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The posterior cruciate ligament inclination angle is higher in anterior cruciate ligament insufficiency

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Magnetic resonance imaging (MRI) is the gold standard image examination for anterior cruciate ligament (ACL) lesion diagnosis. Our hypothesis was that measuring the posterior cruciate ligament inclination angle (PCLIA) using MRI images may be an auxiliary tool to aid the recognition of ACL insufficiency. The purpose of this study was to compare the PCLIA measurement in MRIs of individuals with and without ACL injury.

Methods

The PCLIA was measured by two radiologists in 65 knee MRIs of patients with intact ACL (control group) and in 65 knee MRIs of people with ACL injury (study group). In both groups, the posterior cruciate ligament was intact. The control group was included 35 men (53.8%) and 30 women (46.1%). The patients' average age was 38.7 years (range 15–75; SD ± 14.8 years). In this group, 31 (47.6%) MRIs were from right knees and 34 (52.3%) were from left knees. The study group consisted of 45 men (69.2%) and 20 women (30.7%). The patients' average age was 36.8 years (range 14–55; SD ± 10.3 years). In this group, 33 (50.7%) were right knees and 32 (49.2%) were left knees. PCLIA was formed by the intersection of two lines drawn in MRI sagittal images. The first passed tangentially to the articular surface of the tibial condyle and the second was drawn over the fraction of the ligament that originated where the first crossed the PCL, outlined proximally.

Results

The average PCLIA was 44.2 ± 3.8° in the control group and 78.9 ± 8.6° in the study group. Statistical analyses showed that the PCLIA was higher in the group with ACL injury (p < 0.05).

Conclusion

The PCLIA was significantly higher in individuals with ACL injuries. The measurement of this angle using MRI images may allow for detection of ACL insufficiency and thus assist in an individualized and precise approach to the treatment of injuries to the ACL.

Clinical relevance

PCLIA may be a way to detect ACL insufficiency and thus help surgeons to decide which patient might need ACL reconstruction.

Level of evidence

III.

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Acknowledgements

We are grateful to the brilliant, fabulous and eternal Dr. Freddie Fu for the time we were able to live together and thus learn from his example as a doctor, professor and researcher. We will always miss you so much.

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Authors and Affiliations

  1. Department of Surgery, Faculty of Medical Science and Health, Catholic University of Sao Paulo, Rua Joubert Wey, 290, Sorocaba, SP, 18030-070, Brazil

    Julio Cesar Gali

  2. Santa Lucinda Hospital, Sorocaba, SP, Brazil

    Tyago Araujo Almeida

  3. Centro Médico Sorocaba, Sorocaba, SP, Brazil

    Daniela Cristina de Moraes Miguel & Samir Alexandre Nassar

  4. Núcleo de Ortopedia e Traumatologia do Esporte, Sorocaba, SP, Brazil

    Julio Cesar Gali Filho

  5. Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Nicholas P. Drain & Freddie F. Fu

Authors
  1. Julio Cesar Gali
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  2. Tyago Araujo Almeida
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  3. Daniela Cristina de Moraes Miguel
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  4. Samir Alexandre Nassar
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  5. Julio Cesar Gali Filho
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  6. Nicholas P. Drain
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  7. Freddie F. Fu
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Contributions

JCG—conception, interpretation and drafting of the manuscript. TAA—literature search and submission to the Ethics Committee. DCMM—PCLIA measurements in patients’ MRIs. SAN—PCLIA measurements in patients’ MRIs. JCGF—statistical analysis and drafting of the manuscript. NPD—reviewing and editing of the manuscript. FFF—reviewing and editing of the manuscript.

Corresponding author

Correspondence to Julio Cesar Gali.

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Conflict of interest

The authors declare that they have no conflict of interest.

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There was no funding source.

Ethical approval

This research was approved by the Ethics Committee of the Faculty of Medical Science and Health, Catholic University of Sao Paulo, Sorocaba/SP, Brazil, under the Number CAAE: 33438720.0.0000.5373.

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Informed consent was obtained from all patients included in this research.

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Gali, J.C., Almeida, T.A., de Moraes Miguel, D.C. et al. The posterior cruciate ligament inclination angle is higher in anterior cruciate ligament insufficiency. Knee Surg Sports Traumatol Arthrosc 30, 124–130 (2022). https://doi.org/10.1007/s00167-021-06789-0

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  • DOI: https://doi.org/10.1007/s00167-021-06789-0

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