Computer-Assisted System in Stress Radiography for Anterior Cruciate Ligament Injury with Correspondent Evaluation of Relevant Diagnostic Factors

Wang, Chien-Kuo; Lin, Liang‐Ching; Sun, Yung-Nien; Lai, Cheng-Shih; Chen, Chia‐Hui; Kao, Cheng-Yi

doi:10.3390/diagnostics11030419

Cited by 3 publications

(12 citation statements)

References 24 publications

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“…The concept of passive ATT was re‐introduced in recent studies using MRI examination [14, 25, 37] or stress radiographs [38]. Several studies have demonstrated that an increased passive ATT was associated with the chronicity of the ACL rupture [22, 32], multiple ACL graft failures [13, 31], major knee laxity [20, 30] and worse clinical outcomes [21, 29].…”

Section: Introductionmentioning

confidence: 99%

Side-to-side anterior tibial translation on monopodal weightbearing radiographs as a sign of knee decompensation in ACL-deficient knees

Macchiarola

Jacquet

Dor

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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Purpose To evaluate the influence of time from injury and meniscus tears on the side-to-side difference in anterior tibial translation (SSD-ATT) as measured on lateral monopodal weightbearing radiographs in both primary and secondary ACL deficiencies. Methods Data from 69 patients (43 males/26 females, median age 27-percentile 25-75: 20-37), were retrospectively extracted from their medical records. All had a primary or secondary ACL deficiency as confirmed by MRI and clinical examination, with a bilateral weightbearing radiograph of the knees at 15°-20° flexion available. Meniscal status was assessed on MRI images by a radiologist and an independent orthopaedic surgeon. ATT and posterior tibial slope (PTS) were measured on the lateral monopodal weightbearing radiographs for both the affected and the contralateral healthy side. A paired t-test was used to compare affected/healthy knees. Independent t-tests were used to compare primary/secondary ACL deficiencies, time from injury (TFI) (≤ 4 years/ > 4 years) and meniscal versus no meniscal tear. Results ATT of the affected side was significantly greater than the contralateral side (6.2 ± 4.4 mm vs 3.5 ± 2.8 mm; p < 0.01). There was moderate correlation between ATT and PTS in both the affected and healthy knees (r = 0.43, p < 0.01 and r = 0.41, p < 0.01). SSD-ATT was greater in secondary ACL deficiencies (4.7 ± 3.8 vs 1.9 ± 3.2 mm; p < 0.01), patients with a TFI greater than 4 years (4.2 ± 3.8 vs 2.0 ± 3.0 mm; p < 0.01) and with at least one meniscal tear (3.9 ± 3.8 vs 0.7 ± 2.2 mm; p < 0.01). Linear regression showed that, in primary ACL deficiencies, SSD-ATT was expected to increase (+ 2.7 mm) only if both a meniscal tear and a TFI > 4 years were present. In secondary ACL deficiencies, SSD-ATT was mainly influenced by the presence of meniscal tears regardless of the TFI. Conclusion SSD-ATT was significantly greater in secondary ACL deficiencies, patients with a TFI greater than 4 years and with at least one meniscal tear. These results confirm that SSD-ATT is a time-and meniscal-dependent parameter, supporting the concept of gradual sagittal decompensation in ACL-deficient knees, and point out the importance of the menisci as secondary restraints of the anterior knee laxity. Monopodal weightbearing radiographs may offer an easy and objective method for the follow-up of ACL-injured patients to identify early signs of soft tissue decompensation under loading conditions. Level of evidence Level III.

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Section: Introductionmentioning

confidence: 99%

Side-to-side anterior tibial translation on monopodal weightbearing radiographs as a sign of knee decompensation in ACL-deficient knees

Macchiarola

Jacquet

Dor

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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“…After applying all exclusion criteria, 16 studies were included (Figure 1). § Four studies 6,12,18,30 examined the use of standing stress radiography, and 12 studies investigated the use of supine or lateral decubitus stress radiography. || The included studies reported on a total of 1823 patients.…”

Section: Resultsmentioning

confidence: 99%

“…The mean standing ATT for knees with ACL tears ranged from 1.2 6 4.1 mm to 10.6 6 4.83 mm in 2 studies. 12,30 One group reported a mean ATT side-to-side difference of 2.7 6 3.6 mm in ATT. 18 Another study stratified ATT into medial and lateral, and reported mean side-toside differences of 3.5 6 3.2 mm for M-ATT and 3.7 6 5.8 mm for L-ATT.…”

Section: Standing Acl Stress Radiographsmentioning

confidence: 99%

“…Bilateral lateral radiographs of each knee were obtained, and anterior tibial translation (ATT) was measured by drawing a line on the posterior aspect of the medial and lateral tibial plateaus, measuring the shortest distance from these lines to the most posterior aspect of the medial and lateral femoral condyles, and comparing the injured to the normal contralateral knee. 12 Wang et al 30 had patients obtain lateral radiographs before and after a 150-N force was placed posteriorly on the proximal tibia. Their mean flexion angle during stress testing was 38.47°6 11.22°.…”

Section: Standing Acl Stress Radiographsmentioning

confidence: 99%

“…While MRI is proficient in depicting anatomic disruptions, it falls short in evaluating the dynamic functional integrity of the ACL, which is a critical aspect often assessed through stress radiography or instrumented measurement. 1,2,16,24,30 In addition, MRI is expensive, 4 and its associated cost leaves those in rural facilities or underdeveloped nations at a disadvantage in receiving timely diagnoses. 19,23 Furthermore, MRI is associated with some degree of subjectivity, which adds an important nuance to the high reported values for the sensitivity and specificity of MRI to detect an ACL tear.…”

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confidence: 99%

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The Functional Integrity of the Anterior Cruciate Ligament Can Be Objectively Assessed With the Use of Stress Radiographs: A Systematic Review

Schwartz,

Rodriguez,

Banovetz

et al. 2024

Orthopaedic Journal of Sports Medicine

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Background: Stress radiography is a viable imaging modality that can also be used to assess the integrity of the anterior cruciate ligament (ACL) after primary or secondary injury. Because conventional radiography is relatively easy, affordable, and available worldwide, the diagnostic efficacy of ACL standing, lateral decubitus, and supine stress radiography should be evaluated. Purpose: To examine the existing literature regarding the application of stress radiography in evaluating the integrity of the ACL. Study Design: Systematic review; Level of evidence, 3. Methods: Using the PubMed and MEDLINE databases for relevant articles published between 1980 and the present, a systematic review was conducted to identify evidence related to the radiographic diagnosis or assessment of ACL tears. The literature search was conducted in September 2022. Results: Of 495 studies, 16 (1823 patients) were included. Four studies examined standing stress radiography, and 12 investigated lateral decubitus or supine stress radiography. Significant heterogeneity in imaging technique and recorded anterior tibial translation was identified. Anterior tibial translation for ACL-injured knees ranged from 1.2 to 10.6 mm for standing stress radiographs and 2.7 to 11.2 mm for supine stress radiographs, with high sensitivities and specificities for both. Conclusion: Stress radiography was a dependable diagnostic method for identifying ACL rupture. Further research is necessary to determine the ideal anatomic landmarks, optimal patient positioning, and appropriate applied stresses to establish a standardized protocol for both assessing ACL tears and evaluating the postoperative integrity of ACL reconstruction using stress radiography.

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Anterior Intercondylar Notch Geometry in Relation to the Native Anterior Cruciate Ligament Size

Cernat,

Dima,

Popescu

et al. 2024

JCM

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Background: The intercondylar notch (ICN) and the anterior cruciate ligament (ACL) are important structures in knee morphometry, with key roles in stabilizing the knee. Aim: To determine the associations between the specific shape of the ICN (A-, W-, or U-shape) and the ACL size in patients with intact ACLs. Methods: Magnetic resonance imaging (MRI) scans were independently analyzed by two experts: one orthopedic surgeon and one imaging physician. In all cases, the following measurements were taken based on the existing definitions: ACL area, anterior ICN (aICN) area, ICN width, lateral trochlear inclination (LTI), and Insall–Salvati index. Results: A total of 65 cases (50.8% male; 33.8 ± 10.2 years mean age at inclusion) were included in the study. The ACL and aICN areas were significantly larger in patients with U-shaped compared with A-shaped and W-shaped ICNs: 0.50 (0.20–0.80) vs. 0.40 (0.20–0.80) vs. 0.40 (0.30–0.80), p = 0.011 and 1.16 (0.57–3.60) vs. 0.47 (0.15–0.95) vs. 0.37 (0.15–0.81), p < 0.001, respectively. Internal meniscal lesions were more common in cases with U-shaped ICNs (64.0%), while external ones were more common in W-shaped ICN cases (35.3%). None of the A-shaped cases had external chondral or meniscal lesions. The ACL area was significantly larger in males and internal meniscal injuries, with no differences between chondral lesions, external meniscal injuries, patellar chondral lesions, patella alta, or trochlear dysplasia. Conclusion: The specific shape of the intercondylar notch was associated with the anterior cruciate ligament–anterior intercondylar notch (ACL–aICN) area size correlation, with a strong correlation between ACL and aICN area when the intercondylar notch was A-shaped or W-shaped, and a low correlation when the notch was U- shaped. The specific shape of the intercondylar notch (A-, W-, or U-shape) was associated with the occurrence of both internal and external meniscal injuries, with the U-shaped intercondylar notch morphometry being more frequent in cases with internal meniscal injuries and the W-shape being more common in cases with external meniscal injuries.

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Computer-Assisted System in Stress Radiography for Anterior Cruciate Ligament Injury with Correspondent Evaluation of Relevant Diagnostic Factors

Cited by 3 publications

References 24 publications

Side-to-side anterior tibial translation on monopodal weightbearing radiographs as a sign of knee decompensation in ACL-deficient knees

Side-to-side anterior tibial translation on monopodal weightbearing radiographs as a sign of knee decompensation in ACL-deficient knees

The Functional Integrity of the Anterior Cruciate Ligament Can Be Objectively Assessed With the Use of Stress Radiographs: A Systematic Review

Anterior Intercondylar Notch Geometry in Relation to the Native Anterior Cruciate Ligament Size

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