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Can rotatory knee laxity be predicted in isolated anterior cruciate ligament surgery?

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Abstract

Purpose

Despite the overall success of the surgical anterior cruciate ligament (ACL) reconstruction, some patients still present with instability symptoms even after the surgery, mainly due to the presence of associated lesions. At present, the pivot shift test has been reported to be the benchmark to assess rotatory knee laxity. The purpose of this study was to quantitatively evaluate rotatory knee laxity at time-zero in order to determine whether detected post-reconstruction laxity was predictable by its value measured before the reconstruction, which was hypothized to be influenced by the presence of associated lesions.

Methods

Rotatory knee laxity was retrospectively analysed in 42 patients, including two different ACL reconstructions. The maximal anterior displacement and the absolute value of the posterior acceleration reached during the reduction of the tibial lateral compartment were intra-operatively acquired by using a navigation system and identified as discriminating parameters. For each parameter, statistical linear regression analysis (line slope and intercept) was performed between pre- and post-reconstruction values.

Results

No statistically significant influence of the initial posterior acceleration on the post-reconstruction outcome was found (line slope, p > 0.05), although a statistically significant line intercept was indeed identified (p < 0.001). A statistically significant influence on the surgery outcome was instead found for the initial value of the anterior tibial displacement (line slope = 0.39, p = 0.004), meaning that, on average, about 40 % of the post-reconstruction lateral compartment displacement could be explained by the corresponding pre-reconstruction value. Both of these findings highlighted the importance of intra-operative quantification of rotatory knee laxity to identify correct indications for the surgery.

Conclusions

This study provided important implications for the future possibility of defining a quantifying tool able to assess rotatory knee laxity during ACL reconstruction. This could allow detection of additional injuries to secondary restraints by easily performing rotatory knee laxity tests, which in turn could reduce post-surgical recurrence of knee instability.

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Acknowledgments

We would like to acknowledge all the staff of II Clinica Ortopedica e Traumatologica at Istituto Ortopedico Rizzoli for their assistance during the study. AV would like to particularly thank Emil Ferretti for his great contribution in the management of technological aspects of the lab. No funding was directly received by any of the authors for the proposed study.

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Authors and Affiliations

  1. Laboratorio di Biomeccanica e Innovazione Tecnologica, Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, Italy

    Nicola Lopomo, Cecilia Signorelli, Tommaso Bonanzinga, Giulio Maria Marcheggiani Muccioli, Andrea Visani, Maurilio Marcacci & Stefano Zaffagnini

  2. Laboratorio di NanoBiotecnologie-NaBi, Istituto Ortopedico Rizzoli, Bologna, BO, Italy

    Nicola Lopomo

  3. Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milano, MI, Italy

    Cecilia Signorelli

  4. II Clinica Ortopedica e Traumatologica, Istituto Ortopedico Rizzoli, Bologna, BO, Italy

    Tommaso Bonanzinga, Giulio Maria Marcheggiani Muccioli, Maria Pia Neri, Maurilio Marcacci & Stefano Zaffagnini

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  1. Nicola Lopomo
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  2. Cecilia Signorelli
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  3. Tommaso Bonanzinga
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  4. Giulio Maria Marcheggiani Muccioli
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  5. Maria Pia Neri
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  6. Andrea Visani
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  7. Maurilio Marcacci
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  8. Stefano Zaffagnini
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Correspondence to Nicola Lopomo.

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Lopomo, N., Signorelli, C., Bonanzinga, T. et al. Can rotatory knee laxity be predicted in isolated anterior cruciate ligament surgery?. International Orthopaedics (SICOT) 38, 1167–1172 (2014). https://doi.org/10.1007/s00264-014-2287-0

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  • DOI: https://doi.org/10.1007/s00264-014-2287-0

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