Predicting anterior cruciate ligament integrity in patients with osteoarthritis

  • Alex J. TrompeterEmail author
  • K. Gill
  • M. A. C. Appleton
  • S. H. Palmer


This study looks at the difference between the macroscopic and microscopic appearances of the anterior cruciate ligament (ACL) in a sample of 55 consecutive patients admitted for routine total knee replacement for osteoarthritis. At the time of surgery the macroscopic appearance of the ACL was classified as normal, moderately damaged (fissured) or completely ruptured. The excised ACL was sent for histological examination and grading. The macroscopic appearance of the ACL at surgery was compared to the severity of disease on microscopic examination. At surgery, 31 ACLs were found to be macroscopically normal: 22 of these (71%) showed moderate to severe disease on microscopic assessment. Thus a macroscopically normal ACL does not necessarily imply histological integrity. This has clinical implications in other areas of knee surgery including Unicompartmental Knee Replacement which require a fully functional intact ACL.


Anterior cruciate ligament Pivot shift test Knee replacement Histology Osteoarthritis Macroscopic Microscopic 


  1. 1.
    Allain J, Goutallier D, Voisin MC (2001) Macroscopic and histological assessments of the cruciate ligaments in arthrosis of the knee. Acta Orthop Scand 72:266PubMedCrossRefGoogle Scholar
  2. 2.
    Cibere J, Bellamy N, Thorne A, Edaile J, McGorm K, Chalmers A, Huang S, Peloso P, Shojania K, Singer J, Wong H, Kopec J (2004) Reliability of the knee examination in osteoarthritis: effect of standardisation. Arthritis Rheum 50:458–468PubMedCrossRefGoogle Scholar
  3. 3.
    Cushner FD, La Rosa DF, Vigorita VJ, Scudieri GR, Scott WN, Insall JN (2003) A quantitative histological comparison: ACL degeneration in the osteoarthritic knee. J Arthroplasty 18:687–692PubMedCrossRefGoogle Scholar
  4. 4.
    Donell ST, Glasgow MMS (2007) Isolated patellofemoral osteoarthiritis. Knee 14:169–176PubMedCrossRefGoogle Scholar
  5. 5.
    Engh GA, Ammeen D (2004) Is an intact anterior cruciate ligament needed in order to have a well-functioning unicondylar knee replacement? CORR 428:170–173CrossRefGoogle Scholar
  6. 6.
    Hill CL, Seo GS, Gale D, Totterman S, Gale ME, Felson DT (2005) Cruciate ligament integrity in osteoarthritis of the knee. Arthritis Rheum 52:794–797PubMedCrossRefGoogle Scholar
  7. 7.
    Juni P, Frankel S (2003) Population requirements for primary knee replacement surgery: a cross-sectional study. Rheumatology (Oxford) 42:503–506CrossRefGoogle Scholar
  8. 8.
    Karachalios T, Zibis A, Papanagiotou P, Karantanas AH, Malizos KN, Roidis N (2004) MR imaging findings in early osteoarthritis of the knee. Eur J Radiol 50:225–230PubMedCrossRefGoogle Scholar
  9. 9.
    Khanna G, Levy BA (2007) Oxford unicompartmental knee replacement: literature review. Orthopedics 30(Suppl):11–14PubMedGoogle Scholar
  10. 10.
    Kim S-J, Kim H-K (1995) Reliability of the anterior drawer test, the pivot shift test and the Lachman test. CORR 317:237–242Google Scholar
  11. 11.
    Lee GC, Cushner FD, Vigoritta V, Scudieri GR, Insall JN, Scott WN (2005) Evaluation of the anterior cruciate ligament integrity and degenerative arthritic patterns in patients undergoing total knee arthroplasty. J Arthroplasty 20:59–65PubMedCrossRefGoogle Scholar
  12. 12.
    Limans H (1995) Diagnosis of partial tears of the anterior cruciate ligament of the knee: value of MR imaging. Am J Roentgenol 165:893–897Google Scholar
  13. 13.
    Link IM, Lane N (2003) Osteoarthritis: MR imaging findings in different stages of disease and correlation with clinical findings. Radiology 226:373–381PubMedCrossRefGoogle Scholar
  14. 14.
    National Joint Registry for England and Wales, 3rd annual report, 2005Google Scholar
  15. 15.
    Nawata K, Enokida M, Yamasaki D, Minamizaki T, Hagino H, Morio Y, Teshima R (2001) Tensile properties of rat anterior cruciate ligament in collagen induced arthritis. Ann Rheum Dis 60:395–398PubMedCrossRefGoogle Scholar
  16. 16.
    Phillips AM, Goddard NJ, Tomlinson JE (1996) Current techniques in total knee replacement: results of a national survey. Ann R Coll Surg Engl 78:515–520PubMedGoogle Scholar
  17. 17.
    Smith DK, May DA, Philips P (1996) MR imaging of the anterior cruciate ligament: frequency of discordant findings on sagittal-oblique images and correlation with arthroscopic findings. Am J Roentgenol 166:411–413Google Scholar
  18. 18.
    Suggs JF, Li G, Park SE, Steffenmeiser S, Rubash HE, Freiberg AA (2004) Function of the anterior cruciate ligament after unicompartmental knee arthroplasty: an in vitro robotic study. J Arthroplasty 19:224–229PubMedCrossRefGoogle Scholar
  19. 19.
    Wada M, Imura S, Baba H, Shimada S (1996) Knee laxity in patients with osteoarthritis and rheumatoid arthritis. Br J Rheumatol 35:560–563PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Alex J. Trompeter
    • 1
    Email author
  • K. Gill
    • 2
  • M. A. C. Appleton
    • 3
  • S. H. Palmer
    • 2
  1. 1.South West Thames Orthopaedic RotationBerksUK
  2. 2.Department of Trauma and OrthopaedicsWorthing and Southlands Hospitals NHS TrustWorthingUK
  3. 3.Department of HistopathologyWorthing and Southlands Hospitals NHS TrustWorthingUK

Personalised recommendations