Lesion of the Anterior Cruciate Ligament and Sagittal Disalignment of the Knee in Weight-Bearing

Abstract

Twenty-nine patients with late reconstructive surgery for anterior cruciate ligament lesions had a clinical and radiologic followup ten years after injury. Anterior sagittal displacement of the tibia was recorded on the routine standing radiographs in 16 knees all having a normal femoro-tibial alignment in the nonweight-bearing position. Five of eleven patients with sagittal displacement of between 10 and 19 mm had early osteoarthrosis, which was confirmed by magnetic resonance imaging in four cases; their ages ranged from 23 to 38 years. No radiographic signs of osteoarthrosis were observed in those with displacements of less than 10 mm. In some patients there was a discrepancy between the clinical and radiographic measurements of instability. In addition to the clinical tests of instability standing rather than non-weight-bearing lateral radiographs are suggested for the routine assessment of cruciate ligament injuries.

The Relationship between Anterior Cruciate Ligament Injury and Osteoarthritis of the Knee

“…In a comparison of patients undergoing revision and primary ACLR, Won et al [ 99 ] demonstrated that patients undergoing revision ACLR had more frequent varus malalignment and this was associated with a greater tendency for higher-grade radiographic OA at the medial tibiofemoral joint. Sagittal displacement of the tibia was evaluated by Egund and Friden [ 100 ], who reported in a cohort study of 29 patients that 5 of the 11 patients with sagittal displacement of between 10 and 19 mm had developed early OA at 10 years after surgery despite age ranges from 23 to 28 years old. The occurrence of malalignment as a consequence of ACL injury is seen in the report by Dejour et al [ 101 ] which demonstrated that the development of varus deformity, characterizing progressive OA, has its origination in the wear of the posteromedial tibial plateau due to ACL laxity.…”

Surgical and Biomechanical Perspectives on Osteoarthritis and the ACL Deficient Knee: A Critical Review of the Literature

“…Many studies showed that the conservative treatment of ACL ruptures resulted in a significant increase in osteoarthritis [13,14,33-37]. This prevalent view at the time resulted in the assumption that followed during the late 80s and early 90s that ACL reconstruction would be the solution to prevent later osteoarthritis in ACL injured knees [21-25].…”