The posterior cruciate ligament inclination angle is higher in anterior cruciate ligament insufficiency

Gali, Julio Cesar; Almeida, Tyago Araújo; Miguel, Daniela Cristina de Moraes; Nassar, Samir Alexandre; Filho, Julio Cesar Gali; Drain, Nicholas; Fu, Freddie

doi:10.1007/s00167-021-06789-0

Cited by 5 publications

(8 citation statements)

References 26 publications

(33 reference statements)

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“…In the current study, the cutoff was 21° with a low accuracy at 62%, a specificity at 83%, and a sensitivity at 50%, which is lower in comparison to the original study. The reason for the important discrepancy between Gali et al [4] and the present study remains unsure. In the latter, the two observers were not radiologists and did not had access to the original MRI images, meaning that the native MRI slices could not be precisely selected.…”

Section: Discussioncontrasting

confidence: 99%

“…In the latter, the two observers were not radiologists and did not had access to the original MRI images, meaning that the native MRI slices could not be precisely selected. Furthermore, compared to Gali et al [4] who used a 3 Tesla MRI, only a 1.5 T MRI was available in the present study.…”

Section: Discussionmentioning

confidence: 91%

“…As for the PCLIA, it is an indirect measurement method of the PCL buckling and may thus be less reproducible as well. It is defined with one bone marker, the tibial condyle [4] which is a landmark that may vary not only with the positioning of the knee during the MRI examination, but also with the choice of the section by the examiner because of the inherent anatomic variability between the central part of the medial tibial plateau and the intercondylar eminence. Gali et al [4] defined a superior cutoff at 64.2° indicative of an ACL injury and a lower cutoff at 51.3° suggesting an intact ACL.…”

Section: Discussionmentioning

confidence: 99%

“…The accuracy or the agreement has never been evaluated [5, 9, 12, 14]. The PCLIA [4] was defined by the intersection of two lines of which the first passed tangentially to the articular surface of the tibial condyle and the second line was drawn over the portion of the ligament that originated where the first line crossed the PCL, delineated in the proximal direction (Fig. 2).…”

Section: Methodsmentioning

confidence: 99%

“…2). The accuracy of this sign was reported to be of 99.2% with a good inter‐rater agreement [4]. Finally, the PCL–PCA method was assessed on the sagittal plane image located at the most lateral portion of the tibial insertion of the PCL.…”

Section: Methodsmentioning

confidence: 99%

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The posterior cruciate ligament–posterior femoral cortex angle: a reliable and accurate MRI method to quantify the buckling phenomenon of the PCL in ACL-deficient knees

Pioger

Mouton

Seil

2022

Knee Surg Sports Traumatol Arthrosc

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PurposeThe aim was to validate a new MRI method to measure the buckling phenomenon of the PCL, representative of anterior tibial translation, by comparing its reliability and accuracy to identify anterior cruciate ligament (ACL)‐deficient knees with existing methods. MethodsPatients were selected retrospectively and separated into a group of primary ACL injuries and ACL‐intact knees. Exclusion criteria were: skeletal immaturity, PCL or a concomitant collateral ligament injury, signs of osteoarthritis (> 1 Kellgren and Lawrence score), tibial plateau fracture, previous ACL reconstruction or displaced meniscal bucket handle tear. The assessment of the curvature of the anterolateral bundle of the PCL was performed on T2 sagittal MRI slices according to 3 methods: (1) the PCL angle (PCLA), (2) the PCL inclination angle (PCLIA) and (3) a new method: the PCL‐posterior cortex angle (PCL–PCA), representing the angle between the vertical part of the PCL‐ALB and the posterior diaphyseal cortex of the femur. For each method, the inter‐ and intra‐observer reliability was measured. The ability to discriminate both ACL‐deficient and ACL‐intact knees was evaluated using ROC curves. ResultsTwenty‐four patients were included in each group. Intra‐observer reliability was excellent for all 3 methods (ICCs > 0.90). Inter‐observer reliability was excellent for the PCL–PCA (ICC > 0.90) and good for the PCLA and the PCLIA (ICCs between 0.75 and 0.90). The PCL–PCA had the highest precision (lowest standard error of measurement: 2.7°). It yielded an excellent discrimination between the ACL and CTL groups (AUC 0.80 [0.67–0.93]) with the highest sensitivity (71% [52.8–89.2]) and specificity (88% [75–100]) for a positive threshold when the angle was ≤ 22.7°. The PCLA and PCLIA methods led to acceptable discrimination and lower sensitivities and specificities (PCLA: AUC 0.71, sensitivity 63%, specificity 79%, threshold ≤ 117.9°; PCLIA: AUC 0.62, sensitivity 50%, specificity 83%, threshold ≤ 21.4°). ConclusionIn comparison with previously described methods, the PCL–PCA was the most reliable and accurate method to measure the PCL buckling phenomenon on MRI in anterior cruciate ligament (ACL)‐deficient knees. It offers an easy and objective method for the follow‐up of ACL‐injured patients and can therefore be recommended for routine use. Level of evidenceIV.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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The posterior cruciate ligament–posterior femoral cortex angle: a reliable and accurate MRI method to quantify the buckling phenomenon of the PCL in ACL-deficient knees

Pioger

Mouton

Seil

2022

Knee Surg Sports Traumatol Arthrosc

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The angle of the lower portion of the posterior cruciate ligament assists in the diagnosis of partial anterior cruciate ligament tears

Yang,

Zheng,

Zhang

et al. 2024

Knee surg. sports traumatol. arthrosc.

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PurposeTo compare the difference of angle of the lower portion of the posterior cruciate ligament (PCL) measured via magnetic resonance imaging (MRI) in patients with and without partial anterior cruciate ligament (ACL) tears and to investigate the effectiveness of the angle of the lower portion of the PCL in diagnosing partial ACL tears.MethodsFrom January 2022 to December 2022, a cohort of consecutive patients presenting with ACL tears who underwent ACL reconstruction and patients with isolated meniscus tears undergoing arthroscopic surgery were enroled for this study. The angle of the inferior portion of the PCL comprises α and β angles, and the posterior offset of the lateral condyle were measured on the MRI and compared between the partial ACL tear and control groups. Receiver operating characteristic curves, the areas under the curve (AUCs) and the 95% confidence intervals (CIs) were calculated to identify cutoff values for diagnosing partial ACL injuries.ResultsFollowing an assessment of cohort eligibility and matching for age and sex, 100 patients were included in this study. The mean age of the cohort was 46.1 ± 10.3 years. The AUC for the α angle was 0.88 (95% CI, 0.82–0.94), with a sensitivity of 0.74 and specificity of 0.84 for predicting partial ACL ruptures; the α angle cutoff value was 73.6° (diagnostic odds ratio (OR), 14.10; 95% CI, 5.33–37.28). The AUC for the β angle was 0.86 (95% CI, 0.79–0.93), with a sensitivity of 0.64 and a specificity of 0.92 for predicting partial ACL ruptures; the β angle cutoff value was 73.3° (diagnostic OR, 14.54; 95% CI, 5.76–36.68).ConclusionsA small α angle and a large β angle were associated with partial ACL tears. The angle of the distal portion of the PCL was simple to measure and reproducible, enhancing the diagnosis of partial ACL tears.Level of EvidenceLevel III.

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The potential of posterior cruciate ligament buckling phenomenon as a sign for partial anterior cruciate ligament tears

Tokgoz,

Oklaz,

et al. 2024

Arch Orthop Trauma Surg

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Introduction Diagnosis of a partial tear of the anterior cruciate ligament (ACL) can be challenging with physical examination and imaging techniques. Although magnetic resonance imaging (MRI) has high sensitivity and specificity for diagnosing complete ACL tears, its effectiveness may be limited when it is used to diagnose for partial tears. The hypothesis of the present study is that the posterior cruciate ligament (PCL) buckling phenomenon, which is a secondary sign of complete ACL tears on MRI, may be a useful method for diagnosing partial ACL tears. Materials and methods The data of 239 patients who underwent knee arthroscopy in a single institution between 2016 and 2022 were analyzed retrospectively. Patients were divided into three groups based on the condition of their ligaments: partial tears, complete tears and intact ligaments. To evaluate the buckling phenomenon on sagittal T2-weighted MRI, measurements of the posterior cruciate ligament angle (PCLA) and the posterior cruciate ligament-posterior cortex angle (PCL-PCA) were conducted in each group. Subsequently, the ability of these two measurement methods to distinguish partial tears from the other groups was assessed. Results Both methods provided significantly different results in all three groups. Partial tears could be distinguished from intact ligaments with 86.8% sensitivity, 89.9% specificity when PCLA < 123.13° and 94.5% sensitivity, 93.2% specificity when PCL-PCA < 23.77°. Partial tears could be distinguished from complete tears with 79.5% sensitivity, 78.4% specificity when PCLA > 113.88° and with 86.1% sensitivity, 85.3% specificity when PCL-PCA > 16.39°. Conclusion The main finding of the present study is that the PCLA and PCL-PCA methods are useful on MRI for diagnosing partial ACL tears. PCLA value between 113°-123° and PCL-PCA value between 16°-24° could indicate a partial ACL tear. With these methods, it is possible to distinguish partial tears from healthy knees and reduce missed diagnoses. In addition, the differentiation of partial and complete tears by these methods may prevent unnecessary surgical interventions. Level of evidence Level III.

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The posterior cruciate ligament inclination angle is higher in anterior cruciate ligament insufficiency

Cited by 5 publications

References 26 publications

The posterior cruciate ligament–posterior femoral cortex angle: a reliable and accurate MRI method to quantify the buckling phenomenon of the PCL in ACL-deficient knees

The posterior cruciate ligament–posterior femoral cortex angle: a reliable and accurate MRI method to quantify the buckling phenomenon of the PCL in ACL-deficient knees

The angle of the lower portion of the posterior cruciate ligament assists in the diagnosis of partial anterior cruciate ligament tears

The potential of posterior cruciate ligament buckling phenomenon as a sign for partial anterior cruciate ligament tears

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