scholarly journals Tibial slope in the posterolateral quadrant with and without ACL injury

2021 ◽  
Author(s):  
A. Korthaus ◽  
M. Krause ◽  
G. Pagenstert ◽  
M. Warncke ◽  
F. Brembach ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Risk Factor ◽  
Knee Joint ◽  
Tibial Plateau ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Tibial Slope ◽  
Mri Scans ◽  
The Mean ◽  
Anterior Cruciate

Abstract Introduction An increased tibial slope is a risk factor for rupture of the anterior cruciate ligament. In addition, a tibial bone bruise or posterior lateral impression associated with slope changes also poses chronic ligamentous instability of the knee joint associated with an anterior cruciate ligament (ACL) injury. In the majority of cases, the slope is measured in one plane X-ray in the lateral view. However, this does not sufficient represent the complex anatomy of the tibial plateau and especially for the posterolateral quadrant. Normal values from a “healthy” population are necessary to understand if stability of the knee joint is negatively affected by an increasing slope in the posterolateral area. Until now there are no data about the physiological slope in the posterolateral quadrant of the tibial plateau. Materials and methods In 116 MRI scans of patients without ligamentous lesions and 116 MRI scans with an ACL rupture, tibial slope was retrospectively determined using the method described by Hudek et al. Measurements were made in the postero-latero-lateral (PLL) and postero-latero-central (PLC) segments using the 10-segment classification. In both segments, the osseous as well as the cartilaginous slope was measured. Measurements were performed by two independent surgeons. Results In the group without ligamentous injury the mean bony PLL slope was 5.8° ± 4.8° and the cartilaginous PLL slope was 6.7° ± 4.8°. In the PLC segment the mean bony slope was 6.6° ± 5.0° and the cartilaginous slope was 9.4° ± 5.7°. In the cohort with ACL rupture, the bony and cartilaginous slope in both PLL and PCL were significantly higher (P < 0.001) than in the group without ACL injury (bony PLL 9.8° ± 4.8°, cartilage PLL 10.4° ± 4.7°, bony PLC 10.3° ± 4.8°, cartilage PLL 12.8° ± 4.3°). Measurements were performed independently by two experienced surgeons. There were good inter- (CI 87–98.7%) and good intraobserver (CI 85.8–99.6%) reliability. Conclusion The bony and the cartilaginous slope in the posterolateral quadrant of the tibial plateau are different but not independent. Patients with an anterior cruciate ligament injury have a significantly steeper slope in the posterolateral quadrant compared to a healthy group. Our data indicate that this anatomic feature might be a risk factor for a primary ACL injury which has not been described yet. Level of evidence III.

scholarly journals Distribution of Bone Contusion Patterns in Acute Noncontact Anterior Cruciate Ligament–Torn Knees

2021 ◽  
Vol 49 (2) ◽  
pp. 404-409
Author(s):  
Sophia Y. Kim-Wang ◽  
Melissa B. Scribani ◽  
Michael B. Whiteside ◽  
Louis E. DeFrate ◽  
Tally E. Lassiter ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Tibial Plateau ◽  
Femoral Condyle ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Meniscal Tears ◽  
Mri Scans ◽  
Anterior Cruciate ◽  
Operative Notes ◽  
Bone Contusions

Background: Bone contusions are commonly observed on magnetic resonance imaging (MRI) in individuals who have sustained a noncontact anterior cruciate ligament (ACL) injury. Time from injury to image acquisition affects the ability to visualize these bone contusions, as contusions resolve with time. Purpose: To quantify the number of bone contusions and their locations (lateral tibial plateau [LTP], lateral femoral condyle [LFC], medial tibial plateau [MTP], and medial femoral condyle [MFC]) observed on MRI scans of noncontact ACL-injured knees acquired within 6 weeks of injury. Study Design: Cross-sectional study; Level of evidence, 3. Methods: We retrospectively reviewed clinic notes, operative notes, and imaging of 136 patients undergoing ACL reconstruction. The following exclusion criteria were applied: MRI scans acquired beyond 6 weeks after injury, contact ACL injury, and previous knee trauma. Fat-suppressed fast spin-echo T2-weighted MRI scans were reviewed by a blinded musculoskeletal radiologist. The number of contusions and their locations (LTP, LFC, MTP, and MFC) were recorded. Results: Contusions were observed in 135 of 136 patients. Eight patients (6%) had 1 contusion, 39 (29%) had 2, 41 (30%) had 3, and 47 (35%) had 4. The most common contusion patterns within each of these groups were 6 (75%) with LTP for 1 contusion, 29 (74%) with LTP/LFC for 2 contusions, 33 (80%) with LTP/LFC/MTP for 3 contusions, and 47 (100%) with LTP/LFC/MTP/MFC for 4 contusions. No sex differences were detected in contusion frequency in the 4 locations ( P > .05). Among the participants, 50 (37%) had medial meniscal tears and 52 (38%) had lateral meniscal tears. Conclusion: The most common contusion patterns observed were 4 locations (LTP/LFC/MTP/MFC) and 3 locations (LTP/LFC/MTP).

Posterior Tibial Slope in Patients Undergoing Anterior Cruciate Ligament Reconstruction With Patellar Tendon Autograft: Analysis of Subsequent ACL Graft Tear or Contralateral ACL Tear

2021 ◽  
Vol 49 (3) ◽  
pp. 620-625
Author(s):  
K. Donald Shelbourne ◽  
Rodney W. Benner ◽  
Jonathan A. Jones ◽  
Tinker Gray
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Revision Surgery ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Tibial Slope ◽  
Posterior Tibial ◽  
The Mean ◽  
Anterior Cruciate ◽  
Tendon Autograft

Background: Reports on greater posterior tibial slope (PTS) and its relationship to subsequent anterior cruciate ligament (ACL) injury show conflicting results; it has not been studied much in patients after ACL reconstruction with patellar tendon autograft (PTG). Hypothesis: Patients who suffered a subsequent ACL injury would have a larger PTS than patients who did not suffer a subsequent injury after primary or revision ACL reconstruction. Study Design: Cohort study; Level of evidence, 3. Methods: Patients received primary (n = 2439) or revision (n = 324) ACL reconstruction with PTG and were followed prospectively to determine the rate of graft tear and contralateral ACL tear. The PTS was measured preoperatively on digital lateral view radiographs. Intersecting lines were drawn along the medial tibial plateau and posterior tibia; the value of the acute angle at the lines’ intersection was then subtracted from 90° to obtain the PTS. This procedure was completed by a clinical assistant with an intrarater reliability of 0.89. Chi-square analysis and t tests were used to determine the differences between rate of tears and measurements between groups. A threshold of PTS ≥10° was used for analysis. Results: The mean follow-up time was 11.6 ± 4.0 years. After primary surgery, the mean PTS in patients with graft tears was 5.4°± 3.1° versus 4.8°± 2.9° for patients without a tear ( P = .041). The mean PTS was 4.9°± 3.4° for patients with contralateral tears (not statistically significantly different than the no-tear group; P = .80). Furthermore, patients with primary reconstruction with PTS ≥10° had a statistically significantly higher rate of graft tear (9.7%) than patients with PTS ≤9° (4.8%) ( P = .003), but not a higher rate of contralateral tear. Among patients undergoing revision surgery, there were no statistically significant differences between the graft tear, contralateral tear, and no-tear groups with relation to PTS ≥10°. Conclusion: After primary ACL reconstruction, patients with PTS >10° had a higher rate of subsequent graft tear but not a higher rate of contralateral tear. With revision surgery, there was no significant association between PTS and the rate of subsequent tear. Therefore, caution should be exercised when considering more radical interventions, such as osteotomy, to prevent retear in patients with high PTS.

The Lateral Femoral Condyle Index Is Not a Risk Factor for Primary Noncontact Anterior Cruciate Ligament Injury

2021 ◽  
pp. 036354652110572
Author(s):  
Emma K. Nowak ◽  
Mélanie L. Beaulieu ◽  
Bruce D. Beynnon ◽  
James A. Ashton-Miller ◽  
Daniel R. Sturnick ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Risk Factor ◽  
Femoral Condyle ◽  
Cruciate Ligament ◽  
Conditional Logistic Regression ◽  
Acl Injury ◽  
Tibial Slope ◽  
Magnetic Resonance Images ◽  
Lateral Femoral Condyle ◽  
Anterior Cruciate

Background: The lateral femoral condyle index (LFCI)—a recently developed measure of the sphericity of the lateral femoral condyle—was reported to be a risk factor for anterior cruciate ligament (ACL) injury. However, issues have been raised regarding how the index was measured and regarding the patient group and the knee in which it was measured. Purpose: To investigate the association between the LFCI and the risk of sustaining a primary, noncontact ACL injury, and to examine whether this association was moderated by the posterior-inferior–directed slope of the lateral tibial plateau. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A secondary analysis was conducted of deidentified magnetic resonance images of the uninjured knees of 86 athletes with ACL injury and the corresponding knees of 86 control athletes, matched for sports team, sex, and age. From those images, we measured the LFCI and the posterior-inferior–directed slope of the middle region articular cartilage surface of the tibial plateau’s lateral compartment. Conditional logistic regressions were performed to determine whether the LFCI was significantly associated with ACL injury risk and whether the lateral tibial compartment middle cartilage slope moderated this association. Data were analyzed for female and male participants separately as well as for both groups combined. Results: The LFCI was not found to be significantly associated with experiencing a primary, noncontact ACL injury for all analyses. The lateral tibial slope measure was not found to moderate the association between the LFCI and ACL injury. A conditional logistic regression analysis using the LFCI data of the injured knees, instead of the uninjured knees, of the participants with ACL injury revealed that the LFCI was significantly associated with ACL injury. Conclusion: In this population of athletically active female and male participants, the LFCI was not found to be a risk factor for noncontact ACL injury, regardless of the geometric features of the lateral tibial slope.

scholarly journals The Combined Effect of Body Mass Index and Tibial Slope Angles on Anterior Cruciate Ligament Injury Risk in Male Knees: A Case-Control Study

2019 ◽  
Vol 12 ◽  
pp. 117954411986792
Author(s):  
Volkan Kızılgöz ◽  
Ali Kemal Sivrioğlu ◽  
Hasan Aydın ◽  
Gökhan Ragıp Ulusoy ◽  
Türkhun Çetin ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Anterior Cruciate Ligament ◽  
Body Mass ◽  
Injury Risk ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Tibial Slope ◽  
Receiver Operating Characteristics ◽  
Operating Characteristics ◽  
Anterior Cruciate

Introduction: Tibial slope angles (TSAs) have been identified as potential risk factors of anterior cruciate ligament (ACL) injury in the literature. A higher body mass index (BMI) might increase the risk of ACL tear because of greater axial compressive force. The aim of this study was to determine the relationship of these factors and the combined effect of BMI and TSA in determination of risk potential for ACL injury. Methods: The preoperative magnetic resonance (MR) images of 81 ACL-injured male knees and of 68 male individuals with no ACL injuries were evaluated by 2 radiologists to measure the TSA. The Mann-Whitney U-test was performed to indicate the significant difference in height, weight, and BMI values. The independent samples t-test was used to determine the differences between ACL-injured and non-injured groups regarding TSA values. Odds ratios were calculated by logistic regression tests, and receiver operating characteristics (ROC) curves revealed the area under the receiver operating characteristics curve (AUC) values to compare the relationships of these parameters with ACL injury. Results: Body mass index, lateral tibial slope (LTS), and medial tibial slope (MTS) were predictive of ACL risk injury. Body mass index alone had the greatest effect among these parameters, and there were no statistically significant differences in coronal tibial slope values between the ACL-ruptured and control groups. The greatest AUC was observed for the combination of BMI, MTS, and LTS. Conclusions: Body mass index, LTS, and MTS angles were associated with ACL injury risk and BMI + MTS + LTS together revealed the greatest effect on ACL injury.

Radiological Identification of Injury to the Kaplan Fibers of the Iliotibial Band in Association With Anterior Cruciate Ligament Injury

2020 ◽  
Vol 48 (9) ◽  
pp. 2213-2220
Author(s):  
Lachlan M. Batty ◽  
Jerome Murgier ◽  
Julian A. Feller ◽  
Richard O’Sullivan ◽  
Kate E. Webster ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Lateral Collateral Ligament ◽  
Acl Injury ◽  
Iliotibial Band ◽  
Time Interval ◽  
Collateral Ligament ◽  
Tibial Bone ◽  
Mri Scans ◽  
Anterior Cruciate

Background: Recent biomechanical studies have demonstrated that the Kaplan fibers (KFs) of the iliotibial band play a role in the control of anterolateral rotation of the knee. However, controversy exists regarding whether the KFs are injured in conjunction with anterior cruciate ligament (ACL) injury. Purpose: To establish the prevalence of radiological injury to the KFs in the ACL-injured knee; to evaluate the effect of the time interval between injury and magnetic resonance imaging (MRI) on diagnosis of KF injury; and to assess for any association between KF injury and other qualitative radiological findings. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Preoperative MRI scans were reviewed for 161 patients with ACL injury. Specific diagnostic criteria were developed and applied to identify KF injury. Chi-square testing was performed to look for associations among KF injury, the time from injury to MRI, and associated radiological knee injuries. Results: Radiological evidence of KF injury was identified in 30 (18.6%) patients. The diagnosis of KF injury was higher in patients who had MRI scans performed within 90 days of injury as compared with ≥90 days after injury (23.7 vs 6.4%; P = .010). Patients with an MRI diagnosis of KF injury had significantly higher rates of lateral meniscal injury (40% vs 18%; P = .007), posteromedial tibial bone marrow edema (73% vs 44%; P = .003), and injury to the lateral collateral ligament (13% vs 3%; P = .019) or medial collateral ligament (23% vs 8%; P = .019). Conclusion: The prevalence of injury to the KF in patients with ACL injury as diagnosed by MRI was relatively low (18.6% of patients). However, the time interval from injury to MRI was relevant to diagnosis, with significantly higher rates of injury identification in patients with early (within 90 days) versus delayed (≥90 days) MRI. KF injury was associated with higher rates of injury to the lateral meniscal and collateral ligaments, as well as posteromedial tibial bone bruising.

scholarly journals Additional Anterior Cruciate Ligament MRI Examination Protocols: a Standard of Diagnosis or a Whim of Researchers? (Review)

2020 ◽  
pp. 26-34
Author(s):  
O.O. Kostrub ◽  
V.V. Kotiuk ◽  
V.A. Podik ◽  
V.B. Mazevych ◽  
R.A. Tretiakov ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Knee Joint ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Accurate Diagnosis ◽  
Acute Period ◽  
Mri Examination ◽  
Modern Methods ◽  
Anterior Cruciate ◽  
Methods Of Treatment

Summary. Standard MRI protocols of the knee joint in case of suspected anterior cruciate ligament (ACL) injury involve tomography in three mutually perpendicular planes – coronal, sagittal, and axial. Modern methods of treatment (especially refixation of the ACL and reconstruction of separate ACL bundles) and rehabilitation require more accurate diagnosis not only of the fact of injury, but also its clear location, degree and term. It is especially difficult to assess the nature and extent of ACL damage in the acute period and in cases of partial injury. Therefore, we propose to introduce into the standard of ACL MRI examination the additional use of oblique sagittal and oblique coronal sequences (images) oriented at an angle of ACL fibers with reduced to 0-2 mm interslice interval to improve the diagnosis of ACL injury. To reduce the duration of the study, it is possible to limit yourself to a small number of slices (images) in additional projections only in the area of the ACL.

scholarly journals Increased Lateral Femoral Condyle Ratio Measured by MRI Is Associated with Higher Risk of Noncontact Anterior Cruciate Ligament Injury

2021 ◽  
Author(s):  
Miao He ◽  
Jie Li
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Anterior Cruciate Ligament ◽  
Diagnostic Performance ◽  
Femoral Condyle ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Tibial Slope ◽  
Lateral Femoral Condyle ◽  
Anterior Cruciate

Abstract Background Studies have shown a significant association between the radiographically measured lateral femoral condyle ratio (LFCR) and anterior cruciate ligament (ACL) injury. However, it is unclear whether the the LFCR measured by magnetic resonance imaging (MRI) is associated with risk of noncontact ACL injury. Objective 1 To investigate the effect of the LFCR on the risk of noncontact ACL injury by MRI. 2 To investigate the association of the LFCR measured by MRI with multiple bone morphological risk factors and evaluate the most sensitive risk predictors of noncontact ACL injury. Methods A total of 116 patients, including 58 subjects with noncontact ACL injury and 58 age-matched and sex-matched controls with only meniscus injury, were included in this retrospective case-control study. The LFCR, lateral tibial slope (LTS), lateral tibial height (LTH), medial tibial slope (MTS), and medial tibial depth (MTD) were measured on MRI. The differences in each index between the two groups were compared, and risk factors were screened by single-factor logistic regression analysis. Indicators with P values <0.1 were included in the logistic regression equation. The critical values and areas under the curve (AUCs) of independent risk factors were determined by receiver operating characteristic (ROC) curve analysis. Finally, the diagnostic performance of each risk factor was evaluated by the Z-test. Results A total of 116 patients who met the inclusion criteria were included in the final analysis (58 cases in the noncontact ACL injury group and 58 cases in the control group). Patients with noncontact ACL injury had a higher femoral LFCR (63.5±2.7%) than patients with simple meniscus tear. Among all the risk factors for ACL injury, the AUC for the LFCR was the largest, at 0.81 (95% CI, 0.73-0.88), and when the critical value was 61.35%, the sensitivity and specificity for the diagnosis of ACL injury were 79% and 67%, respectively. Combined with the LTH (> 2.35 mm), the diagnostic performance was improved. The AUC was 0.85 (95% CI, 0.78-0.92), the sensitivity was 0.83, and the specificity was 0.76 Conclusion This study shows that an increased LFCR is related to an increased risk of noncontact ACL injury by MRI. The LFCR and LTH are the most sensitive risk factors for noncontact ACL injury and may help clinicians identify individuals prone to ACL injury, allowing prevention and intervention measures to be applied.

scholarly journals Importance of Posterior Tibial Slope, Medial Tibial Plateau Slope and Lateral Tibial Plateau Slope in Anterior Cruciate Ligament Injury

2021 ◽  
Vol 11 (09) ◽  
pp. 233-248
Author(s):  
Bernat Mas Matas ◽  
Irene Carrión Barberà ◽  
Salvatore Marsico ◽  
Anna Agustí Claramunt ◽  
Raúl Torres-Claramunt ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Tibial Plateau ◽  
Cruciate Ligament ◽  
Tibial Slope ◽  
Ligament Injury ◽  
Medial Tibial Plateau ◽  
Lateral Tibial Plateau ◽  
Posterior Tibial ◽  
Tibial Plateau Slope ◽  
Anterior Cruciate

scholarly journals ANATOMICAL STUDY OF THE MORPHOMETRY OF THE ANTERIOR CRUCIATE LIGAMENT ATTACHMENT SITES. Estudio anatómico de la morfometría de los sitios de fijación del ligamento cruzado anterior

2016 ◽  
Vol 8 (1) ◽  
pp. 29-37
Author(s):  
Paul I Iyaji ◽  
Abduelmenem Alashkham ◽  
Abdulrahman Alraddadi ◽  
Roger Soames
Keyword(s):  
Anterior Cruciate Ligament ◽  
Tibial Plateau ◽  
Cruciate Ligament ◽  
Acl Rupture ◽  
Attachment Sites ◽  
Significant Difference ◽  
The Mean ◽  
Las Mujeres ◽  
Anterior Cruciate ◽  
Pl Bundle

Incidence of anterior cruciate ligament (ACL) rupture and its consequent reconstruction is on the rise. In contributing to the achievement of anatomic reconstruction this study seek to provide information regarding the position and variability of the tibial attachment sites, dimensions of femoral insertions and compare these measurements in males and females, and in right and left knees. Thirty one cadaveric knees (15 right and 16 left from 9 females and 7 males, mean age 77 years) were dissected. Various ACL footprint dimensions were taken. The mean length and width of the tibial anteromedial (AM) bundle footprint were 8.9 and 9.8 mm while that of the posterolateral (PL) bundle were 9.3 and 8.0 mm respectively. The mean length and width of the tibial AM and PL bundles in males were 8.5 and 9.8 mm, and 9.1 and 8.3 mm while corresponding values in females were and 9.2 and 9.7 mm, and 9.4 and 7.8 mm respectively.  Males had larger femoral footprints (P=0.020) and tibial plateau (P<0.001). No significant difference between the right and left knees were observed. The mean anatomical positions of the AM and PL bundles were 46.0% and 50.0% of the mediolateral diameter of the tibial plateau. The mean length and width of the ACL femoral insertion sites were 8.3 and 7.7 mm for the AM bundle and 7.8 and 6.9 mm for the PL bundle respectively. The smaller ACL attachment parameters in females could be a contributing factor to the higher incidence of ACL rupture in female athletes. La incidencia de la rotura del ligamento cruzado anterior (LCA) y su consiguiente reconstrucción está en aumento. Para contribuir a la actualización de la reconstrucción anatómica del ligamento cruzado anterior, este estudio proporciona información sobre la posición y la variabilidad de los sitios de fijación en la tibia, las dimensiones de las inserciones femorales, así como las relaciones de estas mediciones en hombres y mujeres y en las rodillas derecha e izquierda. Se disecaron treinta y un (15 rodillas de cadáver derecha, 16 izquierda, de 9 mujeres y 7 hombres, con una edad media de 77 años). Se tomaron diversas dimensiones de la huella del LCA. La longitud media y la anchura de la huella del haz tibial anteromedial (AM) eran 8,9 mm y 9,8 mm mientras que la del haz posterolateral (PL) eran 9,3 mm y 8 mm respectivamente. La longitud media y la anchura de la AM tibial y paquetes PL en los varones eran 8,5 y 9,8 mm, y 9,1 y 8,3 mm, mientras que los valores correspondientes en las mujeres eran 9,2 y 9,7 mm, y 9,4 y 7,8 mm, respectivamente. Los varones tenían huellas femorales (P = 0,045 para AM, P = 0,043 para PL) y la meseta tibial (P <0,001) más grandes. No se observó ninguna diferencia significativa entre la rodilla derecha e izquierda. Las posiciones anatómicas medias de los haces de AM y PL fueron 46% y 50% del diámetro mediolateral de la meseta tibial. La longitud media y la anchura de los sitios de inserción femoral del LCA fueron 8,3 y 7,7 mm para el paquete de AM y 7,8 y 6,9 mm para el paquete PL respectivamente. Los parámetros más pequeños de fijación del LCA en las mujeres podría ser un factor que contribuye a la mayor incidencia de rotura del LCA en mujeres atletas.   

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