The coronal lateral collateral ligament sign in the anterior cruciate ligament-injured knees was observed regardless of the knee laxity based on the quantitative measurements

Hong, Chih-Kai; Hoshino, Yuichi; Watanabe, Shu; Nagai, Kazuo; Matsushita, Takehiko; Su, Wei-Ren; Kuroda, Ryosuke

doi:10.1007/s00167-022-06970-z

Cited by 3 publications

(5 citation statements)

References 40 publications

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“…This result can be initially interpreted as the inability to achieve pre-rupture rotational stability after ACL reconstruction. However, as an opposing view, Hong et al [26] emphasized in their study that there is no relationship between the coronal LCL sign and instability. In the study conducted by Hong et al, it is emphasized that the pivot shift test was objectively measured using an electromagnetic sensor.…”

Section: Discussionmentioning

confidence: 95%

“…The coronal LCL sign is defined as the appearance of the lateral collateral ligament (LCL) as a single coronal section after tibial anterior translation and internal rotation, which is associated with ACL insufficiency, and it is reported to be correlated with ACL ruptures [8]. This finding is present in the literature as a reflection of knee instability [10,[25][26][27]. In our study, this finding was evaluated in preoperative and postoperative MRIs, and it was observed that there was no significant change after the surgery in 88.2% of cases, with a substantial level of agreement (kappa coefficient: 0.749, p value < 0.01).…”

Section: Discussionmentioning

confidence: 99%

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Does Rotation and Anterior Translation Persist as Residual Instability in the Knee after Anterior Cruciate Ligament Reconstruction? (Evaluation of Coronal Lateral Collateral Ligament Sign, Tibial Rotation, and Translation Measurements in Postoperative MRI)

Karatekin,

Altınayak,

Kehribar

et al. 2023

Medicina

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Purpose: The aim of this study was to evaluate the presence of residual instability in the knee after ACL reconstruction through the analysis of MRI findings. Methods: This study included patients who underwent isolated ACL reconstruction between December 2019 and December 2021, and had preoperative and postoperative MRI, clinical scores, and postoperative isokinetic measurements. The anterior tibial translation (ATT) distance, coronal lateral collateral ligament (LCL) sign, and femorotibial rotation (FTR) angle were compared preoperatively and postoperatively. The correlation between the changes in preoperative–postoperative measurements and postoperative measurements with clinical scores and isokinetic measurements was examined. The clinical outcomes were compared based on the presence of a postoperative coronal LCL sign. Inclusion criteria were set as follows: the time between the ACL rupture and surgery being 6 months, availability of preoperative and postoperative clinical scores, and objective determination of muscle strength using isokinetic dynamometer device measurements. Patients with a history of previous knee surgery, additional ligament injuries other than the ACL, evidence of osteoarthritis on direct radiographs, cartilage injuries lower limb deformities, and contralateral knee injuries were excluded from this study. Results: This study included 32 patients. After ACL reconstruction, there were no significant changes in the ATT distance (preoperatively: 6.5 ± 3.9 mm, postoperatively: 5.7 ± 3.2 mm) and FTR angle (preoperatively: 5.4° ± 2.9, postoperatively: 5.2° ± 3.5) compared to the preoperative measurements (p > 0.05). The clinical measurements were compared based on the presence of a postoperative coronal LCL sign (observed in 17 patients, not observed in 15 patients), and no significant differences were found for all parameters (p > 0.05). There were no observed correlations between postoperative FTR angle, postoperative ATT distance, FTR angle change, and ATT distance change values with postoperative clinical scores (p > 0.05). Significant correlations were observed between the high strength ratios generated at an angular velocity of 60° and a parameters FTR angle and ATT distance (p-values: 0.028, 0.019, and r-values: −0.389, −0.413, respectively). Conclusions: Despite undergoing ACL reconstruction, no significant changes were observed in the indirect MRI findings (ATT distance, coronal LCL sign, and FTR angle). These results suggest that postoperative residual tibiofemoral rotation and tibial anterior translation may persist; however, they do not seem to have a direct impact on clinical scores. Furthermore, the increase in tibial translation and rotation could potentially negatively affect the flexion torque compared to the extension torque in movements requiring high torque at low angular velocities.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Does Rotation and Anterior Translation Persist as Residual Instability in the Knee after Anterior Cruciate Ligament Reconstruction? (Evaluation of Coronal Lateral Collateral Ligament Sign, Tibial Rotation, and Translation Measurements in Postoperative MRI)

Karatekin,

Altınayak,

Kehribar

et al. 2023

Medicina

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“… 1 , 9 Other studies have reported that the occurrence of the coronal LCL sign is not associated with dynamic anterior tibial laxity or rotatory knee laxity. 3 , 4 Despite these inconclusive findings, knee laxity should be evaluated routinely regardless of static knee laxity signs.…”

Section: Discussionmentioning

confidence: 99%

Association of the Coronal Lateral Collateral Ligament Sign in ACL-Deficient Knees With Greater Anterior Tibial Translation and Femorotibial Rotation in Adults and Adolescents

Lin,

Cheng,

Hsu

et al. 2024

Orthopaedic Journal of Sports Medicine

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Background: The coronal lateral collateral ligament (LCL) sign (the entire LCL being seen in 1 coronal slice on a magnetic resonance imaging [MRI] scan), is a new secondary sign of anterior cruciate ligament (ACL) tear. Purpose: To (1) evaluate the coronal LCL sign in adults with ACL tears and (2) compare the magnitude of the MRI scan parameters between adolescent and adult ACL-deficient knees with positive coronal LCL signs. Study Design: Cross-sectional study; Level of evidence: 3. Methods: We retrospectively reviewed patients who underwent ACL reconstruction between February 1, 2013, and May 31, 2021, and divided them into adolescent (10-18 years) and adult (>18 years) groups. Tibial translation, femorotibial rotation, and presence of the coronal LCL sign were evaluated using MRI. The static femorotibial position parameters were also compared between positive and negative coronal LCL sign groups. Independent Student t tests were used to identify statistically significant differences for continuous variables, whereas the categorical variables were compared using the chi-square test. Results: A total of 65 adolescents and 300 adults with ACL tears were identified. The coronal LCL sign was present in a similar percentage of adolescents and adults with ACL tears (57% vs 58%; P = .873). The anterior tibial translation (ATT) in patients with positive coronal LCL signs (adolescents, 7.9 ± 3.4 mm; adults, 6.6 ± 3.5 mm) was significantly greater compared with those with negative signs (adolescents, 1.5 ± 2.6 mm, P < .001; adults, 2.3 ± 4.2 mm, P < .001). Femorotibial rotation was also statistically greater in positive coronal LCL sign groups (adolescents, 6.4°± 5.6°; adults, 7.0°± 5.0°) compared with negative sign groups (adolescents, 0.7°± 4.7°, P < .001; adults, 3.5°± 4.2°, P < .001). Conclusion: The occurrence of the coronal LCL sign on MRI scans was comparable between adolescents and adults with ACL-deficient knees. The presence of the LCL sign was associated with a greater ATT and femorotibial rotation in both adolescents and adults with ACL tears.

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“…These results may, however, be interpreted with caution as this sign has only been recently described in the literature and is not well understood yet. The LCL sign is not systematically present in ACL‐injured knees (33–53%) [8, 9, 16] and has also been found in intact knees (18.6%) [16]. Its relation with anterior knee laxity and internal knee rotation is debated and results in the literature are contradictory [8, 9, 16].…”

Section: Discussionmentioning

confidence: 99%

“…The LCL sign is not systematically present in ACL‐injured knees (33–53%) [8, 9, 16] and has also been found in intact knees (18.6%) [16]. Its relation with anterior knee laxity and internal knee rotation is debated and results in the literature are contradictory [8, 9, 16]. This, however, does not affect the finding that PCL–PCA and LCL sign were associated in our cohort and future studies should help to better understand the reason behind the presence of these signs.…”

Section: Discussionmentioning

confidence: 99%

The posterior cruciate ligament–posterior femoral cortex angle (PCL–PCA) and the lateral collateral ligament (LCL) sign are useful parameters to indicate the progression of knee decompensation over time after an ACL injury

Oronowicz,

Mouton,

Pioger

et al. 2023

Knee surg. sports traumatol. arthrosc.

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Purpose The posterior cruciate ligament-posterior cortex angle (angle between the most vertical part of the anterolateral PCL bundle and the posterior diaphyseal cortex of the femur; PCL-PCA) is the most accurate approach to describe the PCL buckling phenomenon observed in anterior cruciate ligament (ACL)-deicient knees. The aim of this study was to determine whether the PCL-PCA is associated with chronicity of the ACL rupture, the meniscal status, preoperative knee laxity or imaging signs such as the lateral collateral ligament (LCL) sign or the posterior tibial slope (PTS) in ACL-injured knees. Methods Patients with a primary ACL reconstruction (ACLR) after physeal closure were selected retrospectively from a hospital-based ACL registry from 2015 to 2021. Exclusion criteria were: previous ipsilateral/contralateral knee surgery, previous ipsilateral ACL or meniscal tear, ipsilateral PCL and/or collateral ligament injuries or tibial plateau fracture. The ACL deiciency was deined as chronic if time from injury to MRI was > 6 months. The meniscal status was assessed during ACLR, separately for the medial and lateral meniscus, and classiied into no tear, minor or major unstable tear. The MRI analyses included the assessment of the PCL-PCA and the LCL sign. PTS was assessed from the lateral plain radiographs of the injured knee. The side-to-side diference in anterior tibial translation (ATT) at 200N was obtained with the GNRB. Results Eighty-two patients (forty-eight males/thirty-four females) were included in this study. The median PCL-PCA was 16.2° (Q1-Q3: 10.6-24.7) and difered between acute (18.4°) and chronic (10.7°) injuries (p < 0.01). The median PCL-PCA was signiicantly lower (− 4.6°) in patients with a positive LCL sign (p = 0.03) No signiicant association could be found between PCL-PCA and meniscal status, PTS or preoperative anterior knee laxity (Lachman, pivot shift and ATT in millimetres). ConclusionThe PCL-PCA was signiicantly lower in chronic ACL injuries and in patients with a positive LCL sign, indicating a higher buckling phenomenon of the PCL in these patients. These results support the fact that PCL-PCA and the LCL sign may be useful parameters to indicate the progression of knee decompensation over time after an ACL injury, and therefore may constitute a helpful tool to optimise treatment choice and timing of ACL reconstruction if necessary. Level of evidence III.

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The coronal lateral collateral ligament sign in the anterior cruciate ligament-injured knees was observed regardless of the knee laxity based on the quantitative measurements

Cited by 3 publications

References 40 publications

Does Rotation and Anterior Translation Persist as Residual Instability in the Knee after Anterior Cruciate Ligament Reconstruction? (Evaluation of Coronal Lateral Collateral Ligament Sign, Tibial Rotation, and Translation Measurements in Postoperative MRI)

Does Rotation and Anterior Translation Persist as Residual Instability in the Knee after Anterior Cruciate Ligament Reconstruction? (Evaluation of Coronal Lateral Collateral Ligament Sign, Tibial Rotation, and Translation Measurements in Postoperative MRI)

Association of the Coronal Lateral Collateral Ligament Sign in ACL-Deficient Knees With Greater Anterior Tibial Translation and Femorotibial Rotation in Adults and Adolescents

The posterior cruciate ligament–posterior femoral cortex angle (PCL–PCA) and the lateral collateral ligament (LCL) sign are useful parameters to indicate the progression of knee decompensation over time after an ACL injury

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