Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 25, Issue 10, pp 2993–3003 | Cite as

Global rotation has high sensitivity in ACL lesions within stress MRI

  • João Espregueira-MendesEmail author
  • Renato Andrade
  • Ana Leal
  • Hélder Pereira
  • Abdala Skaf
  • Sérgio Rodrigues-Gomes
  • J. Miguel Oliveira
  • Rui L. Reis
  • Rogério Pereira



This study aims to objectively compare side-to-side differences of P-A laxity alone and coupled with rotatory laxity within magnetic resonance imaging, in patients with total anterior cruciate ligament (ACL) rupture.


This prospective study enrolled sixty-one patients with signs and symptoms of unilateral total anterior cruciate ligament rupture, which were referred to magnetic resonance evaluation with simultaneous instrumented laxity measurements. Sixteen of those patients were randomly selected to also have the contralateral healthy knee laxity profile tested. Images were acquired for the medial and lateral tibial plateaus without pressure, with postero-anterior translation, and postero-anterior translation coupled with maximum internal and external rotation, respectively.


All parameters measured were significantly different between healthy and injured knees (P < 0.05), with exception of lateral plateau without stress. The difference between injured and healthy knees for medial and lateral tibial plateaus anterior displacement (P < 0.05) and rotation (P < 0.001) was statistically significant. It was found a significant correlation between the global rotation of the lateral tibial plateau (lateral plateau with internal + external rotation) with pivot-shift, and between the anterior global translation of both tibial plateaus (medial + lateral tibial plateau) with Lachman. The anterior global translation of both tibial plateaus was the most specific test with a cut-off point of 11.1 mm (93.8 %), and the global rotation of the lateral tibial plateau was the most sensitive test with a correspondent cut-off point of 15.1 mm (92.9 %).


Objective laxity quantification of ACL-injured knees showed increased sagittal laxity, and simultaneously in sagittal and transversal planes, when compared to their healthy contralateral knee. Moreover, when measuring instability from anterior cruciate ligament ruptures, the anterior global translation of both tibial plateaus and global rotation of the lateral tibial plateau add diagnostic specificity and sensitivity. This work strengthens the evidence that the anterior cruciate ligament plays an important biomechanical role in controlling the anterior translation, but also both internal and external rotation. The high sensitivity and specificity of this device in objectively identifying and measuring the multiplanar instability clearly guides stability restoration clinical procedures.

Level of evidence Cross-sectional study, Level III.


ACL Magnetic resonance imaging Knee Instability Rotatory laxity Sagittal laxity 



The authors would like to sincerely acknowledge the SMIC Dragão Clinical Director, Dr Rui Aguiar, and all his team for their support in this study. They also thank Professor Cristina Almeida for her valuable help and discussions with the statistical data analysis, as well as the all the members of the physical therapy team of the Clínica do Dragão.

Authors’ contribution

RA and RP drafted the manuscript and performed the statistical analysis. AL carried out the PKTD measurements, AS and SRG validated the PKTD measurements and AS, SRG and JEM interpreted the PKTD measurements. JEM and HP participated in the design of the study. JEM, JMO and RLR validated and critically reviewed the scientific content of the manuscript. All authors read and approved the final manuscript.

Compliance with ethical standards

Conflict of interest

The author (JEM) registered the patent of Porto-Knee Testing Device (PKTD). He is the director of ESPMEN Consultoria Unipessoal, Lda (company which sells the PKTD). However, he does not receive any salary, fees or royalties. The remaining authors declare that they have no conflict of interest.


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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2016

Authors and Affiliations

  • João Espregueira-Mendes
    • 1
    • 2
    • 3
    • 4
    • 5
  • Renato Andrade
    • 2
    • 3
    • 6
  • Ana Leal
    • 2
    • 3
    • 7
  • Hélder Pereira
    • 2
    • 3
    • 8
  • Abdala Skaf
    • 9
    • 10
  • Sérgio Rodrigues-Gomes
    • 2
    • 3
    • 11
  • J. Miguel Oliveira
    • 2
    • 4
    • 5
  • Rui L. Reis
    • 4
    • 5
  • Rogério Pereira
    • 2
    • 3
    • 12
  1. 1.Orthopaedics Department of Minho UniversityBragaPortugal
  2. 2.Clínica do Dragão, Espregueira-Mendes Sports Centre - FIFA Medical Centre of ExcellencePortoPortugal
  3. 3.Dom Henrique Research CentrePortoPortugal
  4. 4.3B’s Research Group–Biomaterials, Biodegradables and Biomimetics, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative MedicineUniversity of MinhoBarco, GuimarãesPortugal
  5. 5.ICVS/3B’s–PT Government Associate LaboratoryBraga/GuimarãesPortugal
  6. 6.Faculty of SportsUniversity of PortoPortoPortugal
  7. 7.CMEMS Center for MicroElectroMechanical Systems, Mechanical Engineering DepartmentUniversity of MinhoGuimarãesPortugal
  8. 8.Orthopaedic DepartmentCentro Hospitalar Póvoa de VarzimVila do CondePortugal
  9. 9.Hospital do CoraçãoSão PauloBrazil
  10. 10.Musculoskeletal DepartmentClínica Alta Excelência DiagnósticaSão PauloBrazil
  11. 11.SMIC GroupPortoPortugal
  12. 12.Faculty of Health SciencesUniversity of Fernando PessoaPortoPortugal

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