The Incidence of Kaplan Fiber Injury Associated With Acute Anterior Cruciate Ligament Tear Based on Magnetic Resonance Imaging

Abstract

Background: Kaplan fibers are distinct deep layers of the distal iliotibial band (ITB) that anchor the ITB to the distal femur and have a role in rotational stability of the knee. However, the incidence of Kaplan fiber injury in the setting of acute anterior cruciate ligament (ACL) tear is unknown. Purpose: To determine the reliability of identifying and evaluating Kaplan fibers on magnetic resonance imaging (MRI) examinations based on previously reported characteristics and to report on the incidence of combined ACL and Kaplan fiber injuries based on MRI examinations. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Patients with an acute primary ACL tear who obtained a postinjury MRI scan at our institution and were treated with ACL reconstruction between January 1, 2007, and May 31, 2012, were identified from an institutional registry. Each patient’s postinjury MRI scan was reviewed by 2 musculoskeletal radiologists, who identified Kaplan fibers and graded them as intact, injured, or not visualized. Intrarater reliability was measured using the intraclass correlation coefficient (ICC), and interrater reliability was measured using the kappa statistic. Results: A total of 72 patients were identified. For the proximal Kaplan fibers, 50% versus 58% were identified as injured, 32% versus 29% were identified as intact, and 18% versus 13% were not visualized by radiologist 1 and 2, respectively. For the distal Kaplan fibers, 46% versus 60% were identified as injured, 43% versus 28% were identified as intact, and 11% versus 12% were not visualized by radiologist 1 and 2, respectively. The ICC intrarater reliability measurements were 0.89 (95% CI, 0.83-0.93) for proximal Kaplan fibers and 0.66 (95% CI, 0.51-0.78) for distal Kaplan fibers. The interrater reliability measurements for both radiologists showed substantial agreement (kappa = 0.7) for proximal Kaplan fibers and moderate agreement (kappa = 0.51) for distal Kaplan fibers. Conclusion: Kaplan fibers were visualized on MRI studies in the majority of cases, with substantial reliability for the proximal fibers and moderate reliability for the distal fibers. There was an associated injury to either the proximal or distal or both Kaplan fibers in the majority of acute primary ACL tears.