Risk factors for passive anterior tibial subluxation on MRI in complete ACL tear

Sigonney, Guillaume; Klouche, Shahnaz; Chevance, Virgile; Bauer, Thomas; Rousselin, B.; Judet, Olivia; Hardy, P.

doi:10.1016/j.otsr.2019.10.025

Cited by 10 publications

(3 citation statements)

References 28 publications

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“…The association between SSD-ATT and MRI-confirmed meniscus tears in the present study is supported by several radiographic [27], MRI [28] and biomechanical studies [10,13]. Other studies have clearly identified the role of the menisci, especially the medial meniscus, as major contributors in anterior tibial translation restraint [11,36].…”

Section: Discussionsupporting

confidence: 86%

Side-to-side anterior tibial translation on monopodal weightbearing radiographs as a sign of knee decompensation in ACL-deficient knees

Macchiarola

Jacquet

Dor

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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Purpose To evaluate the influence of time from injury and meniscus tears on the side-to-side difference in anterior tibial translation (SSD-ATT) as measured on lateral monopodal weightbearing radiographs in both primary and secondary ACL deficiencies. Methods Data from 69 patients (43 males/26 females, median age 27-percentile 25-75: 20-37), were retrospectively extracted from their medical records. All had a primary or secondary ACL deficiency as confirmed by MRI and clinical examination, with a bilateral weightbearing radiograph of the knees at 15°-20° flexion available. Meniscal status was assessed on MRI images by a radiologist and an independent orthopaedic surgeon. ATT and posterior tibial slope (PTS) were measured on the lateral monopodal weightbearing radiographs for both the affected and the contralateral healthy side. A paired t-test was used to compare affected/healthy knees. Independent t-tests were used to compare primary/secondary ACL deficiencies, time from injury (TFI) (≤ 4 years/ > 4 years) and meniscal versus no meniscal tear. Results ATT of the affected side was significantly greater than the contralateral side (6.2 ± 4.4 mm vs 3.5 ± 2.8 mm; p < 0.01). There was moderate correlation between ATT and PTS in both the affected and healthy knees (r = 0.43, p < 0.01 and r = 0.41, p < 0.01). SSD-ATT was greater in secondary ACL deficiencies (4.7 ± 3.8 vs 1.9 ± 3.2 mm; p < 0.01), patients with a TFI greater than 4 years (4.2 ± 3.8 vs 2.0 ± 3.0 mm; p < 0.01) and with at least one meniscal tear (3.9 ± 3.8 vs 0.7 ± 2.2 mm; p < 0.01). Linear regression showed that, in primary ACL deficiencies, SSD-ATT was expected to increase (+ 2.7 mm) only if both a meniscal tear and a TFI > 4 years were present. In secondary ACL deficiencies, SSD-ATT was mainly influenced by the presence of meniscal tears regardless of the TFI. Conclusion SSD-ATT was significantly greater in secondary ACL deficiencies, patients with a TFI greater than 4 years and with at least one meniscal tear. These results confirm that SSD-ATT is a time-and meniscal-dependent parameter, supporting the concept of gradual sagittal decompensation in ACL-deficient knees, and point out the importance of the menisci as secondary restraints of the anterior knee laxity. Monopodal weightbearing radiographs may offer an easy and objective method for the follow-up of ACL-injured patients to identify early signs of soft tissue decompensation under loading conditions. Level of evidence Level III.

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Section: Discussionsupporting

confidence: 86%

Side-to-side anterior tibial translation on monopodal weightbearing radiographs as a sign of knee decompensation in ACL-deficient knees

Macchiarola

Jacquet

Dor

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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“…Long injury chronicity has been reported to increase ATS as well as knee instability 9,28,34,40 ; however, it remains unclear whether the interval from ACL injury to surgery itself or the secondary lesion determines the static and dynamic tibiofemoral relationships. 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.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, magnetic resonance imaging (MRI) was introduced to measure the ATS of medial and lateral compartments (ATSMC and ATSLC, respectively) separately and showed satisfactory interobserver and intraobserver consistencies. 24,25,34,49 Furthermore, some risk factors related to high-grade knee laxity, including chronic injury, meniscal tear, injured ALL, chondral defect, and steep PITS, have been validated as predictive risk factors of excessive ATSMC or ATSLC, 34,40,45,53,55 similarly leading to increased graft failure and inferior knee stability after ACLR. 16,46,56…”

mentioning

confidence: 99%

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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Comparisons of diagnostic performance and the reliability in identifying ACL injury between two measuring protocols of anterior tibial subluxation on MR images

et al. 2023

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Risk factors for passive anterior tibial subluxation on MRI in complete ACL tear

Cited by 10 publications

References 28 publications

Side-to-side anterior tibial translation on monopodal weightbearing radiographs as a sign of knee decompensation in ACL-deficient knees

Side-to-side anterior tibial translation on monopodal weightbearing radiographs as a sign of knee decompensation in ACL-deficient knees

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

Comparisons of diagnostic performance and the reliability in identifying ACL injury between two measuring protocols of anterior tibial subluxation on MR images

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