Evaluation Of Anterior Cruciate Ligament Research Articles

Is conventional magnetic resonance imaging superior to radiography in the functional integrity evaluation of anterior cruciate ligament in patients with knee osteoarthritis?

BackgroundThe functional integrity of the anterior cruciate ligament (ACL) influences surgical decision-making in patients with knee osteoarthritis (KOA). This study aimed to compare the diagnostic value of radiography and magnetic resonance imaging (MRI) in determining the functional status of ACL.MethodsWe analyzed 306 knees retrospectively using preoperative hip-to-ankle anteroposterior standing (APS) radiographs, anteroposterior (AP) and lateral knee radiographs, AP valgus stress (VS) force radiographs, and standard orthogonal MRI. Based on the intraoperative visualization, the knees were grouped into ACL functionally-intact and ACL functionally-deficient (ACLD) groups. The diagnostic validity and reliability were calculated based on the radiograph parameters such as hip-knee-ankle angle (HKA), medial proximal tibial angle (MPTA), lateral distal femoral angle (LDFA), posterior tibial slope (PTS), sagittal tibiofemoral subluxation (STFS), coronal tibiofemoral subluxation (CTFS), joint line convergence angle (JLCA), the maximum wear point of the proximal tibia plateau (MWPPT%), and MRI parameters including ACL grades and MWPPT%.ResultsHKA, MPTA, PTS, STFS, JLCA, and CTFS on APS and AP radiographs, and MWPPT% on radiographs and MRI showed a significant diagnostic value (P < 0.05). There were no statistically significant differences in the single parameters from radiographs and MRI. After constructing the logistic regression models, MRI showed higher sensitivity, specificity, and accuracy, reaching 96.8%, 79.9%, and 83.3%, respectively (P < 0.001).ConclusionsIn patients with KOA, the diagnostic value of single radiographic or MRI parameter in assessing the functional integrity of the ACL are equivalent. However, by constructing predictive models, MRI could significantly improve diagnostic validity compared with radiography.

Evaluation of ACL Graft Remodeling and Prediction of Graft Insufficiency in Sequenced MRI—Two-Year Follow-Up

Background: Postoperative magnetic resonance imaging (MRI) evaluation of anterior cruciate ligament (ACL) graft maturity is a useful and practical tool that allows for assessment of graft status and remodeling stage. The purpose of this study was to evaluate and compare previously described methods of graft evaluation in MRI. We identify factors influencing the maturation and correlating graft appearance in MRI with indirect symptoms of graft insufficiency to identify patients at risk. Methods: Retrospective evaluation was performed in 44 patients who received bone patellar tendon bone (BPTB) ACL reconstruction with nine consecutive postoperative MRIs at 2, 6, 12, 18, 24, 36, 48, 72, and 96 weeks. Graft status was evaluated using signal-to-noise quotient (SNQ) methods in both sagittal and axial planes. We also assessed the homogeneity of the graft by standard deviation (SD) of signal intensity. SNQ was correlated with patient’s age, sex, postoperative weight-bearing, as well as indirect signs of graft insufficiency by MRI including graft appearance, posterior cruciate ligament (PCL) buckling, and measurement of anterior tibia subluxation. Results: We observed that the results of modelling SNQs from both sagittal and axial planes were similar. For both SNQs, the change over weeks quotient was nonlinear where the clinical parameter increased at week 36 and subsequently decreased. The SNQ at week 96 does not reach the levels from week 2. We observed that the model incorporating SNQ and relative SD (rSD) in the sagittal plane predicted the tibia anterior subluxation proportions better than the model with clinical parameters measured in the axial plane. Our results demonstrate that greater SD is associated with less graft homogeneity, which could indicate that this model is a good predictor of graft insufficiency. In addition, the proportion of PCL buckling increased over the course of the study. Conclusions: MRI graft evaluation is very useful for assessing graft ligamentization stage and to predict graft insufficiency.

Diagnostic arthroscopy compared to magnetic resonance imaging in the evaluation of meniscal and ligament tears of the knee

Background: The knee joint gets injured commonly as it has less musculature anteriorly and due to external forces affecting knee movements in coronal and sagittal planes. Rotational injuries are also common at the knee. Aims and Objectives: We wanted to compare the diagnostic capabilities of magnetic resonance imaging (MRI) and diagnostic arthroscopy (DgAr) in the evaluation of anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial meniscus (MM), and lateral meniscus (LM) injuries etc., seek correlation among both MRI and DgAr knee and find the better modality. Materials and Methods: This prospective study involved 50 patients suffering from knee joint injuries in our tertiary care teaching hospital. MRI of the knee was done in knees with internal derangement; all patients went for arthroscopy under general/spinal anesthesia. Keeping DgAr as reference, MRI was compared on parameters such as sensitivity and specificity, positive and negative predictive value plus accuracy. Results: MRI had a high accuracy i.e. 91.1%, 94%, 86%, and 92% for ACL, PCL, MM, and LM, respectively. Furthermore, it had low positive predictive value (PPV) and High PPV for meniscal and cruciate injuries. Conclusion: MRI is commonly used to evaluate various structures of the knee. In cases where clinical findings favor meniscal or ACL injuries, MRI scan prior to arthroscopic examination does not offer additional advantage. We suggest early DgAr as appropriate intervention in such cases.

The underlying mechanism of partial anterior cruciate ligament injuries to the meniscus degeneration of knee joint in rabbit models

BackgroundThe diagnosis, treatment, and efficacy evaluation of anterior cruciate ligament (ACL) partial rupture remains controversial. This research aims to investigate the underlying mechanism of partial ACL injuries to the meniscus degeneration in the rabbit knee.MethodsSixty New Zealand white rabbits were randomly divided into three groups including an experimental group, a sham group (n = 6), and a blank control group (n = 6). The experimental group is composed of an anteromedial bundle (AMB) rupture group (n = 24) and a posterolateral bundle (PLB) rupture group (n = 24). Rabbits in the experimental group were subjected to right hind limbs knee surgery to induce ACL part injury under the arthroscopy. Finally, eight rabbits including 6 in the model group and 2 in the control group were sampled randomly on the 2nd, 4th, and 8th weeks respectively. We observed the typical form of the meniscus through HE staining. Expressions of inflammatory factors including interleukin-1β (IL-1β) and IL-17 in the knee joint fluid were determined by means of an ELISA. Analysis of the mRNA expressions of matrix metalloproteinases-13(MMP-13) was performed to evaluate the inflammatory mediators in the pathogenesis of the meniscus.ResultsHE staining results showed that the surface was rough and the tissues were loose displaying collagen fibers of varying thickness. Both IL-1β and IL-17 in the synovial fluid and the positive rate of MMP-13 in addition to MMP-13 mRNA showed a demonstrable increase treads from the 2nd to the 8th week. The significant difference was found (P < 0.05) compared to the control group.ConclusionWe conclude that the elevated levels of IL-1β and IL-17, along with increased MMP13 expression, resulted in meniscus degradation in the rabbit knee joint model with partial ACL injury.

Efficacy of Routine Magnetic Resonance Imaging (MRI) in Evaluation of Knee Joint Pathologies

Background: Imaging modalities like ultrasonography (USG), magnetic resonance imaging (MRI) and magnetic resonance arthrography (MRAr) provide different form of information about the joint space and tendons related to the knee joint. Knee is the most frequently examined joint by MRI / MRAr as it is relatively non-invasive and highly accurate in assessing joint structures, saving majority of patients from non-therapeutic arthroscopy procedures. The main objective of this study is to understand the comparative role of routine MRI and MRAr in our hospital settings. Subjects and Methods: Twenty-five patients included in the study underwent both MRI and MRAr on the same day. Results were interpreted by radiologists and data was tabulated with the final diagnosis established on MRAr. Results: Efficacy of MRI was inferior in evaluation of Anterior Cruciate ligament, meniscal and capsular tears. In patients, where MRI was normal, MR Arthrography revealed significant findings. Conclusion: Routine MRI misses significant outcome information when compared to MRAr in evaluation of knee joint. Hence, MR Arthrography should be done for optimal evaluation of knee joints in all patients especially those with clinicoradiological discordance.

Preliminary Evaluation on Meniscal and Different Functional Splitting of Anterior Cruciate Ligament Injuries of Knee Joint in Rabbit Models

The diagnosis, treatment and efficacy evaluation of anterior cruciate ligament (ACL) partly jury is controversy. We established the models of different damage to functional bundle, which is used on the ACL of rabbit knee, and analyzed the impact of different damage to functional bundle on ACL. 45 New Zealand, white rabbits were randomly divided into three groups, anteromedial bundle (AMB) fracture group, posterolateral bundle (PLB) fracture group and no fracture group. When finishing building the models, 8 rabbits were killed randomly on the second, fourth and eighth week respectively. Finally, we can observe the general form of the meniscus through experimental HE staining. The two groups were similar to the general form. In addition, the surface was unsmooth in the HE staining experiment and the tissues were loose as well as collagen fibers of varying thickness. It is believed that it will cause meniscus regression along with the ruin of different functional bundle on the ACL.

The quadrant method measuring four points is as a reliable and accurate as the quadrant method in the evaluation after anatomical double-bundle ACL reconstruction.

The quadrant method was described by Bernard et al. and it has been widely used for postoperative evaluation of anterior cruciate ligament (ACL) reconstruction. The purpose of this research is to further develop the quadrant method measuring four points, which we named four-point quadrant method, and to compare with the quadrant method. Three-dimensional computed tomography (3D-CT) analyses were performed in 25 patients who underwent double-bundle ACL reconstruction using the outside-in technique. The four points in this study's quadrant method were defined as point1-highest, point2-deepest, point3-lowest, and point4-shallowest, in femoral tunnel position. Value of depth and height in each point was measured. Antero-medial (AM) tunnel is (depth1, height2) and postero-lateral (PL) tunnel is (depth3, height4) in this four-point quadrant method. The 3D-CT images were evaluated independently by 2 orthopaedic surgeons. A second measurement was performed by both observers after a 4-week interval. Intra- and inter-observer reliability was calculated by means of intra-class correlation coefficient (ICC). Also, the accuracy of the method was evaluated against the quadrant method. Intra-observer reliability was almost perfect for both AM and PL tunnel (ICC>0.81). Inter-observer reliability of AM tunnel was substantial (ICC>0.61) and that of PL tunnel was almost perfect (ICC>0.81). The AM tunnel position was 0.13% deep, 0.58% high and PL tunnel position was 0.01% shallow, 0.13% low compared to quadrant method. The four-point quadrant method was found to have high intra- and inter-observer reliability and accuracy. This method can evaluate the tunnel position regardless of the shape and morphology of the bone tunnel aperture for use of comparison and can provide measurement that can be compared with various reconstruction methods. The four-point quadrant method of this study is considered to have clinical relevance in that it is a detailed and accurate tool for evaluating femoral tunnel position after ACL reconstruction. Case series, Level IV.

Are 3D FSE MRI sequences of the knee at 1.5 T effective in the detection of meniscal and ligament tears? How useful are they?

Radiol Bras. 2016 Mar/Abr;49(2):V–VI The use of fast spin-echo (FSE) magnetic resonance imaging (MRI) sequences is the most versatile way of evaluating the musculoskeletal system. Anisotropic, two-dimensional (2D) sequences have greater resolution in the acquisition plane whereas the voxel resolution in isotropic three-dimensional (3D) volumetric sequences is the same in all planes with no loss of spatial resolution and with no distortion. Initially, 3D gradient-echo sequences which had acceptable acquisition time and high resolution but inadequate tissue contrast were the standard for evaluating the musculoskeletal system. As of 2007, technological advances led to more consistent use of 3D FSE sequences in such evaluations, because 3D FSE sequences provide greater tissue contrast for clinical application in the knee than do 3D gradient-echo sequences. Imaging studies of the knee structures can require the use of oblique planes with special orientation. That is the case of anterior cruciate ligament evaluation, a common situation on the daily practice. In 2007, Rajeswaran et al. highlighted the value of using oblique planes to evaluate the popliteofibular ligament, which plays a role in instability related to lesions of the posterolateral corner structures of the knee. Evaluations of the articular cartilage of the knee can also benefit from the use of 3D isotropic volumetric sequences due to its capacity to reformat in different planes and its greater spatial resolution which improves the characterization of cartilagineous lesions. This last characteristic has a particular application in the femoral trochlea. The articular cartilage evaluation in this area, using axial planes with the usual angulation, has certain limitations. The sagittal plane is called in order to complement this evaluation, although it can be less precise due to partial volume effects. Para-axial slices, perpendicular to the articular surface of the trochlea, can better define injury in this area. Regarding the detection of ligament and meniscal injuries, the performance of volumetric sequences is similar to that of 2D sequences, although the quality of 3D images is considered inferior to that of 2D images. Although some authors question the real value of 3D FSE sequences for the diagnosis of meniscal and cartilaginous lesions in

Evaluation of anterior cruciate ligament reconstructed patients should include both self-evaluation and anteroposterior joint movement estimation?

Abstract Background: The migration of the Tibio-femoral Contact Point of the Femur with respect to the tibial plateau is altered by the rupture of the Anterior Cruciate Ligament and again changed after reconstructive

Arthroscopic Agreement Among Surgeons on Anterior Cruciate Ligament Tunnel Placement

Background: Little is known about surgeon agreement and accuracy using arthroscopic evaluation of anterior cruciate ligament (ACL) tunnel positioning. Purpose: To investigate agreement on ACL tunnel position evaluated arthroscopically between operating surgeons and reviewing surgeons. We hypothesized that operating and evaluating surgeons would characterize tunnel positions significantly differently. Study Design: Controlled laboratory study. Methods: Twelve surgeons drilled ACL tunnels on 72 cadaveric knees using transtibial (TT), medial portal (MP), or 2-incision (TI) techniques and then completed a detailed assessment form on tunnel positioning. Then, 3 independent blinded surgeon reviewers each arthroscopically evaluated tunnel position and completed the assessment form. Statistical comparisons of tunnel position evaluation between operating and reviewing surgeons were completed. Three-dimensional (3D) computed tomography (CT) scans were performed and compared with arthroscopic assessments. Arthroscopic assessments were compared with CT tunnel location criteria. Results: Operating surgeons were significantly more likely to evaluate femoral tunnel position (92.6% vs 69.2%; P = .0054) and femoral back wall thickness as “ideal” compared with reviewing surgeons. Tunnels were judged ideal by reviewing surgeons more often when the TI technique was used compared with the MP and TT techniques. Operating surgeons were more likely to evaluate tibial tunnel position as ideal (95.5% vs 57.1%; P < .0001) and “acceptable” compared with reviewers. The ACL tunnels drilled using the TT technique were least likely to be judged as ideal on the tibia and the femur. Agreement among surgeons and observers was poor for all parameters (κ = −0.0053 to 0.2457). By 3D CT criteria, 88% of femoral tunnels and 78% of tibial tunnels were placed within applied criteria. Conclusion: Operating surgeons are more likely to judge their tunnels favorably than observers. However, independent surgeon reviewers appear to be more critical than results of 3D CT imaging measures. When subjectively evaluated arthroscopically, the TT technique yields more subjectively poorly positioned tunnels than the TI and MP techniques. Surgeons do not agree on the ideal placement for single-bundle ACL tunnels. Clinical Relevance: This study demonstrates that surgeons do not currently uniformly agree on ideal single-bundle tunnel placement and that the TT technique may yield more poorly placed tunnels.

Dynamic functional performance and kinematic analysis of the rotational patterns of single- versus double-bundle anterior cruciate ligament reconstruction

BackgroundThe evaluation of anterior cruciate ligament (ACL) reconstruction has typically focused on the restoration of rotatory stability. Some studies have compared single-bundle and double-bundle ACL reconstruction using subjective clinical tests and questionnaires, but these studies only provide limited data on rotational stability. The purpose of this study is to determine the rotational patterns that present during high-demand pivoting tasks and to evaluate any difference in kinematic rotational patterns between patients who have undergone single- or double-bundle ACL reconstruction. Materials and MethodsTwenty-four males were divided into four groups for this study: intact, ACL deficient, single-bundle reconstructed, and double-bundle reconstructed. Kinematic data were collected using a 10-camera optoelectronic motion analysis system while the participants performed high-demand landing and pivoting tasks. The evaluation period was defined as the time from when the tested foot made contact with the ground to takeoff, and the range of tibial rotation was measured. ResultsRotation was significantly reduced in the single-bundle ACL reconstructed knees (7.8° ± 3.4°) and double-bundle ACL reconstructed knees (7.5° ± 2.6°) in comparison with ACL-deficient knees (13.5° ± 3.7°; p < 0.05). There was no significant difference in terms of tibial rotation between the intact knees (6.5° ± 3.5°) and the single-bundle or double-bundle ACL reconstructed knees after >2 years of follow up (p > 0.05). ConclusionBy using a dynamic functional biomechanical assessment, we demonstrate that the single-bundle ACL reconstruction technique using a composite hamstring tendon graft and the double-bundle ACL reconstruction technique can adequately restore excessive tibial rotation during high-demand activities such as landing and pivoting.

Anatomic Single-bundle ACL Reconstruction

A critical evaluation of anterior cruciate ligament (ACL) reconstruction techniques has revealed that single-bundle grafts placed by conventional transtibial drilling do not provide adequate restraint to translational and rotatory forces. In some knees, this will affect function and possibly contribute to chondral injuries. The method of 2-bundle ACL reconstruction has evolved partly to address these concerns with the premise that greater rotational stability will be provided by 2-bundle grafts. Although the question of what constitutes rotational stability is still debated, the methodology of 2-bundle ACL reconstructions has clearly reinforced the need to center grafts within the native ACL insertions. When the principles of anatomic graft placement are combined with an independent drilling method, then single-bundle grafts can restore physiologic laxity to the knee. A thorough knowledge of the ACL insertions is necessary and an independent drilling method using an anteromedial portal is required. The technique for anteromedial portal drilling requires adjustments to permit knee flexion over 125 degrees when drilling. Grafts positioned in this fashion will tend to lengthen in extension and fixation may be accomplished with the knee in close to full extension.

905 引張りおよび引張り-ねじり試験によるブタ前十字靱帯の力学的特性評価

905 引張りおよび引張り-ねじり試験によるブタ前十字靱帯の力学的特性評価

Anterior cruciate ligament tears and associated meniscal lesions: assessment at dual-detector spiral CT arthrography.

To assess dual-detector spiral computed tomographic (CT) arthrography of the knee in the evaluation of anterior cruciate ligament (ACL) tears and associated meniscal lesions. ACL and meniscal abnormalities in 125 consecutive patients who underwent dual-detector spiral CT arthrography of the knee were evaluated on the basis of both initial interpretations and retrospective review of CT images and were compared with arthroscopic findings. The sensitivity and specificity of CT arthrography for the detection of ACL tears and meniscal lesions in knees with abnormal ACLs were determined. The sensitivities and specificities for the detection of ACL tears were 90% and 96%, respectively, at initial interpretation and 95% and 99%, respectively, at retrospective interpretation. The sensitivities and specificities for the detection of meniscal tears in knees with abnormal ACLs were 92% and 88%, respectively, at initial interpretation and 96% and 94%, respectively, at retrospective interpretation. Dual-detector spiral CT arthrography of the knee is an accurate method for detecting ACL tears and associated meniscal lesions.

Biomechanical evaluation of interference screw fixation in a bovine patellar bone-tendon-bone autograft complex for anterior cruciate ligament reconstruction

A bovine model was developed for biomechanical evaluation of anterior cruciate ligament (ACL) reconstruction using patellar bone-tendon-bone (b-t-b) autograft to examine the differences in time zero fixation mechanical properties of different interference screw lengths and diameters. The surgical technique of interference screw fixation of the b-t-b complex performed clinically was reproduced in a controlled animal model. The femur-patellar tendon graft-tibia complex was tested with anterior displacement of the tibia in 30 degrees of knee flexion to allow examination of the femoral and tibial fixation properties simultaneously. The statistical model concurrently explored differences between screw length and diameter while accounting for variations between graft properties. No statistically significant differences were found between the 7- and 9-mm screws with respect to peak load or energy to failure when using a 10-mm triangular graft in a 10-mm tunnel. The 7- and 9-mm screws were superior to the 5.5-mm screws with respect to these same parameters. Based on our results, the 7-mm interference screws can be used with equal confidence as the 9-mm screw, and the 20-mm length can be similarly exchanged for 30-mm length for patellar b-t-b graft fixation.