Global rotation has high sensitivity in ACL lesions within stress MRI
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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.
KeywordsACL 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.
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.
- 9.Espregueira-Mendes J, Pereira H, Sevivas N, Passos C, Vasconcelos JC, Monteiro A, Oliveira JM, Reis RL (2012) Assessment of rotatory laxity in anterior cruciate ligament-deficient knees using magnetic resonance imaging with Porto-knee testing device. Knee Surg Sports Traumatol Arthrosc 20:671–678CrossRefPubMedGoogle Scholar
- 22.Lopomo N, Signorelli C, Rahnemai-Azar AA, Raggi F, Hoshino Y, Samuelsson K, Musahl V, Karlsson J, Kuroda R, Zaffagnini S (2016) Analysis of the influence of anaesthesia on the clinical and quantitative assessment of the pivot shift: a multicenter international study. Knee Surg Sports Traumatol Arthrosc. doi: 10.1007/s00167-016-4130-1 Google Scholar
- 25.Michalitsis S, Hantes M, Thriskos P, Tsezou A, Malizos K, Fezoulidis I, Vlychou M (2016) Articular cartilage status 2 years after arthroscopic ACL reconstruction in patients with or without concomitant meniscal surgery: evaluation with 3.0 T MR imaging. Knee Surg Sports Traumatol Arthrosc. doi: 10.1007/s00167-016-4153-7 PubMedGoogle Scholar
- 26.Mouton C, Theisen D, Meyer T, Agostinis H, Nührenbörger C, Pape D, Seil R (2015) Noninjured knees of patients with noncontact ACL injuries display higher average anterior and internal rotational knee laxity compared with healthy knees of a noninjured population. Am J Sports Med 43:1918–1923CrossRefPubMedGoogle Scholar
- 33.Nakamura K, Koga H, Sekiya I, Watanabe T, Mochizuki T, Horie M, Nakamura T, Otabe K, Muneta T (2015) Evaluation of pivot shift phenomenon while awake and under anaesthesia by different manoeuvres using triaxial accelerometer. Knee Surg Sports Traumatol Arthrosc. doi: 10.1007/s00167-015-3740-3 Google Scholar
- 43.Tardy N, Marchand P, Kouyoumdjian P, Blin D, Demattei C, Asencio G (2014) A preliminary in vivo assessment of anterior cruciate ligament-deficient knee kinematics with the KneeM device: a new method to assess rotatory laxity using open MRI. Orthop J Sports Med. doi: 10.1177/2325967114525583 PubMedPubMedCentralGoogle Scholar