Compressed Lateral and anteroposterior Anatomical Systematic Sequences «CLASS»: compressed MRI sequences with assessed anatomical femoral and tibial ACL's footprints, a feasibility study

Purpose This study's main objective is to assess the feasibility of processing the MRI information with identified ACL-footprints into 2D-images similar to a conventional anteroposterior and lateral X-Ray image of the knee. The secondary aim is to conduct specific measurements to assess the reliability and reproducibility. This study is a proof of concept of this technique. Methods Five anonymised MRIs of a right knee were analysed. A orthopaedic knee surgeon performed the footprints identification. An ad-hoc software allowed a volumetric 3D image projection on a 2D anteroposterior and lateral view. The previously defined anatomical femoral and tibial footprints were precisely identified on these views. Several parameters were measured (e.g. coronal and sagittal ratio of tibial footprint, sagittal ratio of femoral footprint, femoral intercondylar notch roof angle, proximal tibial slope and others). The intraclass correlation coefficient (ICCs), including 95% confidence intervals (CIs), has been calculated to assess intraobserver reproducibility and interobserver reliability. Results Five MRI scans of a right knee have been assessed (three females, two males, mean age of 30.8 years old). Five 2D-"CLASS" have been created. The measured parameters showed a "substantial" to "almost perfect" reproducibility and an "almost perfect" reliability. Conclusion This study confirmed the possibility of generating "CLASS" with the localised centroid of the femoral and tibial ACL footprints from a 3D volumetric model. "CLASS" also showed that these footprints were easily identified on standard anteroposterior and lateral X-Ray views of the same patient, thus allowing an individual identification of the anatomical femoral and tibial ACL's footprints. Level of evidence Level IV diagnostic study

Comparative Study of Efficacy of Muscle Energy Technique and Positional Release Therapy in Post ACL Reconstruction in Young Adults: A Randomised Clinical Trial

The anterior cruciate ligament (ACL), it is a dense connective tissue band originating from the medial wall of the lateral femoral condyl and inserts into the middle of the intercondylar region on the tibia. It is regarded as a crucial component in the knee joint because it resists anterior tibial translation and rotational load. Young athletes who participate in sports that demand turning, decelerating, and jumping are at high risk for ACL injury. People who participate in Pivoting sports are likely to have them (e.g. football, basketball, netball, soccer, European team handball, gymnastics, downhill skiing). Environmental (e.g., high friction between shoes and the playing surface) and anatomical variables are also risk factors for ACL injury (e.g. narrow femoral intercondylar notch). Knee instability causes a reduction in activity, which can result in a decrease in knee-related quality of life. ACL injury risk factors have been classified as either internal or external to a person. Type of competition, footwear and surface, and environmental conditions are all external risk factors. Anatomical, hormonal, and neuromuscular risk factors are all internal risk factors. Aim and Objective: to compare the efficacy of Myofacial Release Technique versus Positional Release Therapy on range of motion post ACL reconstruction. Methodology: In this study total 45 patients with post ACL reconstruction will be divided into two groups, one group will receive muscle energy technique and other group will received positional release therapy. The treatment will be given for 5 sessions per week for six weeks. The assessment will be done at day one of treatment at the end of treatment at the end of first week and at the end of six week. Discussion: This study will find the better technique for improving Range of motion Post ACL reconstruction. Conclusion: Conclusion of the study will be drawn after the statistical analysis of the data gathered from the individuals enrolled in the study.

Clinical-Grade MRI-Based Methods to Identify Combined Anatomic Factors That Predict ACL Injury Risk in Male and Female Athletes

Background: Recently developed multivariate sex-specific statistical models can predict anterior cruciate ligament (ACL) injury risk using various knee anatomic factors. However, screening tools able to identify individuals at an increased injury risk are unlikely to be developed based on these models, given that sophisticated and time-consuming methods were used to measure those factors on research-grade resolution magnetic resonance images (MRIs). Purpose: To determine whether simpler methods, amenable to using clinical-grade resolution MRIs, can identify the same knee anatomic factors previously found to contribute to ACL injury risk using sophisticated methods and research-grade resolution images. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: High-resolution 3-dimensional MRIs previously acquired from 87 patients with primary, noncontact, grade III ACL injury and 87 uninjured matched control participants for a series of published studies were downgraded to clinical-grade resolution images. The 4 knee anatomic factors found to contribute to ACL injury risk in women and in men in these published studies—femoral intercondylar notch width at the anterior outlet of the ACL (NW_O), posterior-inferior directed slope of the middle region articular cartilage surface of the tibial plateau’s lateral compartment (LatTibMCS), ACL volume, and tibial plateau’s lateral compartment posterior meniscus to subchondral bone wedge angle (LatTibMBA)—were measured using clinical-grade resolution MRI-based methods. Stepwise multivariate conditional logistic regressions were used to identify the combinations of factors most highly associated with an ACL injury risk in women and men separately. Results: The multivariate model that best predicted ACL injury risk in the female participants included the LatTibMCS and the NW_O. For the male participants, this model included the ACL volume and the LatTibMBA. These results corroborate the previously published results that reported models with the same knee anatomic factors to best predict injury risk in this group of young women and men. Conclusion: Simpler methods using MRIs downgraded to a clinical-grade resolution can identify the same knee anatomic factors previously found to significantly contribute to ACL injury risk using sophisticated methods and research-grade resolution MRIs.

Association of Geometric Characteristics of Knee Anatomy (Alpha Angle and Intercondylar Notch Type) With Noncontact ACL Injury

Background: The femoral intercondylar notch type and the alpha angle (the angle between the femoral notch roof and the long axis of the femur) are easily measured in clinical settings; however, their associations with anterior cruciate ligament (ACL) injury remain unclear. Hypothesis/Purpose: The purpose was to determine if the alpha angle and the femoral notch type are associated with noncontact ACL injury univariately and in combination with previously identified knee geometric risk factors. We hypothesized that the alpha angle and the femoral notch type are associated with noncontact ACL injury and that the association differs between men and women. Study Design: Case control study; Level of evidence, 3. Methods: The alpha angle and the femoral notch type were measured via 3T magnetic resonance imaging (MRI) acquired from 61 women and 25 men with a first-time noncontact ACL injury. Each injured patient was matched with a control participant based on age, sex, and participation on the same sports team. A conditional logistic regression was used to assess univariate associations with ACL injury as well as multivariate associations using MRI-based risk factors of knee geometry identified in previous analyses: femoral intercondylar notch width at the anterior outlet, femoral intercondylar notch anteromedial ridge thickness, volume of the ACL, tibial plateau lateral compartment subchondral bone slope, lateral compartment middle articular cartilage slope, lateral compartment meniscus-cartilage height, lateral compartment meniscus-bone angle, and medial tibial spine volume. Results: For female athletes, the alpha angle (odds ratio, [OR], 1.82 per 1-degree increase; P = .001), the tibial lateral compartment articular cartilage slope (OR, 1.25 per 1-degree increase in the posterior-inferior directed slope; P = .022), and the femoral notch anteromedial ridge thickness (OR, 3.36 per 1-mm increase; P = .027) were independently associated with ACL disruption. For men, no other variables entered the models after the alpha angle was inputted as the first step (OR, 2.19 per 1-degree increase; P = .010). Conclusion: For women, ACL injury was most strongly associated with increased alpha angle, increased tibial plateau slope, and increased femoral notch ridge thickness. For men, increased alpha angle was the most significant factor associated with ACL injury. The mechanism of injury might be associated with a combination of impingement of the ACL against the bone and increased ligament loading.