Jayson Lian1,2, João V Novaretti1,3, Andrew J Sheean1, Neel K Patel1, Sean Whaley1, Adam Popchak1, Volker Musahl1. 1. Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. 2. Albert Einstein College of Medicine, Bronx, New York, USA. 3. Orthopaedics and Traumatology Sports Center (CETE), Department of Orthopaedics and Traumatology, Paulista School of Medicine (EPM), Federal University of São Paulo, São Paulo, Brazil.
Abstract
BACKGROUND: In anterior cruciate ligament-deficient (ACL-D) knees, injury pattern and bony morphologic features have been shown to influence both static anterior tibial subluxation relative to the femur and dynamic rotatory knee laxity. Therefore, the relationship between static anterior tibial subluxation and dynamic rotatory knee laxity was investigated. PURPOSE: To determine whether static tibial subluxation as measured on magnetic resonance imaging (MRI) is associated with the grade of rotatory knee laxity in ACL-D knees. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: Two-hundred fifty-eight knees underwent preoperative, image-guided assessment of lateral knee compartment translation during quantitative pivot shift (QPS). Subluxations of the medial and lateral tibial plateaus were measured on preoperative MRI in a subset of primary ACL-D knees meeting criteria for high-grade (QPS > 5.2 mm) and low-grade (QPS < 2.4 mm) rotatory laxity. Tibial subluxations on MRI were compared between patients with high- and low-grade rotatory laxity through use of pairwise t test and were analyzed via univariate and multivariate logistic regression. Significance was set at P < .05. RESULTS: On MRI, greater anterior subluxation of the lateral tibial plateau was observed in patients with high-grade compared with low-grade rotatory knee laxity (4.5 mm vs 2.3 mm; P < .05). No similar relationship was observed for the medial tibial plateau (-0.9 mm vs -0.4 mm; P > .05). Univariate logistic regression demonstrated that static subluxation of the lateral tibial plateau was associated with high-grade rotatory knee laxity (odds ratio [OR], 1.2; P < .05). An optimal cutoff of 2.95 mm of static lateral tibial subluxation was associated with high-grade rotatory knee laxity (sensitivity, 75%; specificity, 63%). Lateral meniscal injury was the first variable entered into a multivariate regression analysis and proved to be most associated with high-grade rotatory knee laxity (OR, 6.8; P < .05). When lateral meniscal injury was excluded from multivariate regression analysis, static anterior subluxation of the lateral tibial plateau alone was associated with high-grade rotatory knee laxity (OR, 1.2; P < .05). CONCLUSION: Data from this MRI study of two distinct rotatory knee laxity groups showed that static anterior subluxation of the lateral tibial plateau of 2.95 mm or greater was associated with high-grade rotatory knee laxity, and each millimeter increase of lateral tibial plateau subluxation was associated with a 1.2-fold odds of high-grade rotatory knee laxity. Anterior subluxation of the lateral tibial plateau on MRI was not independently associated with high-grade rotatory knee laxity in the presence of concomitant lateral meniscal injury. Static measurements made preoperatively may aid in predicting high-grade rotatory knee laxity and refining the indications for individualized knee surgery.
BACKGROUND: In anterior cruciate ligament-deficient (ACL-D) knees, injury pattern and bony morphologic features have been shown to influence both static anterior tibial subluxation relative to the femur and dynamic rotatory knee laxity. Therefore, the relationship between static anterior tibial subluxation and dynamic rotatory knee laxity was investigated. PURPOSE: To determine whether static tibial subluxation as measured on magnetic resonance imaging (MRI) is associated with the grade of rotatory knee laxity in ACL-D knees. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: Two-hundred fifty-eight knees underwent preoperative, image-guided assessment of lateral knee compartment translation during quantitative pivot shift (QPS). Subluxations of the medial and lateral tibial plateaus were measured on preoperative MRI in a subset of primary ACL-D knees meeting criteria for high-grade (QPS > 5.2 mm) and low-grade (QPS < 2.4 mm) rotatory laxity. Tibial subluxations on MRI were compared between patients with high- and low-grade rotatory laxity through use of pairwise t test and were analyzed via univariate and multivariate logistic regression. Significance was set at P < .05. RESULTS: On MRI, greater anterior subluxation of the lateral tibial plateau was observed in patients with high-grade compared with low-grade rotatory knee laxity (4.5 mm vs 2.3 mm; P < .05). No similar relationship was observed for the medial tibial plateau (-0.9 mm vs -0.4 mm; P > .05). Univariate logistic regression demonstrated that static subluxation of the lateral tibial plateau was associated with high-grade rotatory knee laxity (odds ratio [OR], 1.2; P < .05). An optimal cutoff of 2.95 mm of static lateral tibial subluxation was associated with high-grade rotatory knee laxity (sensitivity, 75%; specificity, 63%). Lateral meniscal injury was the first variable entered into a multivariate regression analysis and proved to be most associated with high-grade rotatory knee laxity (OR, 6.8; P < .05). When lateral meniscal injury was excluded from multivariate regression analysis, static anterior subluxation of the lateral tibial plateau alone was associated with high-grade rotatory knee laxity (OR, 1.2; P < .05). CONCLUSION: Data from this MRI study of two distinct rotatory knee laxity groups showed that static anterior subluxation of the lateral tibial plateau of 2.95 mm or greater was associated with high-grade rotatory knee laxity, and each millimeter increase of lateral tibial plateau subluxation was associated with a 1.2-fold odds of high-grade rotatory knee laxity. Anterior subluxation of the lateral tibial plateau on MRI was not independently associated with high-grade rotatory knee laxity in the presence of concomitant lateral meniscal injury. Static measurements made preoperatively may aid in predicting high-grade rotatory knee laxity and refining the indications for individualized knee surgery.
Authors: Theresa Diermeier; Sean J Meredith; James J Irrgang; Stefano Zaffagnini; Ryosuke Kuroda; Yuichi Hochino; Kristian Samuelsson; Clair Nicole Smith; Adam Popchak; Volker Musahl; Andrew Sheean; Jeremy M Burnham; Jayson Lian; Clair Smith; Adam Popchak; Elmar Herbst; Thomas Pfeiffer; Paulo Araujo; Alicia Oostdyk; Daniel Guenther; Bruno Ohashi; James J Irrgang; Freddie H Fu; Kouki Nagamune; Masahiro Kurosaka; Ryosuke Kuroda; Yuichi Hochino; Alberto Grassi; Giulio Maria Marcheggiani Muccioli; Nicola Lopomo; Cecilia Signorelli; Federico Raggi; Stefano Zaffagnini; Alexandra Horvath; Eleonor Svantesson; Eric Hamrin Senorski; David Sundemo; Haukur Bjoernsson; Mattias Ahlden; Neel Desai; Kristian Samuelsson; Jon Karlsson Journal: Orthop J Sports Med Date: 2020-07-07
Authors: Lachlan M Batty; Andrew Firth; Gilbert Moatshe; Dianne M Bryant; Mark Heard; Robert G McCormack; Alex Rezansoff; Devin C Peterson; Davide Bardana; Peter B MacDonald; Peter C M Verdonk; Tim Spalding; Alan M J Getgood; Kevin Willits; Trevor Birmingham; Chris Hewison; Stacey Wanlin; Andrew Firth; Ryan Pinto; Ashley Martindale; Lindsey O'Neill; Morgan Jennings; Michal Daniluk; Dory Boyer; Mauri Zomar; Karyn Moon; Raely Pritchett; Krystan Payne; Brenda Fan; Bindu Mohan; Gregory M Buchko; Laurie A Hiemstra; Sarah Kerslake; Jeremy Tynedal; Greg Stranges; Sheila Mcrae; LeeAnne Gullett; Holly Brown; Alexandra Legary; Alison Longo; Mat Christian; Celeste Ferguson; Nick Mohtadi; Rhamona Barber; Denise Chan; Caitlin Campbell; Alexandra Garven; Karen Pulsifer; Michelle Mayer; Nicole Simunovic; Andrew Duong; David Robinson; David Levy; Matt Skelly; Ajaykumar Shanmugaraj; Fiona Howells; Murray Tough; Pete Thompson; Andrew Metcalfe; Laura Asplin; Alisen Dube; Louise Clarkson; Jaclyn Brown; Alison Bolsover; Carolyn Bradshaw; Larissa Belgrove; Francis Millan; Sylvia Turner; Sarah Verdugo; Janet Lowe; Debra Dunne; Kerri McGowan; Charlie-Marie Suddens; Geert Declercq; Kristien Vuylsteke; Mieke Van Haver Journal: Orthop J Sports Med Date: 2021-04-06