scholarly journals Variances of the intraarticular landmarks for anterior cruciate ligament tibial footprint: Tibial eminencies have less variability than lateral meniscus on sagittal magnetic resonance scans

2021 ◽  
Vol 56 (4) ◽  
pp. 198-202
Author(s):  
Kadir Büyükdoğan ◽  
Lercan Aslan
Keyword(s):  
Anterior Cruciate Ligament ◽  
Magnetic Resonance ◽  
Tibial Plateau ◽  
Sagittal Plane ◽  
Cruciate Ligament ◽  
Lateral Meniscus ◽  
Single Bundle ◽  
Posterior Border ◽  
Tibial Footprint ◽  
Anterior Cruciate

Objective: The purpose of this study was to analyze the sagittal plane variations of intraarticular landmarks for single bundle anterior cruciate ligament (ACL) reconstruction including lateral meniscus, medial and lateral tibial eminencies. Methods: T2 weighted sagittal magnetic resonance (MR) scans of 80 skeletally mature patients aged between 18 to 60 years and without any sign of ligament and meniscal injuries were viewed. Midpoint of ACL, most posterior aspect of anterior horn of lateral meniscus (LMAH), tip of medial eminence (ME) and lateral eminence (LE) were identified on widest antero-posterior (A-P) distance of tibial plateau according to of Staubli-Rausching method and variances were compared. Results: Mean location of center of tibial footprint of ACL at sagittal plane was found as 38.0±4.2% (range, 29-51%) on A-P distance of tibial plateau. Location of posterior border of LMAH, ME and LE were 38.0±12.4% (range, 21-62%), 52.3±4.2% (range, 41- 60%) and 59.5±4.4% (range, 51- 69%), respectively. Difference between the variances of ACL midpoint and LMAH was large enough to be statistically significant (p=<.001) with a large effect size (f=0.59), however differences between the variances of ACL midpoint and bony landmarks were not significant (ME, p=.65; LE, p=.33). Intra and interobserver agreement for measurement of all parameters were detected as moderate to good. Conclusion: There was no constant relationship between ACL midpoint and posterior border of LMAH on sagittal plane MR images. Difference of variances between ACL midpoint and ME and LE were significantly lower than of variances of LMAH.

scholarly journals Morphologic Variants of Posterolateral Tibial Plateau Impaction Fractures in the Setting of Primary Anterior Cruciate Ligament Tear

2020 ◽  
Vol 48 (2) ◽  
pp. 318-325 ◽  
Author(s):  
David L. Bernholt ◽  
Nicholas N. DePhillipo ◽  
W. Jeffrey Grantham ◽  
Matthew D. Crawford ◽  
Zachary S. Aman ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Magnetic Resonance ◽  
Tibial Plateau ◽  
Articular Surface ◽  
Cruciate Ligament ◽  
Lateral Meniscus ◽  
Posterior Root ◽  
Meniscal Tears ◽  
Type Iiia ◽  
Anterior Cruciate

Background: Impaction fractures of the posterolateral tibial plateau commonly occur in the setting of anterior cruciate ligament (ACL) tears, with considerable variability found in fracture size and morphologic features. Purpose: The primary objective was to characterize different morphologic variants of posterolateral tibial plateau impaction fractures. The secondary objective was to investigate the association between these impaction fracture variants and concomitant meniscal and ligamentous injuries. Study Design: Cross-sectional study; Level of evidence 3. Methods: Patients treated for primary ACL tears and having magnetic resonance imaging available were included in this study, and magnetic resonance images were reviewed with denotation of displaced posterolateral tibial impaction fractures. A classification system was created based on morphologic variants of impaction fractures; associations were evaluated through use of independent chi-square testing. Results: There were 825 knees meeting the inclusion criteria, with displaced posterolateral tibial plateau impaction fractures present in 407 knees (49.3%). We observed 3 distinct morphologic variants of lateral tibial plateau impaction fractures: (I) posterior cortical buckle not involving the articular surface; (II) posterior impaction fracture involving the articular surface, with subtypes based on (A) tibial plateau depth bone loss <10% and (B) bone loss >10%; and (III) displaced osteochondral fragment, with subtypes for (A) shear or (B) depressed fragment. Type IIIA impaction fractures were associated with an increased incidence of lateral meniscus posterior root tears (33.3% vs 12.4%; P = .009) and an increased incidence of lateral meniscal tears (83.3% vs 56.7%; P = .024) compared with all knees without type IIIA impaction fracture. An increased incidence of medial collateral ligament (MCL) tears was noted in patients with type IIIA impaction fractures compared with those who had no fracture or had another fracture type (61.1% vs 20.1%; P < .001). Type IIIB impaction fractures were associated with an increased incidence of lateral meniscal tears (80.0% vs 56.2%; P = .005). Conclusion: A high prevalence of displaced posterolateral tibial plateau impaction fractures occur in the setting of ACL tears, and they can be classified into distinct morphologic subtypes. Posterolateral tibial plateau impaction fractures with displaced depressed or shear fragments were both associated with an increased incidence of lateral meniscal tears, whereas impaction fractures with a shear fragment were associated with an increased incidence of lateral meniscus posterior root tears and MCL tears.

scholarly journals Lateral femoral notch sign and posterolateral tibial plateau fractures and their associated injuries in the setting of an anterior cruciate ligament rupture

2021 ◽  
Author(s):  
Alexander Korthaus ◽  
Malte Warncke ◽  
Geert Pagenstert ◽  
Matthias Krause ◽  
Karl-Heinz Frosch ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Tibial Plateau ◽  
Cruciate Ligament ◽  
Lateral Meniscus ◽  
Ligament Injury ◽  
Ligament Rupture ◽  
Impression Fracture ◽  
Anterior Cruciate ◽  
Lateral Femoral Notch ◽  
Femoral Notch

Abstract Introduction ACL injury is one of the most common injuries of the knee joint in sports. As accompanying osseous injuries of the ACL rupture a femoral impression the so-called lateral femoral notch sign and a posterolateral fracture of the tibial plateau are described. However, frequency, concomitant ligament injuries and when and how to treat these combined injuries are not clear. There is still a lack of understanding with which ligamentous concomitant injuries besides the anterior cruciate ligament injury these bony injuries are associated. Materials and methods One hundred fifteen MRI scans with proven anterior cruciate ligament rupture performed at our center were retrospectively evaluated for the presence of a meniscus, collateral ligament injury, a femoral impression, or a posterolateral impression fracture. Femoral impressions were described according to their local appearance and posterolateral tibial plateau fractures were described using the classification of Menzdorf et al. Results In 29 cases a significant impression in the lateral femoral condyle was detected. There was a significantly increased number of lateral meniscal (41.4% vs. 18.6% p = 0.023) and medial ligament (41.4% vs. 22.1%; p = 0.040) injuries in the group with a lateral femoral notch sign. 104 patients showed a posterolateral bone bruise or fracture of the tibial plateau. Seven of these required an intervention according to Menzdorf et al. In the group of anterior cruciate ligament injuries with posterolateral tibial plateau fracture significantly more lateral meniscus injuries were seen (p = 0.039). Conclusion In the preoperative planning of ACL rupture accompanied with a positive femoral notch sign, attention should be paid to possible medial collateral ligament and lateral meniscus injuries. As these are more likely to occur together. A posterolateral impression fracture of the tibial plateau is associated with an increased likelihood of the presence of a lateral meniscal injury. This must be considered in surgical therapy and planning and may be the indication for necessary early surgical treatment.

Anterior Cruciate Ligament Tibial Footprint Size as Measured on Magnetic Resonance Imaging: Does It Reliably Predict Actual Size?

2018 ◽  
Vol 46 (8) ◽  
pp. 1877-1884 ◽  
Author(s):  
Seong Hwan Kim ◽  
Han-Jun Lee ◽  
Yong-Beom Park ◽  
Han-Sol Jeong ◽  
Chul-Won Ha
Keyword(s):  
Anterior Cruciate Ligament ◽  
Magnetic Resonance ◽  
Strong Correlation ◽  
Cruciate Ligament ◽  
Correlation Coefficients ◽  
Actual Measurement ◽  
Actual Length ◽  
Tibial Footprint ◽  
Anterior Cruciate ◽  
Actual Size

Background: Measuring the size of the anterior cruciate ligament (ACL) tibial footprint on magnetic resonance image (MRI) is common for preoperative planning of ACL reconstruction. However, the accuracy of such measurement has not been well documented. Purpose: To investigate whether the actual size of the ACL tibial footprint could be predicted by its measurement on MRI and to develop equations to improve the accuracy of predicting the actual size based on MRI measurement. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: A total of 164 patients with normal visualized ACL in gross evaluation and MRI were included (mean ± SD age, 67.3 ± 8.3 years). Cases with ACL tear, severe mucoid degeneration, osteophyte around the ACL tibial insertion, or intervals >12 months between MRI and actual measurement were excluded. The ACL tibial footprint was carefully dissected and measured during total knee arthroplasty. The length of the ACL tibial footprint on MRI was measured on a sagittal image, while the width was measured on an oblique coronal image. For the ACL tibial footprint, the association between measurement on MRI and actual measurement of length and width was analyzed via univariable and multivariable regression analyses. Reliability of measurements on MRI was also evaluated. Results: The length and width of the ACL tibial footprint as measured on MRI showed strong correlation with the actual length and width (coefficients: ρ = 0.904 and ρ = 0.808, respectively). There were differences between ACL size on MRI and its actual size: length, 12.4 mm (range, 9.7-15.3 mm) vs 13.8 (10.6-17.8) ( P < .001); width, 8.8 mm (range, 7.0-12.1 mm) vs 7.2 (5.8-10.4) ( P < .001). Based on sex, there were also differences between the size per MRI and the actual size ( P < .001 for all): length in men, 12.6 mm (range, 10.9-15.3 mm) vs 14.2 (12.3-17.8); length in women, 12.4 mm (range, 9.7-14.5 mm) vs 13.7 (10.6-15.8); width in men, 9.3 mm (range, 8.0-12.1 mm) vs 7.6 (5.8-10.4); width in women, 8.7 mm (range, 7.0-10.4 mm) vs 7.2 (5.8-9.7). The actual length of the ACL tibial footprint could be predicted by its length on MRI and sex ( R2 = 0.83, P < .001). Similarly, actual width could be predicted by the width on MRI and sex ( R2 = 0.75, P < .001). All intraclass correlation coefficients were >0.8, indicating good reliability. Conclusion: Measurements of the size of the ACL tibial footprint on MRI showed strong correlation with its actual size. Prediction equations showed good concordance correlation coefficients.

scholarly journals Tibial Plateau Slopes in Indian Patients with or without Anterior Cruciate Ligament Injury: A Magnetic Resonance Imaging Study

2016 ◽  
Vol 24 (3) ◽  
pp. 289-293 ◽  
Author(s):  
Shyam Sundar ◽  
Sarthak Patnaik ◽  
Bobur Ubaydullaev ◽  
Vinodh Kolandavelu ◽  
David Rajan
Keyword(s):  
Anterior Cruciate Ligament ◽  
Magnetic Resonance ◽  
Tibial Plateau ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Magnetic Resonance Images ◽  
Lateral Tibial Plateau ◽  
Indian Patients ◽  
Males And Females ◽  
Anterior Cruciate

Purpose To compare anterior cruciate ligament (ACL)–injured and ACL-intact patients as well as males and females in terms of tibial plateau slopes to determine their association with ACL injury. Methods Magnetic resonance images (MRI) of the knee of 310 male and 179 female skeletally mature Indian patients (mean age, 40 years) with (n=170+29) or without (n=140+150) ACL injury were reviewed. Their medial and lateral tibial plateau slopes (MTPS and LTPS), medial tibial plateau depth (MTPD), and lateral tibial plateau height (LTPH) were measured using MRI. Results The ACL-injured and ACL-intact groups were comparable in terms of MTPS (6.72° vs. 6.73°, p=0.07), LTPS (5.68° vs. 5.70°, p=0.09), MTD (1.74 vs. 1.73 mm, p=0.356), and LTH (2.21 vs. 2.22 mm, p=0.393). Males and females were also comparable in terms of MTPS and LTPS in both ACL-injured and ACL-intact groups. Conclusion ACL-injured and ACL-intact patients as well as males and females were comparable in terms of the tibial plateau slope parameters.

Overlap Between Anterior Cruciate Ligament and Anterolateral Meniscal Root Insertions: A Scanning Electron Microscopy Study

2016 ◽  
Vol 45 (2) ◽  
pp. 362-368 ◽  
Author(s):  
Brett D. Steineman ◽  
Samuel G. Moulton ◽  
Tammy L. Haut Donahue ◽  
Cristián A. Fontboté ◽  
Christopher M. LaPrade ◽  
...  
Keyword(s):  
Electron Microscopy ◽  
Scanning Electron Microscopy ◽  
Anterior Cruciate Ligament ◽  
Tibial Plateau ◽  
Sagittal Plane ◽  
Cruciate Ligament ◽  
Iatrogenic Injuries ◽  
Meniscal Root ◽  
Anterior Cruciate ◽  
Scanning Electron

Background: The anterolateral meniscal root (ALMR) has been reported to intricately insert underneath the tibial insertion of the anterior cruciate ligament (ACL). Previous studies have begun to evaluate the relationship between the insertion areas and the risk of iatrogenic injuries; however, the overlap of the insertions has yet to be quantified in the sagittal and coronal planes. Purpose: To investigate the insertions of the human tibial ACL and ALMR using scanning electron microscopy (SEM) and to quantify the overlap of the ALMR insertion in the coronal and sagittal planes. Study Design: Descriptive laboratory study. Methods: Ten cadaveric knees were dissected to isolate the tibial ACL and ALMR insertions. Specimens were prepared and imaged in the coronal and sagittal planes. After imaging, fiber directions were examined to identify the insertions and used to calculate the percentage of the ACL that overlaps with the ALMR instead of inserting into bone. Results: Four-phase insertion fibers of the tibial ACL were identified directly medial to the ALMR insertion as they attached onto the tibial plateau. The mean percentage of ACL fibers overlapping the ALMR insertion instead of inserting into subchondral bone in the coronal and sagittal planes was 41.0% ± 8.9% and 53.9% ± 4.3%, respectively. The percentage of insertion overlap in the sagittal plane was significantly higher than in the coronal plane ( P = .02). Conclusion: This study is the first to quantify the ACL insertion overlap of the ALMR insertion in the coronal and sagittal planes, which supplements previous literature on the insertion area overlap and iatrogenic injuries of the ALMR insertion. Future studies should determine how much damage to the ALMR insertion is acceptable to properly restore ACL function without increasing the risk for tears of the ALMR. Clinical Relevance: Overlap of the insertion areas on the tibial plateau has been previously reported; however, the results of this study demonstrate significant overlap of the insertions superior to the insertion sites on the tibial plateau as well. These findings need to be considered when positioning for tibial tunnel creation in ACL reconstruction to avoid damage to the ALMR insertion.

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