Evaluating rotational kinematics of the knee in ACL-ruptured and healthy patients using 3.0 Tesla magnetic resonance imaging
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Rotational knee laxity is an important measure in restoring knee stability following anterior cruciate ligament (ACL) injury, but is difficult to quantify with current clinical tools. The hypothesis of the study is that there is greater tibial rotation (TR) in women than men, and also in ACL-deficient than healthy knees.
Sixteen healthy (8 men, 26.8 ± 6.4 years; 8 women, 26.9 ± 3.8 years) and ten ACL-deficient (5 men, 33.6 ± 10.5 years; 5 women, 36.3 ± 10.7 years) subjects received bilateral knee MRI in 15° of flexion using a custom device to apply a constant axial compressive load (44 N). A rotational torque (3.35 Nm) was sequentially applied to obtain images at internal and external rotation positions. T 2-weighted images were acquired in internal and external rotation. Images were segmented and TR was calculated. To assess reproducibility, six knees were scanned twice on separate days. Group comparisons were made with unpaired t tests, while intrasubject comparisons were made using paired t tests.
Healthy women demonstrated greater TR than men (13.6° ± 4.7° vs. 8.3° ± 3.6°; P = 0.001). Male ACL-deficient knees showed greater TR than the contralateral knee (15.7° ± 6.9° vs. 7.7° ± 5.6°; P = 0.003), and compared to male controls (P = 0.002). ACL-deficient women showed greater TR compared to their contralateral leg (15.1° ± 2.3° vs. 10.0° ± 4.3°; P = 0.01). The intraclass correlation coefficient of the TR measurement was 0.913, and the SEM = 1.1°.
Kinematic MRI is a reproducible method to quantify total knee rotation. Women have more rotational laxity than men, particularly in the external rotation position. ACL rupture leads to increased rotational laxity of the knee.
Level of evidence
Retrospective case–control series, Level III.
KeywordsAnterior cruciate ligament Tibial rotation Kinematics Knee Imaging MRI
- 1.Ahlden M, Kartus J, Ejerhed L, Karlsson J, Sernert N (2009) Knee laxity measurements after anterior cruciate ligament reconstruction, using either bone-patellar-tendon-bone or hamstring tendon auto grafts, with special emphasis on comparison over time. Knee Surg Sports Traumatol Arthrosc 17(9):1117–1124PubMedCrossRefGoogle Scholar
- 11.Chouliaras V, Ristanis S, Moraiti C, Stergiou N, Georgoulis AD (2007) Effectiveness of reconstruction of the anterior cruciate ligament with quadrupled hamstrings and bone-patellar tendon-bone autografts: an in vivo study comparing tibial internal-external rotation. Am J Sports Med 35(2):189–196PubMedCrossRefGoogle Scholar
- 12.Claes S, Neven E, Callewaert B, Desloovere K, Bellemans J (2011) Tibial rotation in single- and double-bundle ACL reconstruction: a kinematic 3-D in vivo analysis. Knee Surg Sports Traumatol Arthrosc. doi: 10.1007/s00167-011-1568-z
- 19.Gobbi A, Mahajan V, Karnatzikos G, Nakamura N (2011) Single- versus double-bundle ACL reconstruction: is there any difference in stability and function at 3-year followup? Clin Orthop Relat Res. doi: 10.1007/s11999-011-1940-9
- 21.Ireland ML, Ott SM (2004) Special concerns of the female athlete. Clin Sports Med 23(2):281–298, viiGoogle Scholar
- 22.Isberg J, Faxen E, Laxdal G, Eriksson BI, Karrholm J, Karlsson J (2011) Will early reconstruction prevent abnormal kinematics after ACL injury? Two-year follow-up using dynamic radiostereometry in 14 patients operated with hamstring autografts. Knee Surg Sports Traumatol Arthrosc 19(10):1634–1642PubMedCrossRefGoogle Scholar
- 31.Shultz SJ, Shimokochi Y, Nguyen AD, Schmitz RJ, Beynnon BD, Perrin DH (2007) Measurement of varus-valgus and internal-external rotational knee laxities in vivo–Part II: relationship with anterior-posterior and general joint laxity in males and females. J Orthop Res 25(8):989–996PubMedCrossRefGoogle Scholar