee flexion increased, the femoral adhesion site of the ACL had a more horizontal position and the anteromedial bundle was also tightened.…”

Section: Discussionmentioning

confidence: 99%

“…They found that as knee flexion increased, the femoral adhesion site of the ACL had a more horizontal position and the anteromedial bundle was also tightened. With the increased flexion angle, the ACL moved away from the intercondylar roof at the femoral adhesion site, thus the tear could be better visualized, especially in sagittal MRI scans [ 18 , 25 ]. In addition, with knee flexion, the ACL shape was cylindrical and tears could be better detected [ 18 , 25 ].…”

Section: Discussionmentioning

confidence: 99%

“…With the increased flexion angle, the ACL moved away from the intercondylar roof at the femoral adhesion site, thus the tear could be better visualized, especially in sagittal MRI scans [ 18 , 25 ]. In addition, with knee flexion, the ACL shape was cylindrical and tears could be better detected [ 18 , 25 ]. Total ACL tears were detected with a sensitivity of 83% at full extension of the knee, 83% at 30° knee flexion, and 93% at 55° knee flexion; however, in partial ACL tears, sensitivity was 50% with full extension of the knee, 63% with 30° knee flexion, and 63% with 55° knee flexion [ 18 , 25 ].…”

Section: Discussionmentioning

confidence: 99%

“…In addition, with knee flexion, the ACL shape was cylindrical and tears could be better detected [ 18 , 25 ]. Total ACL tears were detected with a sensitivity of 83% at full extension of the knee, 83% at 30° knee flexion, and 93% at 55° knee flexion; however, in partial ACL tears, sensitivity was 50% with full extension of the knee, 63% with 30° knee flexion, and 63% with 55° knee flexion [ 18 , 25 ]. These findings led to the question of whether an increase in the flexion angle would improve the visualization of a partial ACL tear.…”

Section: Discussionmentioning

confidence: 99%

“…To reduce the interference of tissue signal and improve the visualization of the ligament, optimizing both the patient’s position and the scanning method has attracted considerable attention. According to a previous study [ 18 ], MRI with the patient in the prone position allowed a maximum knee flexion that assisted in the diagnosis and treatment of partial ACL ruptures. In our study, we found that maximum knee flexion occurred in the lateral decubitus position.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of the Use of Magnetic Resonance Imaging of Partial Anterior Cruciate Ligament Tears Using Maximum Knee Flexion in the Lateral Decubitus Position with Routine Knee Positioning

Chen

Zhu

et al. 2021

Med Sci Monit

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Background This study assessed magnetic resonance imaging (MRI) of acute and chronic partial anterior cruciate ligament (ACL) tears using maximum knee flexion in the lateral decubitus position compared with routine knee positioning in 204 patients at a single center. Material/Methods Based on the time interval from injury to MRI examination, the 204 patients in this study were divided into 3 groups: subacute (6 weeks to 3 months), intermediate (3 months to 1 year), and chronic (>1 year). All patients received both routine MRI (MRI R) and maximum knee flexion in the lateral decubitus position MRI (MRI S) examination, followed by knee arthroscopy. Three radiologists blinded to patient groups evaluated the MRI scans and made a diagnosis. Results of knee arthroscopy were referenced as the criterion standard. The sensitivity and specificity of MRI R and MRI S groups were calculated and compared. Results The MRI S diagnostic rate was comparable to that of knee arthroscopy. MRI S had significantly higher sensitivity than MRI R for partial ACL tears, especially in the intermediate group ( P <0.01). Conclusions MRI of partial ACL tears using maximum knee flexion in the lateral decubitus position improved the diagnostic rate relative to routine MRI examination, particularly in patients in the intermediate group.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Comparison of the Use of Magnetic Resonance Imaging of Partial Anterior Cruciate Ligament Tears Using Maximum Knee Flexion in the Lateral Decubitus Position with Routine Knee Positioning

Chen

Zhu

et al. 2021

Med Sci Monit

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The angle of the lower portion of the posterior cruciate ligament assists in the diagnosis of partial anterior cruciate ligament tears

Yang,

Zheng,

Zhang

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeTo compare the difference of angle of the lower portion of the posterior cruciate ligament (PCL) measured via magnetic resonance imaging (MRI) in patients with and without partial anterior cruciate ligament (ACL) tears and to investigate the effectiveness of the angle of the lower portion of the PCL in diagnosing partial ACL tears.MethodsFrom January 2022 to December 2022, a cohort of consecutive patients presenting with ACL tears who underwent ACL reconstruction and patients with isolated meniscus tears undergoing arthroscopic surgery were enroled for this study. The angle of the inferior portion of the PCL comprises α and β angles, and the posterior offset of the lateral condyle were measured on the MRI and compared between the partial ACL tear and control groups. Receiver operating characteristic curves, the areas under the curve (AUCs) and the 95% confidence intervals (CIs) were calculated to identify cutoff values for diagnosing partial ACL injuries.ResultsFollowing an assessment of cohort eligibility and matching for age and sex, 100 patients were included in this study. The mean age of the cohort was 46.1 ± 10.3 years. The AUC for the α angle was 0.88 (95% CI, 0.82–0.94), with a sensitivity of 0.74 and specificity of 0.84 for predicting partial ACL ruptures; the α angle cutoff value was 73.6° (diagnostic odds ratio (OR), 14.10; 95% CI, 5.33–37.28). The AUC for the β angle was 0.86 (95% CI, 0.79–0.93), with a sensitivity of 0.64 and a specificity of 0.92 for predicting partial ACL ruptures; the β angle cutoff value was 73.3° (diagnostic OR, 14.54; 95% CI, 5.76–36.68).ConclusionsA small α angle and a large β angle were associated with partial ACL tears. The angle of the distal portion of the PCL was simple to measure and reproducible, enhancing the diagnosis of partial ACL tears.Level of EvidenceLevel III.

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The potential of posterior cruciate ligament buckling phenomenon as a sign for partial anterior cruciate ligament tears

Tokgoz,

Oklaz,

et al. 2024

Arch Orthop Trauma Surg

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Introduction Diagnosis of a partial tear of the anterior cruciate ligament (ACL) can be challenging with physical examination and imaging techniques. Although magnetic resonance imaging (MRI) has high sensitivity and specificity for diagnosing complete ACL tears, its effectiveness may be limited when it is used to diagnose for partial tears. The hypothesis of the present study is that the posterior cruciate ligament (PCL) buckling phenomenon, which is a secondary sign of complete ACL tears on MRI, may be a useful method for diagnosing partial ACL tears. Materials and methods The data of 239 patients who underwent knee arthroscopy in a single institution between 2016 and 2022 were analyzed retrospectively. Patients were divided into three groups based on the condition of their ligaments: partial tears, complete tears and intact ligaments. To evaluate the buckling phenomenon on sagittal T2-weighted MRI, measurements of the posterior cruciate ligament angle (PCLA) and the posterior cruciate ligament-posterior cortex angle (PCL-PCA) were conducted in each group. Subsequently, the ability of these two measurement methods to distinguish partial tears from the other groups was assessed. Results Both methods provided significantly different results in all three groups. Partial tears could be distinguished from intact ligaments with 86.8% sensitivity, 89.9% specificity when PCLA < 123.13° and 94.5% sensitivity, 93.2% specificity when PCL-PCA < 23.77°. Partial tears could be distinguished from complete tears with 79.5% sensitivity, 78.4% specificity when PCLA > 113.88° and with 86.1% sensitivity, 85.3% specificity when PCL-PCA > 16.39°. Conclusion The main finding of the present study is that the PCLA and PCL-PCA methods are useful on MRI for diagnosing partial ACL tears. PCLA value between 113°-123° and PCL-PCA value between 16°-24° could indicate a partial ACL tear. With these methods, it is possible to distinguish partial tears from healthy knees and reduce missed diagnoses. In addition, the differentiation of partial and complete tears by these methods may prevent unnecessary surgical interventions. Level of evidence Level III.

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A new method for diagnosis of anterior cruciate ligament tear: MRI with maximum flexion of knee in the prone position: A case control study

Cited by 8 publications

References 26 publications

Comparison of the Use of Magnetic Resonance Imaging of Partial Anterior Cruciate Ligament Tears Using Maximum Knee Flexion in the Lateral Decubitus Position with Routine Knee Positioning

Comparison of the Use of Magnetic Resonance Imaging of Partial Anterior Cruciate Ligament Tears Using Maximum Knee Flexion in the Lateral Decubitus Position with Routine Knee Positioning

The angle of the lower portion of the posterior cruciate ligament assists in the diagnosis of partial anterior cruciate ligament tears

The potential of posterior cruciate ligament buckling phenomenon as a sign for partial anterior cruciate ligament tears

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