Anterior Cruciate Ligament Length in Pediatric Populations: An MRI Study

Tran, Emily; Dingel, Aleksei; Terhune, E. Bailey; Segovia, Nicole A.; Vuong, Brian; Ganley, Theodore J.; Fabricant, Peter D.; Green, Daniel W.; Stavinoha, Tyler J.; Shea, Kevin G.

doi:10.1177/23259671211002286

Cited by 7 publications

(4 citation statements)

References 32 publications

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“…Several researchers have attempted to predict the ACL size before surgery through different methods, including MRI studies on the ACL length and width in vivo and on the graft size[ [11,[13][14][15][16][17] ]. However, previous studies are generally limited by the use of a single independent variable for building a univariate linear model or neglect of classification by gender or age.…”

Section: Discussionmentioning

confidence: 99%

How to predict the dimensions of anterior cruciate ligament in children based on MRI?

Xiao,

Tang,

et al. 2023

Medicine

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There are many studies examining the dimensions of the anterior cruciate ligament (ACL) in children. The correlations between the ACL size in children and other parameters are not well understood. To detect the correlations between the ACL size in children and other parameters including age, gender, bone and soft tissue parameters through measurements on MRI images, and to establish prediction models for the ACL size. A total of 99 patients who underwent MRI scan were included (39 girls, 60 boys; mean age, 13.01 ± 3.94; range of age, 4 to 18). The following measurements were taken on MRI images by 2 observers: ACL length, ACL width, posterior cruciate ligament (PCL) length, the distance from the most anterior aspect of the tibial epiphysis to the anterior aspect of the ACL tibial insertion (AATI), the distance from the most anterior aspect of the tibial epiphysis to the posterior aspect of the ACL tibial insertion (APTI), and the tibial anteroposterior diameter (AP). Correlations between these measurements and the patients’ gender and age were investigated, and univariate and multiple linear regression models were established accordingly. Before 13 years old, the ACL length was significantly correlated with the tibial anteroposterior diameter and age (R2 = 0.872, P < .001), and there were no statistically significant gender differences. After 13 years old, the ACL length was significantly correlated with the PCL length and APTI in males (R2 = 0.443, P < .001), and with the PCL length in females (R2 = 0.443, P < .001). In children under 13 years old, there was no significant gender difference in ACL length, and the tibial anteroposterior diameter and age were found to be important indicators in assessing the ACL size. After 13 years old, a significant gender difference in ACL length was observed, and the ACL length was found to be weakly correlated with age and bone parameters. In order to accurately evaluate the ACL size in children aged 13 years and above, it is necessary to refer to the dimensions of the ACL on the collateral side.

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Section: Discussionmentioning

confidence: 99%

How to predict the dimensions of anterior cruciate ligament in children based on MRI?

Xiao,

Tang,

et al. 2023

Medicine

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“… 38 Graft healing in the orthopaedic field is therefore mostly evaluated using MRI. 9 , 11 , 22 , 34 , 37 , 42 , 43 A detailed description of the graft status using MRI is important to distinguish whether the graft is healing or if a pathologic condition (eg, partial tear, total rupture) has emerged. Our new classification for the graft status after SCR uses 5 different grading scores.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of a New MRI-Based Classification of Graft Status After Superior Capsule Reconstruction

Lee,

Kholinne,

Yeom

et al. 2023

Orthopaedic Journal of Sports Medicine

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Background: A classification system for the graft state after superior capsule reconstruction (SCR) using magnetic resonance imaging (MRI) has not been described previously. Purpose: To introduce a new, MRI-based classification system for graft integrity after SCR and to evaluate the system according to postoperative outcomes. Study Design: Cohort study (diagnosis); Level of evidence, 3. Method: Included were 62 consecutive patients who underwent SCR using autologous fascia lata graft between January 2013 and April 2021. Postoperative outcomes were assessed (American Shoulder and Elbow Surgeons [ASES] score, Constant score, pain visual analog scale [pVAS], range of motion [ROM], acromiohumeral distance [AHD], Hamada grade). Graft status was classified by 2 orthopaedic surgeons on postoperative MRI in accordance with the signal intensity and the presence or extent of the tear, as follows: type 1 (hypointense signal without tear), type 2 (hyperintense signal without tear), type 3 (partial-thickness tear), type 4 (full-thickness tear with partial continuity), and type 5 (full-thickness tear with complete discontinuity). Intra- and interobserver agreement were assessed using Cohen kappa. The correlation between postoperative outcomes (ASES score, Constant score, pVAS, ROM, AHD, and Hamada grade) and the SCR graft classification system was assessed with the Pearson correlation coefficient, and the outcomes were compared according to classification type. Results: Patients were classified according to the new system as follows: type 1 (n = 15), type 2 (n = 20), type 3 (n = 7), type 4 (n = 8), and type 5 (n = 12). There was excellent interobserver agreement (κ = 0.819) and intraobserver agreement (κ = 0.937 and 0.919). The classification system showed a moderate to high correlation with the ASES score ( r = –0.451; P = .001), pVAS ( r = 0.359; P = .005), AHD ( r = –0.642; P < .001), and Hamada grade ( r = 0.414; P < .001). Patients classified as having types 1 and 2 showed better outcomes in terms of ASES score, pVAS, ROM, and AHD compared with type 5 patients ( P ≤ .021 for all). Conclusion: The new classification system was highly reproducible and showed clinical utility for both radiological and clinical evaluation after SCR.

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“…Additional variables were measured, including the sagittal graft angle (SGA) and intercondylar roof inclination angle (RIA) (Fig. 4C) [14, 36].…”

Section: Methodsmentioning

confidence: 99%

Graft impingement increases anterior cruciate ligament graft signal more than acute graft bending angle: magnetic resonance imaging‐based study in outside‐in anterior cruciate ligament reconstruction

Park

Cho

et al. 2023

Knee surg. sports traumatol. arthrosc.

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Purpose In this study, the relationship between patient-speciic geometric factors and tunnel placement in graft impingement was identiied by using magnetic resonance imaging (MRI) signal intensity of anterior cruciate ligament (ACL) grafts. Methods Ninety-two patients, who were treated between 2014 and 2020, were included retrospectively. These patients underwent primary remnant-preserving outside-in ACL reconstruction (ACLR) and were followed up with postoperative MRI at least one year after surgery. Plain radiographs and computed tomography (CT) were used to analyze tibial and femoral tunnel positions. Postoperative MRI was performed, at 32.8 ± 17.5 months after surgery, to evaluate the graft signal intensity, the ACL/posterior cruciate ligament (PCL) ratio (APR), ACL/muscle ratio (AMR), tunnel positions, and graft impingement. Clinical and stability outcomes were analyzed using the International Knee Documentation Committee (IKDC) subjective and objective scores, Lysholm scores, and side-to-side diferences (SS-D). ResultsThe mean APR and AMR of the proximal third of the grafts were signiicantly lower than those of the middle third of the grafts (p = 0.017 and p = 0.045, respectively). Multivariate regression analysis showed that there was a negative association between the mean APR and AMR of entire intra-articular ACL graft and the distance from the anterior end of the intercondylar roof to the center of the tibial tunnel in the sagittal plane (p < 0.001 and p < 0.001, respectively) and the notch width index (p < 0.001 and p = 0.002, respectively). No signiicant correlations were found between tunneling and geometric factors, and clinical scores or SS-D. Conclusions Graft impingement on the anterior tibial tunnel relative to the end of the intercondylar roof and narrow notch was a more signiicant contributing factor on increased signal intensities of the ACL graft, compared with the acute femoral bending angle in remnant-preserving outside-in ACLR. Therefore, surgeons should focus on intercondylar notch anatomy during tibial tunnel placement to avoid roof impingement. Level of evidence Level III.

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Anterior Cruciate Ligament Length in Pediatric Populations: An MRI Study

Cited by 7 publications

References 32 publications

How to predict the dimensions of anterior cruciate ligament in children based on MRI?

How to predict the dimensions of anterior cruciate ligament in children based on MRI?

Evaluation of a New MRI-Based Classification of Graft Status After Superior Capsule Reconstruction

Graft impingement increases anterior cruciate ligament graft signal more than acute graft bending angle: magnetic resonance imaging‐based study in outside‐in anterior cruciate ligament reconstruction

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