Feasibility of a double-bundle anterior cruciate ligament reconstruction can be predicted by anthropometric and skeletal parameters: An MR imaging study

Abstract

Purpose: To evaluate the rate of anatomic restrictions on MR imaging which may prevent anterior cruciate ligament (ACL) double-bundle reconstruction (DBr) technique. The hypothesis was that some patients may not meet the criteria for this procedure. Material and Methods: From November 2013 to June 2016, 680 consecutive knee magnetic resonance (MR) imaging studies, from 656 patients (322 males and 334 females; age range 2-85 years; mean age 44.5 years; SD ± 18.8) were retrospectively reviewed. Exclusion criteria included: (i) presence of non-anatomic parameters (open physes, severe osteoarthritic changes, multiligamentous injuries), (ii) previous ACL reconstruction and (iii) incomplete MR imaging examination. Following the exclusion of 128 patients (139 MR imaging studies), 528 patients (541 MR imaging studies) comprised the study group. The femoral notch width (FNw) was measured on coronal T1-w whereas the ACL tibial insertion site (TIS) length was measured on sagittal fat-suppressed proton density MR images. A TIS length and an FNw of less than 14 mm and 12 mm respectively were regarded abnormal. Results: Ninety-eight patients (18.5%) proved to be improper candidates for DBr technique. Ninety of them (91.8%) were not suitable due to short TIS length, 8 (8.2%) due to narrow FNw and 2 (2%) due to coexistence of both the above anatomic limitations. The number of female patients showing anatomic restrictions was significantly higher compared to that of male patients (p<0.00001). Conclusions: A significant number of patients do not meet the criteria for DBr technique due to anatomic restrictions. MR imaging can identify them pre-operatively and prevent failure of a demanding procedure. Level of evidence: III, retrospective comparative study