Translation and rotation analysis based on stress MRI for the diagnosis of anterior cruciate ligament tears.

Abstract

Due to the increasing need for a detailed biomechanical analysis of anterior cruciate ligament (ACL) lesions, the aim of the study was to develop a method of direct measurement of the three-dimensional tibial translation and rotation based on stress MRI. For the purpose of the study, thirty patients with acute ACL rupture and 17 healthy control subjects were selected. Based on clinical examination, they were qualified for MRI examination using the Arthroholder Device prototype to perform anterior tibial translation. Each examination was performed at 30° of knee flexion, initially without tibia translation and then using the force applied to the calf of 80 N. The femur and tibia were separately registered using rigid local SimpleITK landmark refinement; translation and rotation parameters were then calculated using the 3D transformation algorithms. The significance level was set at 0.05. Initially, the device and method for obtaining the parameters of the 3D translation and rotation were validated. The pooled Standard Deviation for translation parameters was 0.81 mm and for rotation parameters 0.87°. Compared to the control group, statistically significant differences were found in parameters such as Anterior Shift [(median ± interquartile range) 3.89 mm ±6.55 vs. 0.90 mm ±2.78, P=0.002238] and External Rotation (-0.55° ±3.88 vs. -2.87° ±2.40, P=0.005074). Statistically significant correlations were observed in combined groups between Anterior Shift and parameters such as External Rotation (P=0.001611), PCL Tibial Attachment Point (pPCL) Anterior Shift (<0.000001), Rolimeter Measurement (P=0.000016), and Side-to-Side Difference (SSD) (P=0.000383). A significant statistical correlation was also observed between External Rotation and parameters such as Rolimeter (P=0.02261) and SSD (P=0.03458). The analysis of the anterior tibia translation using stress MRI and the proposed three-dimensional calculation method allows for a detailed analysis of the tibial translation and rotation parameters. The correlations showed the importance of external rotation during anterior tibial translation.