Anterior tibial displacement on preoperative stress radiography of ACL-injured knee depending on knee flexion angle

Noh, Jung Ho; Nam, Woo Dong; Roh, Young Hak

doi:10.1186/s43019-019-0014-2

Cited by 7 publications

(8 citation statements)

References 25 publications

(29 reference statements)

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“…They found that 28 of 29 (97%) knees exhibited a positive Lachman test, and the average of differential laxity according to the TelosTM device (Telos Medical, Austin and Associates, Millersville, MD, USA) was 8.3 mm (range, 5 to 13 mm). Anterior instability can be seen in ACL-deficient knees, and >5 mm of anterior tibial translation is generally considered as a cut off value for ACL reconstruction [ 19 , 20 ]. However, two patients underwent subsequent ACL reconstruction.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of Arthroscopic Notchplasty and Partial Resection for Mucoid Degeneration of the Anterior Cruciate Ligament

Lee

Ahn

Gwak

et al. 2021

JCM

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Background: Mucoid degeneration of the anterior cruciate ligament (MD-ACL) is a chronic degenerative process involving a hypertrophied ACL, which may lead to notch impingement syndrome. As a treatment method, there is consensus regarding arthroscopic resection for MD-ACL resulting in good clinical outcomes; however, additional notchplasty remains controversial. The purpose of this study was to investigate clinical outcomes after arthroscopic partial resection of the ACL and additional notchplasty performed to minimize volume reduction of the ACL. Study Design: Level IIIb retrospective cohort study. Methods: Of 1810 individuals who underwent knee arthroscopic surgery performed by the same surgeon between July 2011 and October 2020, 52 were included, while 10 were excluded due to a follow-up period of <1 year. Clinical data including pain location, terminal flexion or extension pain, range of motion (ROM), Lysholm knee score, and Hospital for Special Surgery (HSS) knee score were assessed pre- and postoperatively. Additionally, according to the resected volume of the ACL, patients were classified into two groups: <25% (Group 1), and 25–50% (Group 2). Clinical outcomes were compared between the two groups. Results: There were 17 (40.5%) men and 25 (59.5%) women with a mean age of 53.9 years (range, 16–81 years) at the time of surgery. The mean duration of symptoms before surgery was 14.4 months (range, 3–66 months). Arthroscopic partial resection of the MD-ACL was performed in all patients, and concomitant notchplasty was performed in 36 (81.8%). All clinical scores improved postoperatively, and were statistically significant (p < 0.01). However, there was no significant difference in clinical outcomes between groups 1 and 2 classified according to the resected ACL volume. Recurrence of MD-ACL was recorded in only one patient, 11 months after arthroscopic treatment. No patients underwent ACL reconstruction because of symptoms of anterior instability. Conclusion: Arthroscopic partial resection of the ACL and concomitant notchplasty yielded satisfactory outcomes for the treatment of MD-ACL. Notchplasty may be an alternative procedure to avoid total ACL resection and postoperative instability.

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Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of Arthroscopic Notchplasty and Partial Resection for Mucoid Degeneration of the Anterior Cruciate Ligament

Lee

Ahn

Gwak

et al. 2021

JCM

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“…Overall, 20 devices/techniques were used in the assessment of more than one plane of stability throughout the literature. These included the Telos device (Metax, Hungen‐Obbornhofen, Germany) [1–4, 9, 16, 25, 29, 30, 37, 41–45, 47], manual force [4, 13, 14, 32, 39, 46, 52, 53], hydraulic force [20–22], S‐type load cell [12, 27, 28, 31, 32, 38], a constant‐tension spring [31, 32], and the dynamic stress test using active muscle contraction [1, 7, 25]. The stress techniques described in the presented review are summarized in Table 3.…”

Section: Resultsmentioning

confidence: 99%

“…The procedure of applying the stress and the magnitude of the applied stress differed among different presented studies as well as based on the utilized stress technique. The Telos device was the most commonly used stress device in the ACL and PCL studies [1, 2, 4, 8–10, 16, 25, 30, 37, 41–45, 47, 48].…”

Section: Resultsmentioning

confidence: 99%

“…Varus stress radiography was demonstrated to be more sensitive in diagnosing fibular collateral ligament (FCL) injuries compared to MRI with an overall sensitivity of 70% versus 66% [28]. Also, varus stress radiographs were Studies unable to be assessed using the QUADAS-2 tool: a cadaveric study; b descriptive of a technique using healthy controls only; c characterize the reliability and repeatability of a technique only ACL anterior cruciate ligament, PCL posterior cruciate ligament [44] Telos 15 kPa Granberry et al [11] Genucom device 140 N Franklin [7] Quadriceps contraction 133-178 N Rijke et al [43] Telos 0, 7, 14, 21 kPa Stäubli et al [54] KT-1000 89 N Lerat et al [34] Free weight 9 kg Dejour et al [5] Manual/monopodal stance test -/body weight Garcés et al [9] Telos 147 N Lerat et al [35] Free weight 9 kg Wirz et al [57] Custom steel apparatus 50 N Beldame et al [1] Telos/quadriceps contraction 250 N/-Beldame et al [2] Telos/free weight 250 N/9 kg Panisset et al [42] Telos 15 kg Dejour et al [4] Telos 15 kg Jenny and Arndt [26] GNRB arthrometer 250 N Srisuwanporn et al [51] Stress radiographic device (SRD) 120 N Mae et al [36] Gravity stress radiographs Gravity Noh et al [41] Telos 150 N Milano et al [40] BLU-DAT device; free weight/manual 7 kg (69 N)/9kg (89 N), MMT PCL Stäubli et al [53] Manual 25-30 kg Hewett et al [15] X-stress device 89 N Margheritini et al [37] Telos 89 N Schulz et al [47] Telos 15 kPa Jung et al [25] Telos/hamstring contraction/kneeling 150 N/-/-Garavaglia et al [8] Telos/PCL press 150 N/150 N Schulz et al [48] Telos 150 N Jackman et al [19] Kneeling -Garofalo et al [10] Telos/kneeling 15 kg/-Hoher et al [16] Telos 150 N Kim et al [30] Telos GA II device 134 N Severyns et al [50] Free weight 15 kg (150 N) Hol...…”

Section: Stress Radiography Compared To Other Diagnostic Techniquesmentioning

confidence: 99%

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Reference standards for stress radiography measurements in knee ligament injury and instability: a systematic review

Mabrouk,

Olson,

Tagliero

et al. 2023

Knee surg. sports traumatol. arthrosc.

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Purpose Stress radiographs are an easily accessible, cost-effective tool in the evaluation of acute and chronic ligament knee injuries. Stress radiographs provide an objective, quantifiable, and functional assessment of the injured ligament and can be a useful adjunct when planning surgical management and to objectively assess postoperative outcomes. This study aimed to review the literature reporting on stress radiographic techniques in evaluating knee ligament injury and instability and propose thresholds for interpreting stress radiography techniques. Methods The following three databases, OVID MEDLINE, the EMBASE library, and the Cochrane Controlled Trials Register, were systematically searched on January 23, 2023, for studies published from January 1970 to January 2023. The search extended to the reference lists of all relevant studies and orthopedic journals. Included studies were those that described a stress technique for the diagnosis of knee ligament injury; studies that reported a description or comparison of the accuracy and/or reliability of one or several stress radiography techniques, or studies that reported a comparison with alternative diagnostic modalities. Results Sixteen stress radiography techniques were reported for assessing the ACL with stress applied in the anterior plane, 10 techniques for assessing the PCL with stress applied in the posterior plane, 3 techniques for valgus stress, and 4 techniques for varus stress. The Telos device was the most commonly used stress device in the ACL and PCL studies. There was no consensus on the accuracy and reliability of stress radiography techniques for the diagnosis of any knee ligament injury. Stress radiography techniques were compared with alternative diagnostic techniques including instrumented arthrometry, MRI, and physical examination in 18 studies, with variability in the advantages and disadvantages of stress radiography techniques and alternatives. Analysis of results pooled from different studies demonstrated average delta gapping in knees with a completely injured ligament compared to the normal contralateral knee as per the following: for the ACL 4.9 ± 1.4 mm; PCL 8.1 ± 2.5 mm; MCL 2.3 ± 0.05 mm; and the FCL 3.4 ± 0.2 mm. Conclusion Despite heterogeneity in the available literature with regard to stress examination techniques and device utilization, the data support that stress radiography techniques were accurate and reliable when compared to numerous alternatives in the diagnosis of acute and chronic knee ligament injuries. The present study also provides average increased ipsilateral compartment gapping/translation for specific knee ligament injuries based on the best available data. These values provide a reference standard for the interpretation of stress radiography techniques, help to guide surgical decision-making, and provide benchmark values for future investigations. Level of evidence III.

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“…However, exact matching for meniscal and ligamentous injuries is hardly feasible in a retrospective single-center study design. Other confounding factors to be considered to influence tibial internal rotation are knee flexion [ 45 ] and quadriceps activity [ 46 ]. Both factors, most likely, can be neglected due to uniform positioning of the knees in the MRI coil and absence of active voluntary quadriceps muscle contraction during image acquisition.…”

Section: Discussionmentioning

confidence: 99%

Tibial internal rotation in combined anterior cruciate ligament and high-grade anterolateral ligament injury and its influence on ACL length

Hodel

Torrez

Flury

et al. 2022

BMC Musculoskelet Disord

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Background Assessment of combined anterolateral ligament (ALL) and anterior cruciate ligament (ACL) injury remains challenging but of high importance as the ALL is a contributing stabilizer of tibial internal rotation. The effect of preoperative static tibial internal rotation on ACL -length remains unknown. The aim of the study was analyze the effect of tibial internal rotation on ACL length in single-bundle ACL reconstructions and to quantify tibial internal rotation in combined ACL and ALL injuries. Methods The effect of tibial internal rotation on ACL length was computed in a three-dimensional (3D) model of 10 healthy knees with 5° increments of tibial internal rotation from 0 to 30° resulting in 70 simulations. For each step ACL length was measured. ALL injury severity was graded by a blinded musculoskeletal radiologist in a retrospective analysis of 61 patients who underwent single-bundle ACL reconstruction. Preoperative tibial internal rotation was measured in magnetic resonance imaging (MRI) and its diagnostic performance was analyzed. Results ACL length linearly increased 0.7 ± 0.1 mm (2.1 ± 0.5% of initial length) per 5° of tibial internal rotation from 0 to 30° in each patient. Seventeen patients (27.9%) had an intact ALL (grade 0), 10 (16.4%) a grade 1, 21 (34.4%) a grade 2 and 13 (21.3%) a grade 3 injury of the ALL. Patients with a combined ACL and ALL injury grade 3 had a median static tibial internal rotation of 8.8° (interquartile range (IQR): 8.3) compared to 5.6° (IQR: 6.6) in patients with an ALL injury (grade 0–2) (p = 0.03). A cut-off > 13.3° of tibial internal rotation predicted a high-grade ALL injury with a specificity of 92%, a sensitivity of 30%; area under the curve (AUC) 0.70 (95% CI: 0.54–0.85) (p = 0.03) and an accuracy of 79%. Conclusion ACL length linearly increases with tibial internal rotation from 0 to 30°. A combined ACL and high-grade ALL injury was associated with greater preoperative tibial internal rotation. This potentially contributes to unintentional graft laxity in ACL reconstructed patients, in particular with concomitant high-grade ALL tears. Study design Cohort study; Level of evidence, 3.

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Anterior tibial displacement on preoperative stress radiography of ACL-injured knee depending on knee flexion angle

Cited by 7 publications

References 25 publications

Clinical Outcomes of Arthroscopic Notchplasty and Partial Resection for Mucoid Degeneration of the Anterior Cruciate Ligament

Clinical Outcomes of Arthroscopic Notchplasty and Partial Resection for Mucoid Degeneration of the Anterior Cruciate Ligament

Reference standards for stress radiography measurements in knee ligament injury and instability: a systematic review

Tibial internal rotation in combined anterior cruciate ligament and high-grade anterolateral ligament injury and its influence on ACL length

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