Anterior and rotational tibial subluxation in the setting of anterior cruciate ligament injuries: An MRI analysis

Zhang, Zhiyu; Wang, Cheng; Maimaitimin, Maihemuti; Huang, Hongjie; Pan, Xiaoyu; Maimaitijiang, Pakezhati; He, Ziyi; Wang, Xue-wen; Zhang, Xin; Wang, Jianquan

doi:10.1016/j.knee.2021.10.012

Cited by 10 publications

(17 citation statements)

References 39 publications

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“…Compared with ACL-intact knees, ACL-injured knees demonstrated more anterior subluxation and internal rotation of the tibia, causing the ATSLC to be greater than the ATSMC. 17,34,54 Although both ATSMC and ATSLC were statistically significant in the univariate analyses in the present study, the ATSLC showed better diagnostic performance and was more important in the multivariate regression models, especially for chronic injuries and high-grade pivot shift. Lian et al 24 documented the ATSLC at full knee extension as a predictor of high-grade rotatory instability (quantitatively measured with surface markers) and obtained a cutoff value of 2.95 mm, whereas no statistical difference in ATSMC was detected between the high-grade and low-grade groups.…”

Section: Discussioncontrasting

confidence: 56%

Association Between Anterior Tibial Subluxation of Lateral Compartment and High-Grade Knee Laxity in Patients With Anterior Cruciate Ligament Deficiency

Chen

et al. 2023

Am J Sports Med

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Background: High-grade knee laxity and excessive anterior tibial subluxation (ATS) are correlated with poor clinical outcomes in patients with anterior cruciate ligament (ACL) deficiency and share similar risk factors; however, the association between excessive ATS and high-grade knee laxity remains unclear. Purpose: To identify the association between excessive ATS and high-grade knee laxity in patients with ACL deficiency and determine the possibility that ATS can predict high-grade knee laxity. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 226 patients who underwent ACL reconstruction between May 2018 and March 2022 were analyzed in the present study; the high-grade group consisted of 113 patients who had a grade 3 result on the preoperative anterior drawer test, Lachman test, or pivot-shift test while under anesthesia, and the low-grade group consisted of 113 matched patients. The ATS values for medial and lateral compartments (ATSMC and ATSLC) were measured on magnetic resonance imaging while patients relaxed the quadriceps in the supine position under no anesthesia. The optimal cutoff values of ATSMC and ATSLC for high-grade knee laxity were determined using receiver operating characteristic curves. Univariate and multivariate logistic regression analyses with stratification were performed to identify the association between excessive ATS and high-grade knee laxity. Results: Compared with the low-grade group, the high-grade group had a longer time from injury to surgery; higher rates of medial meniscus posterior horn tear (MMPHT), lateral meniscus posterior horn tear (LMPHT), and anterolateral ligament (ALL) abnormality; and larger lateral tibial slope, ATSMC, and ATSLC. The optimal cutoff value was 2.6 mm (sensitivity, 52.2%; specificity, 76.1%) for ATSMC and 4.5 mm (sensitivity, 67.3%; specificity, 64.6%) for ATSLC in predicting high-grade knee laxity. After adjustment for covariates, ATSLC ≥4.5 mm (odds ratio [OR], 2.94; 95% CI, 1.56-5.55; P = .001), MMPHT (OR, 2.62; 95% CI, 1.35-5.08; P = .004), LMPHT (OR, 2.39; 95% CI, 1.20-4.78; P = .014), and ALL abnormality (OR, 2.09; 95% CI, 1.13-3.89; P = .019) were associated with high-grade knee laxity. The association between excessive ATSLC and high-grade knee laxity was validated in patients with acute ACL injury as well as those with chronic ACL injury. Conclusion: Excessive ATSLC was associated with high-grade knee laxity in patients who had ACL deficiency, with a predictive cutoff value of 4.5 mm. This study may help surgeons estimate the degree of knee instability more accurately before anesthesia and may facilitate preliminary surgical decision-making, such as appropriate graft choices and consideration of extra-articular augmentation.

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Section: Discussioncontrasting

confidence: 56%

Association Between Anterior Tibial Subluxation of Lateral Compartment and High-Grade Knee Laxity in Patients With Anterior Cruciate Ligament Deficiency

Chen

et al. 2023

Am J Sports Med

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“…Likewise, a recent matched control study found that in knees with a torn ACL, the tibia not only subluxated anteriorly but also internally rotated when evaluated by MRI. 49 Our study suggests that patients with ACLR failure had higher internal tibial rotation compared with patients with intact ACLR at a minimum of 2 years' follow-up. From a surgical point of view, increased tibiofemoral rotation may result in higher reliance on secondary stabilizers and may therefore loosen secondary stabilizers sooner.…”

Section: Discussionmentioning

confidence: 57%

“…Nevertheless, radiographic measurements of axial rotation may play a role in ACL injuries and reinjuries after ACLR. In the clinical setting, tibial rotation abnormalities are frequently encountered in patients who have sustained an ACL injury, 2,49 as demonstrated by recent studies. 27,45 However, the relevance of these measurements is unclear.…”

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confidence: 99%

Effect of Tibiofemoral Rotation Angle on Graft Failure After Anterior Cruciate Ligament Reconstruction

et al. 2023

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Background: Coronal and sagittal malalignment of the knee are well-recognized risk factors for failure after anterior cruciate ligament (ACL) reconstruction (ACLR). However, the effect of axial malalignment on graft survival after ACLR is yet to be determined. Purpose: To evaluate whether increased tibiofemoral rotational malalignment, namely, tibiofemoral rotation angle (TFA) and tibial tubercle–trochlear groove (TT-TG) distance, is associated with graft failure after ACLR. Study Design: Cohort study; Level of evidence, 3. Methods: In this retrospective matched control study of a single center’s database, 151 patients who underwent revision ACLR because of graft failure (ACLR failure group, defined as symptomatic patients with anterior knee instability and an ACL graft tear appreciated on magnetic resonance imaging [MRI] and confirmed during arthroscopic surgery) were compared with a matched control group of 151 patients who underwent primary ACLR with no evidence of failure after ≥2-year follow-up (intact ACLR group). Patients were matched by sex, age, and meniscal injury during primary ACLR. Axial malalignment was assessed on preoperative MRI through the TFA and the TT-TG distance. Sagittal alignment was measured through the posterior tibial slope on MRI. The optimal TFA cutoff associated with graft failure was identified by a receiver operating characteristic curve. The Kaplan-Meier curve with log-rank analysis was performed to evaluate the influence of the TFA on ACLR longevity. Results: The mean age was 25.7 ± 10.4 years for the ACLR failure group and 25.9 ± 10.0 years for the intact ACLR group. Among all the included patients, 174 (57.6%) were male. In the ACLR failure group, the mean TFA was 5.8°± 4.5° (range, −5° to 16°), while it was 3.0°± 3.3° (range, −3° to 15°) in the intact ACLR group ( P < .001). Neither the TT-TG distance nor the posterior tibial slope presented statistical differences between the groups. The receiver operating characteristic curve suggested an optimal TFA cutoff of 4.5° for graft failure (area under the curve = 0.71; P < .001; sensitivity, 68.2%; specificity, 75.5%). Considering this a threshold, patients who had a TFA ≥4.5° had 6.6 times higher odds of graft failure compared with patients with a TFA <4.5° ( P < .001). Survival analysis demonstrated a 5-year survival rate of 81% in patients with a TFA <4.5°, while it was 44% in those with a TFA ≥4.5° ( P < .001). Conclusion: An increased TFA was associated with increased odds of ACLR failure when the TFA was ≥4.5°. Measuring the TFA in patients with ACL tears undergoing reconstruction may inform the surgeon about additional factors that may require consideration before ACLR for a successful outcome.

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“…Subsequently, more and more quantitative evaluations of the anterior-posterior position relationship of the femorotibial joint based on X-ray [13,14] or MRI [15,16] were reported, but the research on the rotational position relationship of the femorotibial joint remained scarce. Zhang et al [17] used the difference between lateral ATT and medial ATT to represent the degree of tibial rotational subluxation (RTS), so as to evaluate the relative rotational relationship between the femur and tibia. Their results showed that the medial ATT, lateral ATT, and RTS in the ACL injury group were all higher than those in the healthy control group.…”

Section: Introductionmentioning

confidence: 99%

Differences in Magnetic Resonance Imaging between the Surgical Side and Healthy Side of Knee Joint after Anterior Cruciate Ligament Reconstruction

Huang

Liang

Gao

et al. 2023

Preprint

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Objective The inclination angle of the graft and the femorotibial position relationship after anterior cruciate ligament (ACL) reconstruction surgery has been widely discussed for long. However, studies comparing the surgical side with the healthy side are rarely reported. This study aimed to quantitatively describe the changes in the inclination angle of the graft and the femorotibial position relationship of the knee joint after ACL reconstruction relative to the healthy side based on magnetic resonance imaging (MRI), so as to identify effective indicators for quantifying the femorotibial relationship.Methods A retrospective analysis was performed on 50 cases of ACL reconstruction operated in the Sports Medicine Department of Shenzhen Second People’s Hospital from June 2019 to June 2020. MRI of the surgical side and healthy side was obtained for each patient. Based on the MRI, the inclination angle of the graft/ACL on the coronal plane and sagittal plane, the medial and lateral anterior tibial translation (ATT), and the femoral rotation angle (FA) and tibial rotation angle (TA) of both knees were measured. Then, the femorotibial angle (FTA) and the rotational tibial subluxation (RTS) were calculated in order to evaluate the differences in MRI results between the surgical and healthy sides.Results After ACL reconstruction, the inclination angle of the graft on the coronal plane and sagittal plane, the medial and lateral ATT, and the FA and TA were all greater than those of the healthy knee joint (P < 0.05). There were no significant differences in the FTA and RTS between the surgical and healthy sides, but there was a significant correlation between these two indicators.Conclusions After ACL reconstruction, the inclination angle of the graft cannot be restored to the level of the healthy knee joint, and obvious medial and lateral ATT occurred on the surgical side compared to the healthy side of the knee joint. In addition, there is a significant correlation between FTA and RTS, which are expected to be used as combined clinical indicators for evaluating the stability of knee joint rotation.

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Anterior and rotational tibial subluxation in the setting of anterior cruciate ligament injuries: An MRI analysis

Cited by 10 publications

References 39 publications

Association Between Anterior Tibial Subluxation of Lateral Compartment and High-Grade Knee Laxity in Patients With Anterior Cruciate Ligament Deficiency

Association Between Anterior Tibial Subluxation of Lateral Compartment and High-Grade Knee Laxity in Patients With Anterior Cruciate Ligament Deficiency

Effect of Tibiofemoral Rotation Angle on Graft Failure After Anterior Cruciate Ligament Reconstruction

Differences in Magnetic Resonance Imaging between the Surgical Side and Healthy Side of Knee Joint after Anterior Cruciate Ligament Reconstruction

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