Anterior Tibial Subluxation of Lateral Compartment Is Associated With High-Grade Rotatory Instability for Acute But Not Chronic Anterior Cruciate Ligament Injuries: An Magnetic Resonance Imaging Case-Control Study

Liu, An; Cui, Wushi; Yang, Weinan; Li, Congsun; Yan, Shigui; Xin, Zengfeng; Wu, Haobo

doi:10.1016/j.arthro.2022.04.012

Cited by 11 publications

(11 citation statements)

References 29 publications

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“…McDonald et al 34 conducted multivariate regression analyses and concluded that chondral and meniscal injuries were more predictive of increased ATS rather than long chronicity in primary ACL deficiency. Liu et al 25 noted that high-grade pivot shift (grade 2 or 3) was correlated with excessive ATSLC (6 mm) in acute ACL injuries and with prolonged time and meniscal tears in chronic ACL injuries; however, the sample size in that study was quite limited for conducting multivariate analyses for the acute and chronic subgroups separately. In contrast, the present study emphasized that excessive ATSLC and secondary stabilizer injuries, rather than injury chronicity, were determinant predictors of high-grade knee laxity in patients with acute ACL injury as well as those with chronic ACL injury, suggesting that repairing the menisci 21,32,50 and strengthening the ALL 3,15,47 should be considered in all patients with concomitant injuries in order to restore as normal static and dynamic tibiofemoral relationships as possible.…”

Section: Discussionmentioning

confidence: 94%

“…In accordance with Magnussen et al 27 and Bernholt et al, 11 our study found that high-grade pivot shift or rotatory instability was confined to grade 3 pivot shift, whereas the same term was defined as a PST grade 2 or 3 by other researchers. 25,37,45 Moreover, our MRI protocol of knee positioning was similar to the protocols described by Tanaka et al 49 and McDonald et al 34 (mild extension with slight external rotation) and was different from the protocols that entailed full extension or hyperextension applied by Lian et al 24 and Liu et al 25 Previous studies have verified the secondary stabilizing effects of MM, LM, and ALL. The MM and LM act as secondary restraints of the tibia to anteriorly directed forces and pivoting maneuvers, respectively, 13,36,38 whereas the posterior horns of menisci may be more crucial.…”

Section: Discussionmentioning

confidence: 99%

“…To detect a minimum difference in the ATS of 1.5 mm between groups (SD, 3) mm, 24,25,34 a total of 70 patients were required in each group with an a error of .05 and a power of 0.9. The power analysis was performed using G*Power software (Version 3.1.9.7; HHU).…”

Section: Discussionmentioning

confidence: 99%

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Association Between Anterior Tibial Subluxation of Lateral Compartment and High-Grade Knee Laxity in Patients With Anterior Cruciate Ligament Deficiency

Chen

et al. 2023

Am J Sports Med

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Background: High-grade knee laxity and excessive anterior tibial subluxation (ATS) are correlated with poor clinical outcomes in patients with anterior cruciate ligament (ACL) deficiency and share similar risk factors; however, the association between excessive ATS and high-grade knee laxity remains unclear. Purpose: To identify the association between excessive ATS and high-grade knee laxity in patients with ACL deficiency and determine the possibility that ATS can predict high-grade knee laxity. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 226 patients who underwent ACL reconstruction between May 2018 and March 2022 were analyzed in the present study; the high-grade group consisted of 113 patients who had a grade 3 result on the preoperative anterior drawer test, Lachman test, or pivot-shift test while under anesthesia, and the low-grade group consisted of 113 matched patients. The ATS values for medial and lateral compartments (ATSMC and ATSLC) were measured on magnetic resonance imaging while patients relaxed the quadriceps in the supine position under no anesthesia. The optimal cutoff values of ATSMC and ATSLC for high-grade knee laxity were determined using receiver operating characteristic curves. Univariate and multivariate logistic regression analyses with stratification were performed to identify the association between excessive ATS and high-grade knee laxity. Results: Compared with the low-grade group, the high-grade group had a longer time from injury to surgery; higher rates of medial meniscus posterior horn tear (MMPHT), lateral meniscus posterior horn tear (LMPHT), and anterolateral ligament (ALL) abnormality; and larger lateral tibial slope, ATSMC, and ATSLC. The optimal cutoff value was 2.6 mm (sensitivity, 52.2%; specificity, 76.1%) for ATSMC and 4.5 mm (sensitivity, 67.3%; specificity, 64.6%) for ATSLC in predicting high-grade knee laxity. After adjustment for covariates, ATSLC ≥4.5 mm (odds ratio [OR], 2.94; 95% CI, 1.56-5.55; P = .001), MMPHT (OR, 2.62; 95% CI, 1.35-5.08; P = .004), LMPHT (OR, 2.39; 95% CI, 1.20-4.78; P = .014), and ALL abnormality (OR, 2.09; 95% CI, 1.13-3.89; P = .019) were associated with high-grade knee laxity. The association between excessive ATSLC and high-grade knee laxity was validated in patients with acute ACL injury as well as those with chronic ACL injury. Conclusion: Excessive ATSLC was associated with high-grade knee laxity in patients who had ACL deficiency, with a predictive cutoff value of 4.5 mm. This study may help surgeons estimate the degree of knee instability more accurately before anesthesia and may facilitate preliminary surgical decision-making, such as appropriate graft choices and consideration of extra-articular augmentation.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

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Association Between Anterior Tibial Subluxation of Lateral Compartment and High-Grade Knee Laxity in Patients With Anterior Cruciate Ligament Deficiency

Chen

et al. 2023

Am J Sports Med

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“…10,22,23 Some radiological studies correlated the bony anatomy of the knee with pivot-shift grading and suggested that a flatter lateral femoral condyle (LFC) and a smaller lateral tibial plateau (LTP) led to a pivot shift of higher grade. 15,17 Considering the association between ATS and rotational knee instability revealed by previous studies, 12,13 an injury to the ALL and bony anatomic changes of LFC and LTP could be the predisposing factors for increased ATS after an acute ACL injury.…”

mentioning

confidence: 97%

“…The concept of anterior tibial subluxation (ATS) in extension describes a pathological tibiofemoral relationship in the setting of anterior cruciate ligament (ACL) deficiency. 1 Previous studies found that this altered tibiofemoral alignment soon appeared after an acute ACL injury and was more obvious in the lateral compartment, 13,24 resulting in graft impingement and even failure after anatomic ACL reconstruction (ACLR). 16,19 These findings raise concerns about surgical outcomes of patients with acute ACL injury who have excessive ATS.…”

mentioning

confidence: 99%

Effect of Anterolateral Ligament Status and Inherent Knee Anatomy on Anterior Tibial Subluxation of the Lateral Compartment After Acute Anterior Cruciate Ligament Injury: A Cohort Study Based on MRI Analysis

et al. 2023

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Background: Anterior tibial subluxation (ATS) of the lateral compartment entails a pathological tibiofemoral alignment in knees with anterior cruciate ligament (ACL) injury. Causes of increased ATS after an acute ACL injury are not clear, but soft tissue abnormalities and bony variations of the knee are potential causes. Purpose: To determine whether increased ATS of the lateral compartment in knees with acute ACL injury is associated with (1) anterolateral ligament (ALL) status and (2) inherent anatomy of the lateral femoral condyle (LFC) and lateral tibial plateau (LTP). Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 337 patients with clinically diagnosed ACL injuries treated between September 2019 and August 2021 were retrospectively reviewed, and 119 patients with acute ACL injury were included. Of them, 79 patients with impaired ALL (ALL injury group) and 40 patients with intact ALL (ALL intact group) were identified based on magnetic resonance imaging (MRI). The ATS of the lateral compartment measured on MRI was compared between the 2 groups. The bony anatomy of knees, quantified by the LFC length, LFC height, LTP length, and LTP slope, was also evaluated on MRI and correlated with the ATS with partial correlation coefficients. Multivariate linear regression was used to identify the independent predictors of increased ATS. Results: The ATS of the lateral compartment in the ALL injury group was significantly larger than that in the ALL intact group (6.3 mm vs 4.0 mm, respectively; P = .001). In all included patients, the presence of ALL injuries independently predicted a mean increase in ATS of 1.8 mm ( P = .003). In the ALL injury group, ATS was significantly correlated with LFC length ( r = 0.463; P < .001), LFC height ( r = −0.415; P < .001), and LTP slope ( r = 0.453; P < .001); further, a 1-mm increase in LFC length, 1-mm decrease in LFC height, and 1° increase in LTP slope independently predicted a mean increase in ATS of 0.7 mm ( P < .001), 0.6 mm ( P < .001), and 0.5 mm ( P < .001), respectively. In the ALL intact group, there was no significant correlation between ATS and any bony parameter. Conclusion: An impaired ALL increased the ATS of the lateral compartment after acute ACL injuries. In patients with combined ALL injuries, a flatter LFC and a steeper LTP in the sagittal plane were predictors of a further increase in ATS.

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Increased anterior tibial subluxation and differences between anterior tibial subluxation in the lateral and medial compartments are associated with failure of primary anterior cruciate ligament reconstruction: A systematic review and meta‐analysis

Bai,

Zhang,

Hong

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeThe purpose of this study is to investigate whether increased anterior tibial subluxation (ATS) and differences between ATS in the lateral and medial compartments (ATSL−M) are associated with primary anterior cruciate ligament (ACL) reconstruction (ACLR) failure.MethodsPubMed, Scopus, Embase and Web of Science were systematically searched from their inception through 21 November 2023. The focus was on comparative studies reporting ATS in patients who experienced primary ACLR failure, in contrast to patients after primary ACLR with no evidence of graft failure. A random‐effects model was employed to calculate the overall standardized mean difference between the two groups.ResultsA total of eight studies involving 963 patients were included in the final review. Three studies (64 cases and 171 controls) measured ATS on radiographs. The failed ACLR group exhibited a significantly increased ATS on radiographs compared to the control group (p < 0.001). Six studies (324 cases and 488 controls) measured lateral ATS on magnetic resonance imaging and five of them (285 cases and 374 controls) also measured medial ATS. The average values of lateral and medial ATS, as well as ATSL−M, were calculated and compared between the two groups. The failed ACLR group demonstrated significantly increased lateral (p < 0.001) and medial ATS (p < 0.001), the average value of lateral and medial ATS (p < 0.001) and ATSL−M (p = 0.039) compared to the control group.ConclusionIncreased ATS and ATSL−M are associated with primary ACLR failure. The measurement of tibiofemoral position shows promise for its application in preoperative planning and postoperative management of ACLR.Level of EvidenceLevel III.

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Anterior Tibial Subluxation of Lateral Compartment Is Associated With High-Grade Rotatory Instability for Acute But Not Chronic Anterior Cruciate Ligament Injuries: An Magnetic Resonance Imaging Case-Control Study

Cited by 11 publications

References 29 publications

Association Between Anterior Tibial Subluxation of Lateral Compartment and High-Grade Knee Laxity in Patients With Anterior Cruciate Ligament Deficiency

Association Between Anterior Tibial Subluxation of Lateral Compartment and High-Grade Knee Laxity in Patients With Anterior Cruciate Ligament Deficiency

Effect of Anterolateral Ligament Status and Inherent Knee Anatomy on Anterior Tibial Subluxation of the Lateral Compartment After Acute Anterior Cruciate Ligament Injury: A Cohort Study Based on MRI Analysis

Increased anterior tibial subluxation and differences between anterior tibial subluxation in the lateral and medial compartments are associated with failure of primary anterior cruciate ligament reconstruction: A systematic review and meta‐analysis

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