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

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

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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Acknowledgements

The authors would first like to thank the Department of Radiology from the Clinique d'Eich (Centre Hospitalier de Luxembourg) for their help in the standardization and execution of monopodal radiographs.

Funding

No funding was received for the present work.

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Authors and Affiliations

  1. Clinica Ortopedica E Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy

    Luca Macchiarola & Stefano Zaffagnini

  2. Department of Orthopaedic Surgery, Centre Hospitalier de Luxembourg-Clinique d’Eich, 78 Rue d’Eich, 1460, Luxembourg, Luxembourg

    Christophe Jacquet, Jeremie Dor, Stefano Zaffagnini, Caroline Mouton & Romain Seil

  3. Luxembourg Institute of Research in Orthopaedics, Sports Medicine and Science, Luxembourg, Luxembourg

    Christophe Jacquet, Jeremie Dor, Caroline Mouton & Romain Seil

  4. Department of Orthopedic Surgery, Institute for Movement and Locomotion (IML), Traumatology St. Marguerite Hospital, Marseille, France

    Christophe Jacquet

  5. Human Motion, Orthopaedics, Sports Medicine and Digital Methods, Luxembourg Institute of Health, Luxembourg, Luxembourg

    Romain Seil

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  1. Luca Macchiarola
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  2. Christophe Jacquet
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Correspondence to Romain Seil.

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All procedure performed in this study were in accordance with the ethical standards of the institutional committee and with the 1964 Helsinki declaration and its later amendments.

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Macchiarola, L., Jacquet, C., Dor, J. et al. Side-to-side anterior tibial translation on monopodal weightbearing radiographs as a sign of knee decompensation in ACL-deficient knees. Knee Surg Sports Traumatol Arthrosc 30, 1691–1699 (2022). https://doi.org/10.1007/s00167-021-06719-0

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