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Distal remnant length can be measured reliably and predicts primary repair of proximal anterior cruciate ligament tears

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To assess the reliability and predictive value of quantifying anterior cruciate ligament (ACL) tear location on magnetic resonance imaging (MRI) and assess the predictive value of tear location on the eligibility for arthroscopic primary repair of proximal ACL tears.

Methods

In this case–control study, all adult patients undergoing acute ACL surgery between 2008 and 2020 were retrospectively reviewed. All patients were treated with the treatment algorithm of undergoing primary repair when proximal tears with sufficient tissue quality were present intraoperatively, and otherwise underwent single-bundle ACL reconstruction. Sagittal MRI images were reviewed to measure proximal and distal remnant lengths along the anterior aspect of the torn ligament, and tear location was calculated as distal remnant divided by total remnant length. Interobserver and intraobserver reliability for remnant measurements were calculated. Then, receiver operating curve analysis (ROC) was performed to calculate the optimal cut-off for the possibility of primary repair with the different measurements.

Results

Two hundred and forty-eight patients were included, of which 151 underwent repair (61%). Inter- and intraobserver reliability ranged between 0.92 and 0.96 [95% confidence interval (CI) 0.55–0.98] and 0.91–0.97 (95% CI 0.78–0.98, respectively). All patients with a tear location of  ≥ 80% on MRI could undergo repair, whereas all patients with tear location of < 60% required reconstruction. The positive predictive value of a proximal quarter tear (≥ 75%) on primary repair was 94%. Older age was correlated with more proximal tear location (p < 0.001), but there was no correlation between tear location and gender, BMI, or timing of surgery (all n.s).

Conclusion

This study showed that tear location could reliably be quantified on MRI by assessing distal and proximal remnant lengths. Tear location in the proximal quarter of the ACL was found to have a positive predictive value for repairability of 94%. These findings may assist orthopaedic surgeons in evaluating which patients are eligible for primary ACL repair preoperatively.

Level of evidence

III.

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Funding

No funding was received to perform this study.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA

    Harmen D. Vermeijden, Jelle P. van der List & Gregory S. DiFelice

  2. Department of Orthopaedic Surgery, Spaarne Gasthuis Hospital, Hoofddorp, The Netherlands

    Harmen D. Vermeijden, Maarten V. Rademakers & Jelle P. van der List

  3. Department of Orthopaedic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Science, Amsterdam, The Netherlands

    Harmen D. Vermeijden, Gino M. M. J. Kerkhoffs & Jelle P. van der List

  4. Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA

    Brett Cerniglia & Douglas N. Mintz

  5. Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands

    Gino M. M. J. Kerkhoffs

  6. Amsterdam UMC, Amsterdam Collaboration On Health and Safety in Sports (ACHSS), University of Amsterdam and Vrije Universiteit Amsterdam IOC Research Center, Amsterdam, The Netherlands

    Gino M. M. J. Kerkhoffs

Authors
  1. Harmen D. Vermeijden
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  2. Brett Cerniglia
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  3. Douglas N. Mintz
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  4. Maarten V. Rademakers
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  5. Gino M. M. J. Kerkhoffs
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  6. Jelle P. van der List
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  7. Gregory S. DiFelice
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Corresponding author

Correspondence to Gregory S. DiFelice.

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Conflict of interest

GSD declares he is a paid consultant and receives research grants from Arthrex (Naples, FL, USA). GK declares that the Department of Orthopedic Surgery of the Amsterdam University Medical Centers received an unrestricted research Grant from Arthrex (Naples, FL, USA).

Ethics approval

This study was approved by the Institutional Review Board of Hospital for Special Surgery, New York, NY, USA.

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Vermeijden, H.D., Cerniglia, B., Mintz, D.N. et al. Distal remnant length can be measured reliably and predicts primary repair of proximal anterior cruciate ligament tears. Knee Surg Sports Traumatol Arthrosc 29, 2967–2975 (2021). https://doi.org/10.1007/s00167-020-06312-x

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  • DOI: https://doi.org/10.1007/s00167-020-06312-x

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