Painful Palpation of the Tibial Insertion of the Anterolateral Ligament Is Concordant With Acute Anterolateral Ligament Injury

Background: The anterolateral ligament (ALL) has been shown to contribute to the rotational stability of the knee. However, no clinical sign specific to ALL injury has been described. Purpose/Hypothesis: The primary aim of this study was to determine the concordance between pain elicited upon ALL palpation and ALL injury diagnosed by ultrasonography (US). The secondary aim was to look for a relationship between ALL injury and high-grade pivot shift. We hypothesized that an ALL lesion can be diagnosed clinically in an acute knee injury by palpating its tibial insertion. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: A total of 130 patients (89 men, 41 women; mean age, 27.2 ± 8.3 years) with an acute, isolated anterior cruciate ligament injury who were scheduled for ligament reconstruction were enrolled in this study. ALL palpation was carried out a mean 8.8 ± 3.2 days after injury. Preoperatively, ALL integrity was evaluated with US, and the pivot shift was determined under general anesthesia. The agreement between pain upon ALL palpation and ALL injury detected on US was determined by calculating the intraclass correlation coefficient (ICC), along with 95% CIs. Results: Distal palpation of the ALL tibial insertion elicited pain in 67 (51.5%) patients, and upon US the ALL was found to be damaged in 64 (49.2%) patients. The agreement between pain over the ALL tibial insertion and the ALL being damaged on US was excellent (ICC, 0.801; 95% CI, 0.730-0.855). Moreover, the clinical test had excellent sensitivity (92%; 95% CI, 88%-97%) and specificity (88%; 95% CI, 82%-93%). The agreement between pain at the ALL distal insertion and the pivot shift was good (ICC, 0.654; 95% CI, 0.543-0.742), and ALL palpation had excellent diagnostic accuracy for identifying rotational instability (sensitivity, 88% [95% CI, 82%-93%]; specificity, 97% [95% CI, 94%-100%]). Conclusion: Palpation of the ALL tibial insertion highly correlates with ultrasonographic evidence of an ALL injury in the context of an acute knee injury. This simple test should become part of our standard examination when evaluating patients with acute knee injuries.

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Can the distal tibial insertion of the anterolateral ligament be palpated to identify lesions in anterior cruciate ligament tears?

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00001 ◽

2020 ◽

Vol 8 (2_suppl) ◽

pp. 2325967120S0000

Author(s):

Etienne Cavaignac ◽

Jérôme Murgier ◽

Pierre Thomas ◽

Louis Courtot ◽

Vincent Marot

Keyword(s):

Confidence Interval ◽

Operating Room ◽

Predictive Value ◽

Pivot Shift ◽

Cruciate Ligament ◽

Anterolateral Ligament ◽

Rotational Stability ◽

Clinical Test ◽

Pain Status ◽

Injury Assessment

Background: It has been established that the anterolateral ligament (ALL) plays a role in controlling the rotational stability of the knee. We have demonstrated that ALL injuries can be identified by ultrasound. In most instances, the injury is tibial. The objective of this study was to evaluate the correlation between acutely painful palpation of the distal insertion of the ALL and the lesion as observed on ultrasound. Methods: We conducted a prospective single center study with 130 patients (89 men and 41 women). The mean age was 27.2 ± 8.3 years and the subjects had unilateral ACL injury for less than one month. On average, the distal insertion was palpated 8.8 ± 3.2 days after the trauma to determine the pain status of the ALL. An ultrasound was performed preoperatively by a surgeon trained in ultrasound diagnosis. All assessments were conducted in a double blind method (the surgeon did not know the clinical status of the ALL). We measured the correlation between the ALL ultrasound injury assessment and pain on palpation of the distal insertion using the intra-class correlation coefficient with a 95% confidence interval. The correlation between the preoperative pivot shift grade in the operating room and the ultrasound injury assessment was also examined. This study was approved by the ethics committee. Considering that the objective could not be quantified, the number of subjects required was determined by recruitment for 1 year. Results: The consistency between painful palpation of the distal insertion of the ALL and the ultrasound injury assessment was good with a 95% confidence interval of the ICC at 0.801 (95% CI: 0.730, 0.855) The sensitivity of this clinical test was 92% (95% CI: 88-97), specificity, 88 (95% CI: 82-93), the positive predictive value, 88% (95% CI: 82-94) and the negative predictive value, 92% (95% CI: 87 -97). The consistency between the pivot shift grade in the operating room and the injury on ultrasound was good, ICC = 0.850 (95% CI: 0.794, 0.891) Conclusion: The diagnostic value of painful palpation of the distal insertion of the ALL in identifying ALL injury was excellent. This structure is involved in the rotational stability of the knee. Therefore, assessment by palpation is adapted to the specific management of knee trauma.

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Nonoperative Treatment for Partial Ruptures of the Lateral Collateral Ligament Occurring in Combination With Complete Ruptures of the Anterolateral Ligament: A Common Injury Pattern in Brazilian Jiu-Jitsu Athletes With Acute Knee Injury

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967118822450 ◽

2019 ◽

Vol 7 (1) ◽

pp. 232596711882245

Author(s):

Eduardo Frois Temponi ◽

Adnan Saithna ◽

Lúcio Honório de Carvalho ◽

Bruno Presses Teixeira ◽

Bertrand Sonnery-Cottet

Keyword(s):

Knee Injury ◽

Nonoperative Management ◽

Nonoperative Treatment ◽

Anterolateral Ligament ◽

Injury Pattern ◽

Functional Scores ◽

The Mean ◽

Acute Knee ◽

Acute Knee Injury

Background: Combined partial lateral collateral and complete anterolateral ligament (PLCCALL) injuries are a specific injury pattern seen in Brazilian jiu-jitsu (BJJ) because of the knee varus-flexion mechanism that frequently occurs during grappling. Purpose/Hypothesis: The purpose of this study was to evaluate the incidence of this injury pattern in a series of BJJ athletes with an acute knee injury and to evaluate clinical and functional outcomes after nonoperative management at a minimum follow-up of 1 year. Our hypotheses were that PLCCALL injuries are common in BJJ and that nonoperative treatment is associated with excellent clinical outcomes and return to the preinjury level of sport. Study Design: Case series; Level of evidence, 4. Methods: All BJJ athletes who presented with an acute knee injury between July 2013 and June 2017 and who underwent magnetic resonance imaging (MRI) of the knee were included. A specific emphasis was placed on identifying those whose imaging demonstrated PLCCALL injury. Clinical evaluation included physical examination as well as Lysholm and International Knee Documentation Committee (IKDC) scores. Results: Of the 27 patients analyzed, 7 (25.9%) had MRI-proven PLCCALL injuries. The mean follow-up after nonoperative management was 41.3 months. The mean IKDC and Lysholm scores were 94 and 92 before the injury, 26 and 36 at the initial assessment after the injury, and 83 and 78 at 12-month follow-up, respectively ( P < .00001). All 7 patients had returned to their preinjury level of sports by the 12-month follow-up. The mean time between injury and return to competition level was 4.7 months (range, 4-6 months). Conclusion: PLCCALL injury is a specific but infrequent injury pattern in BJJ. The prognosis of this injury after nonoperative treatment appears to be excellent. Improved functional scores (IKDC and Lysholm) and changes on MRI demonstrated that the anterolateral ligament has intrinsic healing potential, as the images showed complete healing of the previously documented rupture of the anterolateral ligament from its proximal attachment.

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Short-term recovery of physical activity and knee function after an acute knee injury

BMJ Open Sport & Exercise Medicine ◽

10.1136/bmjsem-2020-000950 ◽

2020 ◽

Vol 6 (1) ◽

pp. e000950

Author(s):

Sanne Fomin ◽

Håkan Gauffin ◽

Joanna Kvist

Keyword(s):

Physical Activity ◽

Knee Injury ◽

Knee Injuries ◽

Acl Injury ◽

Knee Function ◽

Physical Activity Participation ◽

Activity Participation ◽

Acute Knee ◽

Acute Knee Injury

ObjectivesTo describe self-reported knee function, participation in physical activity and the number of knee surgeries at 3 and 6 months following acute knee injury.MethodsProspective cohort study. Participants, aged 15–40 years with an acute knee injury sustained no more than 6 weeks prior to inclusion, were recruited. There were 279 participants with ACL injury and 101 participants with other acute knee injuries included. Follow-up questionnaires were sent at 3 and 6 months after injury. Demographic information, activity participation, International Knee Documentation Committee subjective knee form (IKDC-SKF) and the Single Assessment Numeric Evaluation (SANE) score were collected. Additional knee injuries were obtained from self-report and medical charts.ResultsThe IKDC-SKF, SANE and physical activity participation were reduced at 3-month and 6-month follow-up. The number of participants who achieved health-promoting physical activity levels was reduced by 50% at 6-month follow-up compared with before injury. Seventeen per cent of participants with ACL injury and 41% of participants with other acute knee injuries had returned to their preinjury physical activity at 6 months. Participants with ACL injury reported worse knee function, lower physical activity participation and had more surgeries (128 surgeries, including 109 ACL-reconstructions) compared with participants with other acute knee injuries (six surgeries).ConclusionAcute knee injuries, including ACL injuries, affected self-reported knee function and physical activity participation for at least 6 months after index injury. More research is needed to understand how best to help people with acute knee injuries return to physical activity and achieve satisfactory knee function.

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