The crevice sign: a new indicator of meniscal instability in ACL reconstructions

Murgier, Jérôme; Bayle-Iniguez, Xavier; Clatworthy, Mark

doi:10.1007/s00167-021-06823-1

Cited by 5 publications

(6 citation statements)

References 31 publications

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“…(2) Leaving the lateral flexion gap larger than the medial and (3) a combination of 1 and 2. Option 1 is chosen in some tibia first alignment workflows, such as constitutional varus [20] or patient‐specific technique (PST) [4]. By placing the tibia in more varus simultaneously the amount of external rotation needed to balance the flexion gap is reduced.…”

Section: Discussionmentioning

confidence: 99%

Navigated, gap-balanced, adjusted mechanical alignment achieves alignment and balancing goals in a very high percentage but with partially non-anatomical resections

Graichen

Luderer

Strauch

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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Purpose Navigated, gap-balanced adjusted mechanical alignment (AMA) including a 0° varus tibial cut and modiication of angles and resections of the femoral cuts to obtain optimal balance accepting minor axis deviations. Objectives of this study were (1) to analyse to what extent AMA achieves the goals for leg alignment and gap balance, and ( 2) in what percentage non-anatomical cuts are needed to achieve these goals. Methods Out of 1000 total knee arthroplasties (TKA) all varus knees (hip-knee-ankle (HKA) angle < 178°; n = 680) were included. All surgeries were performed as computer assisted surgery (CAS) in AMA technique. CAS data at the end of surgery were analysed with respect to HKA and gap-sizes. All bone cuts were quantiied. Depending on the amount of deformity, a subgroup analysis was performed. It was analysed whether the amount of deformity inluences the non-anatomical cuts by correlation analysis. Results AMA reached the goals for postoperative HKA (3° corridor) in 636 cases (93.5%). While extension and lexion gap balance were achieved in more than 653 cases (96%), lexion and extension gap size were equalled in 615 knees (90.4%). The resections of the lateral tibia plateau and distal and posterior medial femoral condyle were anatomical (Tibia: 7.0 ± 1.7 mm; medial condyle distal: 7.8 ± 1.4 mm; medial posterior: 8.2 ± 1.8 mm). The number of non-anatomical resections for those cuts were low; 67 (9.9%); 24 (3.5%); 32 (4.7%). For the medial tibia plateau and the lateral posterior condyle, the cuts were non-anatomical in a high percentage of cases; Tibia: 606 (89.1%), lateral posterior condyle: 398 (58.5%). Moderate but signiicant correlations were found between resection diferences and amount of deformity (medio-lateral: tibia: 0.399; distal femur: 0.310; posterior femur: 0.167). No correlations were found between resection diferences and gap values. Conclusion AMA reaches the intended target for HKA and gap balance in over 612 (90%) of cases and maintains the medial femoral condyle anatomically. Non-anatomical tibial resection causes increased external rotation of the femoral component and by that non-anatomical cut of the posterior lateral condyle. Nonanatomical resections of AMA might be one reason for the persisting high rate of unsatisied patients after TKA. Anatomical and individual alignment philosophies might help to reduce this rate of dissatisfaction.

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Section: Discussionmentioning

confidence: 99%

Navigated, gap-balanced, adjusted mechanical alignment achieves alignment and balancing goals in a very high percentage but with partially non-anatomical resections

Graichen

Luderer

Strauch

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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“… 5 When this sign is present, MM injuries (especially ramp lesions) are possibly present and require treatment. 6 …”

Section: Discussionmentioning

confidence: 99%

Effectivity of the Outside-In Pie-Crusting Technique and an All-Inside Meniscal Repair Device in the Repair of Ramp Lesions

Kawada¹,

Furumatsu²,

Tamura³

et al. 2023

Arthroscopy Techniques

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“…Thank you for bringing our attention to your previous work on the “crevice sign” and its association with anterior cruciate ligament (ACL) tears. 2,3 It was not our intent to omit your work, merely our negligence in identifying that the crevice sign appears to be the same as our striations in the cartilage related to medial meniscal ramp lesions. 1 However, it is interesting to note that your 2 articles on the subject focus on meniscal instability, which is slightly in contrast (per your definition using anterior displacement) with our findings and ramp lesions.…”

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confidence: 97%

Meniscal Ramp Lesions in Adolescent Patients Undergoing Primary Anterior Cruciate Ligament Reconstruction: Response

Edmonds,

Hollnagel,

Bomar

et al. 2023

Am J Sports Med

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We are writing in regard to the recently published study by Hollnagel et al. 1 The authors propose that a cartilage striation on the femoral condyle correlates with a ramp lesion of the posterior horn of the medial meniscus in adolescent anterior cruciate ligament (ACL)-deficient knees. They recommend using this as a sign to aid arthroscopic identification. We are in complete agreement with this recommendation. However, in terms of the citations, they make no reference to a strikingly similar study from 2022 by Murgier et al 3 in which an identical sign is described, but named differently, as the ''crevice sign.'' The latter study confirmed the hypothesis that there would be a strong correlation between the presence of an unstable medial meniscal tear and the crevice sign in patients with ACL-deficient knees. Furthermore, this was demonstrated with high specificity and positive predictive value. On the one hand, it is reassuring to see that others have identified the importance of the crevice sign, 4 further expanding the demographic diversity of findings with this recent series from an adolescent population. However, the lack of a valid literature search on the subject may explain the absence of appropriate referencing to a sign that has already been identified and named in the literature. Of further relevance is that both our original study and this more recent one highlight the growing emphasis on medial meniscal repair in ACL-reconstructed knees because of the subsequent improvements in stability conferred. When considering the possible pathogenesis involved, Inoue et al 2 reported that at 90°of flexion, in ACL-deficient knees, the posterior portion of the medial meniscus is deformed because of compression against the medial femoral posterior condyle. This is the point at which the crevice sign can be detected. Given the risk of osteoarthritis that arises from meniscal tears associated with ACL injuries, 5 meniscal repair has a clear role in the ACL-reconstructed knee. 6 The crevice sign facilitates the diagnosis of this in a variety of age groups.

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The crevice sign: a new indicator of meniscal instability in ACL reconstructions

Cited by 5 publications

References 31 publications

Navigated, gap-balanced, adjusted mechanical alignment achieves alignment and balancing goals in a very high percentage but with partially non-anatomical resections

Navigated, gap-balanced, adjusted mechanical alignment achieves alignment and balancing goals in a very high percentage but with partially non-anatomical resections

Effectivity of the Outside-In Pie-Crusting Technique and an All-Inside Meniscal Repair Device in the Repair of Ramp Lesions

Meniscal Ramp Lesions in Adolescent Patients Undergoing Primary Anterior Cruciate Ligament Reconstruction: Response

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