Seong Hwan Kim1, Yong-Beom Park2, Dae-Woong Ham3, Jung-Won Lim3, Han-Jun Lee3. 1. Department of Orthopedic Surgery, Hyundae General Hospital, Chung-Ang University College of Medicine, 21, Bonghyeon-ro, Jinjeop-eup, Namyangju-si, Gyeonggi-do, 12013, South Korea. 2. Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, South Korea. whybe1122@gmail.com. 3. Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul, 06973, South Korea.
Abstract
PURPOSE: To evaluate the diagnostic value of stress radiography and determine the cutoff values for high-grade anterolateral rotatory laxity in complete anterior cruciate ligament (ACL)-deficient knees at different positions. METHODS: Forty-two patients with complete ACL rupture (group 1) and 37 normal subjects (group 2) were prospectively enrolled. The amount of anterior translation in the medial (MM) and lateral (LL) distance compartments and the difference between them (LL-MM distance) were measured using stress radiography at 30°, 45°, 60°, and 90° positions. The area under the receiver operating characteristic curve (AUC) was assessed for the presence of a high-grade (grade > 2) pivot shift. RESULTS: The MM and LL distances in group 1 were significantly different at 30° and 45° positions (P < 0.05). The AUC of the MM (AUC, 0.903) and LL (AUC, 0.901) distances at the 30° position was significantly higher than that of the other positions (P = 0.000); however, the cutoff values were different to diagnose ACL injury (MM vs. LL, 3.1 mm vs. 5.4 mm). A 2.1-mm cutoff for the LL-MM distance showed 78.4% sensitivity and 90.3% specificity for detecting the presence of a high-grade pivot shift (AUC = 0.905, P = 0.000). CONCLUSION: The cutoff values of stress radiography differed according to anatomical references and knee flexion positions. Stress radiography of a 2.1 mm difference in LL-MM distance at 30° of knee flexion can be a reliable method for high-grade rotatory laxity in complete ACL-injured knees. LEVEL OF EVIDENCE: Level 1, diagnostic study.
PURPOSE: To evaluate the diagnostic value of stress radiography and determine the cutoff values for high-grade anterolateral rotatory laxity in complete anterior cruciate ligament (ACL)-deficient knees at different positions. METHODS: Forty-two patients with complete ACL rupture (group 1) and 37 normal subjects (group 2) were prospectively enrolled. The amount of anterior translation in the medial (MM) and lateral (LL) distance compartments and the difference between them (LL-MM distance) were measured using stress radiography at 30°, 45°, 60°, and 90° positions. The area under the receiver operating characteristic curve (AUC) was assessed for the presence of a high-grade (grade > 2) pivot shift. RESULTS: The MM and LL distances in group 1 were significantly different at 30° and 45° positions (P < 0.05). The AUC of the MM (AUC, 0.903) and LL (AUC, 0.901) distances at the 30° position was significantly higher than that of the other positions (P = 0.000); however, the cutoff values were different to diagnose ACL injury (MM vs. LL, 3.1 mm vs. 5.4 mm). A 2.1-mm cutoff for the LL-MM distance showed 78.4% sensitivity and 90.3% specificity for detecting the presence of a high-grade pivot shift (AUC = 0.905, P = 0.000). CONCLUSION: The cutoff values of stress radiography differed according to anatomical references and knee flexion positions. Stress radiography of a 2.1 mm difference in LL-MM distance at 30° of knee flexion can be a reliable method for high-grade rotatory laxity in complete ACL-injured knees. LEVEL OF EVIDENCE: Level 1, diagnostic study.
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