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Khaled W, Gerometta A, Guerini H, Monzani Q, Pessis E, Campagna R, Bouvier FM, Drapé JL, Feydy A. Complete and Partial Tears of the Anterior Cruciate Ligament: Acute and Evolution. Semin Musculoskelet Radiol 2025; 29:390-402. [PMID: 40393498 DOI: 10.1055/s-0045-1806795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2025]
Abstract
Anterior cruciate ligament tears represent a prevalent injury in sports that involves rotational movements and rapid changes in direction, such as pivot-contact sports. The anterior cruciate ligament serves as the primary stabilizer of the knee, preventing anterior tibial translation and medial tibial rotation. Although clinical examination is essential for diagnosis, magnetic resonance imaging plays a crucial role in confirming complete tears and evaluating associated injuries, particularly meniscal injuries. Diagnosis relies on both direct and secondary signs that are instrumental in assessing knee laxity and stability. Despite advancements in imaging techniques, challenges persist in using magnetic resonance imaging to distinguish between complete and partial tears, evaluate knee instability, and determine the potential for anterior cruciate ligament healing.
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Affiliation(s)
- Wassef Khaled
- Department of Musculoskeletal Radiology, AP-HP Centre, Université Paris Cité, Hôpital Cochin, Paris, France
- Imagerie Médicale Léonard de Vinci, Centre Cortambert, Paris, France
| | | | - Henri Guerini
- Department of Musculoskeletal Radiology, AP-HP Centre, Université Paris Cité, Hôpital Cochin, Paris, France
- Imagerie Médicale Léonard de Vinci, Centre Cortambert, Paris, France
| | - Quentin Monzani
- Imagerie Médicale Léonard de Vinci, Centre Cortambert, Paris, France
- Department of Radiology, AP-HP, Pitié-Salpêtrière University Hospital, Sorbonne University, University Pierre et Marie Curie, Paris, France
| | - Eric Pessis
- Department of Musculoskeletal Radiology, AP-HP Centre, Université Paris Cité, Hôpital Cochin, Paris, France
| | - Raphaël Campagna
- Department of Musculoskeletal Radiology, AP-HP Centre, Université Paris Cité, Hôpital Cochin, Paris, France
| | - Fadila Mihoubi Bouvier
- Department of Musculoskeletal Radiology, AP-HP Centre, Université Paris Cité, Hôpital Cochin, Paris, France
- Imagerie Médicale Léonard de Vinci, Centre Cortambert, Paris, France
| | - Jean-Luc Drapé
- Department of Musculoskeletal Radiology, AP-HP Centre, Université Paris Cité, Hôpital Cochin, Paris, France
| | - Antoine Feydy
- Department of Musculoskeletal Radiology, AP-HP Centre, Université Paris Cité, Hôpital Cochin, Paris, France
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Yang Y, Zheng B, Zhang M, Lin X, Zhang W, Han D, Chen H, Zhou X. The angle of the lower portion of the posterior cruciate ligament assists in the diagnosis of partial anterior cruciate ligament tears. Knee Surg Sports Traumatol Arthrosc 2024; 32:3015-3022. [PMID: 38989785 DOI: 10.1002/ksa.12346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 05/03/2024] [Accepted: 06/17/2024] [Indexed: 07/12/2024]
Abstract
PURPOSE To 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. METHODS From 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. RESULTS Following 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). CONCLUSIONS A 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 EVIDENCE Level III.
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Affiliation(s)
- Yang Yang
- Department of Orthopedics, Taizhou Hospital of Zhejiang Province, Affiliated to Wenzhou Medical University, Linhai City, Zhejiang, China
- Department of Medical Education, Taizhou Hospital of Zhejiang Province, Affiliated to Wenzhou Medical University, Linhai City, Zhejiang, China
| | - Binbin Zheng
- Department of Orthopedics, Taizhou Hospital of Zhejiang Province, Affiliated to Wenzhou Medical University, Linhai City, Zhejiang, China
| | - Mengqin Zhang
- Department of Critical Care Medicine, Taizhou Hospital of Zhejiang Province, Affiliated to Wenzhou Medical University, Linhai City, Zhejiang, China
| | - Xiaofang Lin
- Department of Orthopedics, Taizhou Hospital of Zhejiang Province, Affiliated to Wenzhou Medical University, Linhai City, Zhejiang, China
| | - Wei Zhang
- Department of Orthopedics, Taizhou Hospital of Zhejiang Province, Affiliated to Wenzhou Medical University, Linhai City, Zhejiang, China
| | - Dawei Han
- Department of Orthopedics, Taizhou Hospital of Zhejiang Province, Affiliated to Wenzhou Medical University, Linhai City, Zhejiang, China
| | - Haixiao Chen
- Department of Orthopedics, Taizhou Hospital of Zhejiang Province, Affiliated to Wenzhou Medical University, Linhai City, Zhejiang, China
| | - Xiaobo Zhou
- Department of Orthopedics, Taizhou Hospital of Zhejiang Province, Affiliated to Wenzhou Medical University, Linhai City, Zhejiang, China
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Tokgoz MA, Oklaz EB, Ak O, Guler Oklaz EB, Ataoglu MB, Kanatli U. The potential of posterior cruciate ligament buckling phenomenon as a sign for partial anterior cruciate ligament tears. Arch Orthop Trauma Surg 2024; 144:2181-2187. [PMID: 38492061 PMCID: PMC11093845 DOI: 10.1007/s00402-024-05270-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 03/03/2024] [Indexed: 03/18/2024]
Abstract
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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Affiliation(s)
- Mehmet Ali Tokgoz
- Department of Orthopaedics and Traumatology, Gazi University Faculty of Medicine, Emniyet Mahallesi, Mevlana Bulvarı No: 29 Yenimahalle, Ankara, Turkey
| | - Ethem Burak Oklaz
- Department of Orthopaedics and Traumatology, Gazi University Faculty of Medicine, Emniyet Mahallesi, Mevlana Bulvarı No: 29 Yenimahalle, Ankara, Turkey.
| | - Oguzhan Ak
- Department of Orthopaedics and Traumatology, Gazi University Faculty of Medicine, Emniyet Mahallesi, Mevlana Bulvarı No: 29 Yenimahalle, Ankara, Turkey
| | | | - Muhammet Baybars Ataoglu
- Department of Orthopaedics and Traumatology, Gazi University Faculty of Medicine, Emniyet Mahallesi, Mevlana Bulvarı No: 29 Yenimahalle, Ankara, Turkey
| | - Ulunay Kanatli
- Department of Orthopaedics and Traumatology, Gazi University Faculty of Medicine, Emniyet Mahallesi, Mevlana Bulvarı No: 29 Yenimahalle, Ankara, Turkey
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Luo P, Wang Q, Cao P, Chen T, Li S, Wang X, Li Y, Gong Z, Zhang Y, Ruan G, Zhou Z, Wang Y, Han W, Zhu Z, Hunter DJ, Li J, Ding C. The association between anterior cruciate ligament degeneration and incident knee osteoarthritis: Data from the osteoarthritis initiative. J Orthop Translat 2024; 44:1-8. [PMID: 38174315 PMCID: PMC10762318 DOI: 10.1016/j.jot.2023.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 09/06/2023] [Accepted: 09/20/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Though anterior cruciate ligament (ACL) tear has been widely accepted as an important accelerator for knee osteoarthritis (KOA), the role of intrinsic ACL degeneration in developing KOA has not been fully investigated. PURPOSE To determine whether ACL degeneration, in the absence of ACL tear, is associated with incident KOA over 4 years. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Participants' knees in this nested case-control study were selected from the Osteoarthritis Initiative (OAI) study, with Kellgren-Lawrence grading (Kellgren-Lawrence grading) of 0 or 1 at baseline (BL). Case knees which had incident KOA (KLG ≥2) over 4 years, were matched 1:1 with control knees by gender, age and radiographic status. ACL signal intensity alteration (0-3 scale) and volume were assessed as compositional feature and morphology of ACL degeneration, using knee MRI at P0 (time of onset of incident KOA), P-1 (1 year prior to P0) and baseline. Conditional logistic regression was applied to analyze the association between measures of ACL degeneration and incident KOA. RESULTS 337 case knees with incident KOA were matched to 337 control knees. Participants were mostly female (68.5%), with an average age of 59.9 years old. ACL signal intensity alterations at BL, P-1 and P0 were significantly associated with an increased odds of incident KOA respectively (all P for trend ≤0.001). In contrast, ACL volumes were not significantly associated with incident KOA at any time points. CONCLUSIONS ACL signal intensity alteration is associated with increased incident KOA over 4 years, whereas ACL volume is not.The translational potential of this article: This paper focused on ACL signal intensity alteration which could better reflect ACL degeneration rather than ACL tear during the progression of KOA and explored this topic in a nested case-control study. Utilizing MR images from KOA participants, we extracted the imaging features of ACL. In addition, we established a semi-quantitative score for ACL signal intensity alteration and found a significant correlation between it and KOA incidence. Our findings confirmed that the more severe the ACL signal intensity alteration, the stronger relationship with the occurrence of KOA. This suggests that more emphasis should be placed on ACL degeneration rather than ACL integrity in the future.
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Affiliation(s)
- Ping Luo
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
- Department of Spinal Surgery, The Fourth Hospital of Changsha, Changsha Hospital of Hunan Normal University, Changsha, Hunan, China
| | - Qianyi Wang
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Peihua Cao
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Tianyu Chen
- Department of Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Shengfa Li
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Xiaoshuai Wang
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Yamin Li
- Department of Nephrology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Ze Gong
- Department of Rehabilitation Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Yan Zhang
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Guangfeng Ruan
- Clinical Research Centre, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Zuoqing Zhou
- Department of Orthopedics, The First Affiliated Hospital, Shaoyang University, Shaoyang, Hunan, China
| | - Yuanyuan Wang
- Department of Health Management, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Weiyu Han
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Zhaohua Zhu
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - David J. Hunter
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
- Department of Rheumatology, Royal North Shore Hospital and Sydney Musculoskeletal Health, Kolling Institute, University of Sydney, Australia
| | - Jia Li
- Division of Orthopaedic Surgery, Department of Orthopedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Changhai Ding
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
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Xu J, Lian Y, Sun S, Yang Z, Chen H. Diagnostic Performance of Multi-Direction Adjusted Multi-Planar Reconstruction with Helical CT for Evaluating Continuity of the Anterior Cruciate Ligament. Acad Radiol 2022; 29:e240-e247. [PMID: 35246375 DOI: 10.1016/j.acra.2021.12.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/30/2021] [Accepted: 12/30/2021] [Indexed: 11/23/2022]
Abstract
RATIONALE AND OBJECTIVES To analyze the diagnostic performance of MDA-MPR with CT for evaluating ACL structural continuity. METHODS A total of 145 patients with highly suspected ACL injury admitted to our hospital between January 2016 and May 2021 were retrospectively enrolled. All patients had undergone examination with MRI, CT, and arthroscopy. Taking arthroscopy results as the gold standard, the diagnostic accuracy for identifying ACL rupture by MRI and MDA-MPR with CT were compared. RESULTS The receiver operator characteristic curves demonstrated that both MRI and MDA-MPR with CT performed well in the diagnosis of ACL tears. The sensitivities of MRI and MDA-MPR with CT for diagnosing complete ACL tears were 95.16% (59/62) and 90.32% (56/62), respectively. Their specificities in this regard were 77.11% (64/83) and 84.34% (70/83), respectively. MRI had a higher sensitivity but MDA-MPR with CT had a higher specificity for detecting complete ACL tears, and the differences were statistically significant (p <.05). The sensitivities of diagnosing partial ACL tears using MRI and MDA-MPR with CT were 78.79% (26/33) and 75.76% (25/33), respectively, while the specificities were 86.61% (97/112) and 90.18% (101/112), respectively. These differences were non-significant (p >.05). CONCLUSION MDA-MPR with CT has high diagnostic efficiency for ACL injuries, especially in the diagnosis of complete ACL tears.
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Affiliation(s)
- Jun Xu
- Department of Radiology, The Affiliated Hospital of Qingdao University, Jiangsu Road, Qingdao City, 266003, Shandong Province, China
| | - Yuanyuan Lian
- Department of Radiology, The Affiliated Hospital of Qingdao University, Jiangsu Road, Qingdao City, 266003, Shandong Province, China
| | - Shiqing Sun
- Department of Radiology, The Affiliated Hospital of Qingdao University, Jiangsu Road, Qingdao City, 266003, Shandong Province, China
| | - Zhitao Yang
- Department of Radiology, The Affiliated Hospital of Qingdao University, Jiangsu Road, Qingdao City, 266003, Shandong Province, China
| | - Haisong Chen
- Department of Radiology, The Affiliated Hospital of Qingdao University, Jiangsu Road, Qingdao City, 266003, Shandong Province, China.
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Tajima T, Yamaguchi N, Morita Y, Yokoe T, Nagasawa M, Ota T, Kawagoe S, Nakamura Y, Chosa E. Remnant-Preserved Single-Bundle Anterior Cruciate Ligament Augmentation in Multi-ligamentous Knee Reconstruction. J Knee Surg 2022. [PMID: 35688445 DOI: 10.1055/s-0042-1749603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This study was conducted to present remnant-preserving anterior cruciate ligament (ACL) augmentation as a useful option for partial ACL injury in multiligament knee injury (MLKI) cases, which may also contribute to conserving graft resources. The present study involved patients diagnosed with MLKI at our institute from Spring 2006 to February 2021. A total of 71 MLKI cases were provided surgery due to knee instability and disability. For every patient, an arthroscopic diagnostic was performed to ensure that ACL tear and a remnant were present. When the ACL remnant was classified into group 2, 3, or 4 of Nakamae's classification, remnant-preserved single bundle ACL augmentation was performed. Graft selection and the combination of injured ligaments were evaluated. The side-to-side difference under an anterior tibial load of 134 N with an arthrometer and the leg symmetry index at 60 degrees/s were measured. The present procedure was performed for five cases (male/female: 4/1, mean age: 33.6 years). The mean follow-up period was 26.4 months. The combination of torn ligaments was as follows: 3 cases of ACL + medial collateral ligament, one case of ACL + posterior cruciate ligament, and one case of ACL + posterolateral corner. An ACL augmentation graft was performed using an ipsilateral gracilis tendon in 2 cases, a contralateral full semitendinosus tendon in 2 cases, and the ipsilateral distal 1/2 of the semitendinosus tendon in 1 case. The mean side-to-side difference was 1.07 ± 0.4 mm. The mean leg symmetry index was 82.6 ± 12.2% in knee extension and 96.3 ± 9.9% in knee flexion. Although the present study was a small case series, the remnant-preserved single-bundle ACL augmentation for MLKI surgery provided good clinical outcome and conserved the graft resource. Even in the MLKI case, this technique is one of the useful surgical options. The level of evidence of this study is level IV (case series).
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Affiliation(s)
- Takuya Tajima
- Department of Medicine of Sensory and Motor Organs, Division of Orthopedic Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Nami Yamaguchi
- Department of Medicine of Sensory and Motor Organs, Division of Orthopedic Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Yudai Morita
- Department of Medicine of Sensory and Motor Organs, Division of Orthopedic Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Takuji Yokoe
- Department of Medicine of Sensory and Motor Organs, Division of Orthopedic Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Makoto Nagasawa
- Department of Medicine of Sensory and Motor Organs, Division of Orthopedic Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Tomomi Ota
- Department of Medicine of Sensory and Motor Organs, Division of Orthopedic Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Shuichi Kawagoe
- Department of Medicine of Sensory and Motor Organs, Division of Orthopedic Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Yoshihiro Nakamura
- Department of Medicine of Sensory and Motor Organs, Division of Orthopedic Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Etsuo Chosa
- Department of Medicine of Sensory and Motor Organs, Division of Orthopedic Surgery, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
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Li Z, Li M, Du Y, Zhang M, Jiang H, Zhang R, Ma Y, Zheng Q. Femur-tibia angle and patella-tibia angle: new indicators for diagnosing anterior cruciate ligament tears in magnetic resonance imaging. BMC Sports Sci Med Rehabil 2022; 14:66. [PMID: 35418093 PMCID: PMC9009057 DOI: 10.1186/s13102-022-00462-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/05/2022] [Indexed: 11/17/2022]
Abstract
Background Femur-tibia angle (FTA) and patella-tibia angle (PTA) are two MRI measurements that reflect the rotation of the knee joint. The purposes of this study were to assess whether FTA and PTA are associated with ACL tear and to explore their roles in ACL tear diagnosis. Methods FTA, PTA, ACL angle and anterior tibial subluxation were compared between the two matched groups: ACL tear group and control group (each n = 20). Diagnostic performance was evaluated in a consecutive 120-patient cohort who underwent MR imaging of the knee and subsequently had arthroscopy. Different measurements were assessed by area under the curve (AUC) of receiver operating characteristic (ROC) curve. Results FTA and PTA increased significantly in ACL tears group when compared to the control group (4.79 and 7.36 degrees, respectively, p < 0.05). In distinguishing complete ACL tear, ACL angle had the highest AUC of 0.906 while AUC of PTA and FTA were 0.849 and 0.809. The cutoff of FTA was 80 degrees with a sensitivity of 82% and specificity of 68%, while the cutoff of PTA was 91 degrees with a sensitivity of 82% and specificity of 74%. In distinguishing partial ACL tear, FTA and PTA had the highest AUCs of 0.847 and 0.813, respectively. The calculated cutoff of FTA was 84 degrees with a sensitivity of 90% and specificity of 81%, while the cutoff of PTA was 92 degrees with a sensitivity of 80% and specificity of 77%. Conclusion FTA and PTA increased when ACL tears and they might be valuable in diagnosing ACL tears, especially in distinguishing partial ACL tear from intact ACL.
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Affiliation(s)
- Zeng Li
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Mengyuan Li
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Yan Du
- Clinical Research Unit, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, 200011, China
| | - Mo Zhang
- Clinical Research Unit, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, 200011, China
| | - Hai Jiang
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Ruiying Zhang
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Yuanchen Ma
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.
| | - Qiujian Zheng
- Department of Orthopedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.
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Gali JC, Almeida TA, de Moraes Miguel DC, Nassar SA, Filho JCG, Drain NP, Fu FF. The posterior cruciate ligament inclination angle is higher in anterior cruciate ligament insufficiency. Knee Surg Sports Traumatol Arthrosc 2022; 30:124-130. [PMID: 34787689 DOI: 10.1007/s00167-021-06789-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 10/25/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE Magnetic resonance imaging (MRI) is the gold standard image examination for anterior cruciate ligament (ACL) lesion diagnosis. Our hypothesis was that measuring the posterior cruciate ligament inclination angle (PCLIA) using MRI images may be an auxiliary tool to aid the recognition of ACL insufficiency. The purpose of this study was to compare the PCLIA measurement in MRIs of individuals with and without ACL injury. METHODS The PCLIA was measured by two radiologists in 65 knee MRIs of patients with intact ACL (control group) and in 65 knee MRIs of people with ACL injury (study group). In both groups, the posterior cruciate ligament was intact. The control group was included 35 men (53.8%) and 30 women (46.1%). The patients' average age was 38.7 years (range 15-75; SD ± 14.8 years). In this group, 31 (47.6%) MRIs were from right knees and 34 (52.3%) were from left knees. The study group consisted of 45 men (69.2%) and 20 women (30.7%). The patients' average age was 36.8 years (range 14-55; SD ± 10.3 years). In this group, 33 (50.7%) were right knees and 32 (49.2%) were left knees. PCLIA was formed by the intersection of two lines drawn in MRI sagittal images. The first passed tangentially to the articular surface of the tibial condyle and the second was drawn over the fraction of the ligament that originated where the first crossed the PCL, outlined proximally. RESULTS The average PCLIA was 44.2 ± 3.8° in the control group and 78.9 ± 8.6° in the study group. Statistical analyses showed that the PCLIA was higher in the group with ACL injury (p < 0.05). Conclusion The PCLIA was significantly higher in individuals with ACL injuries. The measurement of this angle using MRI images may allow for detection of ACL insufficiency and thus assist in an individualized and precise approach to the treatment of injuries to the ACL. CLINICAL RELEVANCE PCLIA may be a way to detect ACL insufficiency and thus help surgeons to decide which patient might need ACL reconstruction. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Julio Cesar Gali
- Department of Surgery, Faculty of Medical Science and Health, Catholic University of Sao Paulo, Rua Joubert Wey, 290, Sorocaba, SP, 18030-070, Brazil.
| | | | | | | | | | - Nicholas P Drain
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Freddie F Fu
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Zicaro JP, Garcia-Mansilla I, Zuain A, Yacuzzi C, Costa-Paz M. Has platelet-rich plasma any role in partial tears of the anterior cruciate ligament? Prospective comparative study. World J Orthop 2021; 12:423-432. [PMID: 34189080 PMCID: PMC8223727 DOI: 10.5312/wjo.v12.i6.423] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/18/2021] [Accepted: 05/07/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Partial tears of the anterior cruciate ligament (ACL) are frequent, and there is still considerable controversy surrounding their diagnosis, natural history and treatment.
AIM To examine patient-reported outcomes, physical examination and magnetic resonance imaging (MRI) findings of partial ACL tears treated with an intraarticular injection of platelet-rich plasma (PRP) compared to a control group.
METHODS From January 2015 to November 2017, consecutive patients from a single institution with partial ACL tears treated nonoperatively were prospectively evaluated. Partial tears were defined as a positive Lachman test with a clear end-point, a negative pivot-shift and less than 3 mm of side-to-side difference using the KT1000 arthrometer. Patients in group 1 were treated with one intraarticular injection of PRP and specific physical therapy protocol. Control group consisted of patients treated only with physical therapy. Prospective analyzed data included physical examination, Tegner activity level and Lysholm and International Knee Documentation Committee scores. Baseline MRI findings and at 6 mo follow-up were reviewed. Failure was defined as those patients with clinical instability at follow-up that required a subsequent ACL reconstruction.
RESULTS A total of 40 patients where included, 21 treated with PRP injection with a mean follow-up of 25 mo [standard deviation (SD): 3.6] and 19 in the control group with a mean follow-up of 25 mo (SD: 5.68). Overall failure rate was 32.0% (n = 13). No significant differences were observed between groups regarding subjective outcomes, return to sport and failure rate. MRI findings revealed an improvement in the ACL signal in half of the patients of both groups. However, we did not find a significant relationship between MRI findings and clinical outcomes.
CONCLUSION Overall, 95.0% of patients returned to sports at a mean follow-up of 25 mo. Mean time to return to sports was 4 mo. Out of these patients, almost 30.0% in each group had a new episode of instability and required surgery at a median time of 5 mo in group 1 and 8 mo in group 2. The addition of PRP alone was not sufficient to enhance any of the outcome measures evaluated, including MRI images, clinical evaluation and failure rate.
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Affiliation(s)
- Juan Pablo Zicaro
- Knee Division, Hospital Italiano de Buenos Aires, Buenos Aires 1181, Argentina
| | | | - Andres Zuain
- Knee Division, Hospital Italiano de Buenos Aires, Buenos Aires 1181, Argentina
| | - Carlos Yacuzzi
- Knee Division, Hospital Italiano de Buenos Aires, Buenos Aires 1181, Argentina
| | - Matias Costa-Paz
- Knee Division, Hospital Italiano de Buenos Aires, Buenos Aires 1181, Argentina
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Guenther D, Zhang C, Ferlin F, Vernacchia C, Musahl V, Irrgang JJ, Fu FH. Clinical examination of partial ruptures of the anterior cruciate ligament: A retrospective case-control study. Knee 2020; 27:1866-1873. [PMID: 33202290 DOI: 10.1016/j.knee.2020.07.093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 07/13/2020] [Accepted: 07/30/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Anterior drawer test, Lachman test including evaluation of the endpoint, and pivot shift test have been commonly applied clinically in diagnosing anterior cruciate ligament (ACL) injury but how they function in the appraisal of partial ACL tears is less known. The aims of this study were to examine the diagnostic values of the commonly used knee function tests on patients in detecting ACL injury including partial injury patterns, to assess each of the test's predictive values on the specific ACL injury pattern, and to assess if using multiple tests collectively for the diagnosis of the injury could improve diagnostic accuracy. METHODS We evaluated 36 consecutive patients who underwent ACL single bundle augmentation surgery. Those patients were matched by gender and age to 36 patients with a complete rupture of the ACL. Data was obtained from the patients' records. The rupture pattern was confirmed by arthroscopy. An examination under anesthesia was routinely performed by two surgeons who were blinded to the rupture pattern prior to surgery. RESULTS Collectively using both Lachman test and pivot shift test increases ability to distinguish between partial tears and complete ruptures. When comparing partial PL tears and complete ruptures the pivot shift test is more important than the Lachman test. In diagnosing a complete rupture, the evaluation of the endpoint during the Lachman test is more sensitive than the evaluation of the anterior tibial translation during the Lachman test. CONCLUSION Based on the findings of this study, a diagnostic algorithm has been implemented and is presented in this manuscript.
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Affiliation(s)
- Daniel Guenther
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Kaufman Medical Building, Suite 1011, 3941 Fifth Avenue, Pittsburgh, PA 15203, USA; Department of Orthopaedic Surgery, Trauma Surgery, and Sports Medicine, Cologne Merheim Medical Center, Ostmerheimer Str. 200, 51109, Cologne, Germany
| | - Caiyan Zhang
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Kaufman Medical Building, Suite 1011, 3941 Fifth Avenue, Pittsburgh, PA 15203, USA
| | - Fernando Ferlin
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Kaufman Medical Building, Suite 1011, 3941 Fifth Avenue, Pittsburgh, PA 15203, USA
| | - Cara Vernacchia
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Kaufman Medical Building, Suite 1011, 3941 Fifth Avenue, Pittsburgh, PA 15203, USA
| | - Volker Musahl
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Kaufman Medical Building, Suite 1011, 3941 Fifth Avenue, Pittsburgh, PA 15203, USA
| | - James J Irrgang
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Kaufman Medical Building, Suite 1011, 3941 Fifth Avenue, Pittsburgh, PA 15203, USA
| | - Freddie H Fu
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Kaufman Medical Building, Suite 1011, 3941 Fifth Avenue, Pittsburgh, PA 15203, USA.
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Deng X, Chen W, Shao D, Hu H, Zhu J, Ye Z, Zhang Y. Arthroscopic evaluation for tibial plateau fractures on the incidence and types of cruciate ligamentous injuries following closed reduction and internal fixation. INTERNATIONAL ORTHOPAEDICS 2020; 45:1287-1298. [PMID: 33123747 DOI: 10.1007/s00264-020-04864-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 10/23/2020] [Indexed: 01/08/2023]
Abstract
PURPOSE To evaluate the overall incidence and types of anterior cruciate ligament (ACL) injuries and posterior cruciate ligament (PCL) injuries associated with tibial plateau fractures (TPFs) following closed reduction and internal fixation (CRIF), and to identify the relationship between the incidence and types of cruciate ligamentous injuries with Schatzker classification and "three-column" classification. METHODS From January 2016 to January 2018, 185 patients with closed TPFs who underwent CRIF were included in this retrospective study. All patients were performed with arthroscopic examination after CRIF, and then, the incidence and types of cruciate ligamentous injuries were recorded and evaluated. RESULTS The overall incidence rates of cruciate ligamentous injuries associated with TPFs were 37.3% with 21.6% of these being ACL injuries and 15.7% had PCL injuries. Importantly, patients with fractures in "two-column" fractures have a significantly higher incidence rate of ACL avulsion fracture and PCL complete tears (P < 0.05) than other fracture types, especially involving anteromedial and posterior column fractures. In addition, the incidence of PCL partial tears in patients with three-column involvement was 11.8%, which was higher than other fracture patterns based on three-column classification system (P < 0.05). In the current study, Schatzker IV was most commonly associated with ACL injuries, occurring in 48.1% of our series. Furthermore, PCL injuries occurred at a significantly higher incidence in Schatzker VI with 34.5% than other fracture types (P < 0.05). Statistical analysis revealed that there was a significant difference between Schatzker classification and incidence of injury to the ACL (P < 0.05) and PCL (P < 0.05). Of note, avulsion fracture was the most common types of ACL injuries which was observed in 45% ACL injuries, while partial tear was the most common types of PCL injuries. However, no significant relationship was identified between the types of cruciate ligamentous injuries and Schatzker classification (P > 0.05). CONCLUSIONS In the recognition of concomitant cruciate ligamentous injuries associated with TPFs based on Schatzker classification and three-column classification, orthopaedic trauma surgeons may better guide optimal surgical protocols for patients.
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Affiliation(s)
- Xiangtian Deng
- School of Medicine, Nankai University, Tianjin, 300071, People's Republic of China.,Department of Orthopaedic Surgery of Hebei Province, Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Wei Chen
- Department of Orthopaedic Surgery of Hebei Province, Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Decheng Shao
- Department of Orthopaedic Surgery of Hebei Province, Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Hongzhi Hu
- Department of Orthopaedic Surgery of Hebei Province, Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China.,Department of Orthopedics, Union Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, 430022, People's Republic of China
| | - Jian Zhu
- School of Medicine, Nankai University, Tianjin, 300071, People's Republic of China.,Department of Orthopaedic Surgery of Hebei Province, Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - ZhiPeng Ye
- School of Medicine, Nankai University, Tianjin, 300071, People's Republic of China.,Department of Orthopaedic Surgery of Hebei Province, Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China
| | - Yingze Zhang
- School of Medicine, Nankai University, Tianjin, 300071, People's Republic of China. .,Department of Orthopaedic Surgery of Hebei Province, Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People's Republic of China.
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