Purpose
This study aimed to determine whether anterior cruciate ligament (ACL) features on
magnetic resonance imaging (MRI) and knee laxity are improved 2 years after ACL rupture
treated nonoperatively and to analyze the relation between changes in scores of ACL
features and changes in laxity.
Methods
One hundred fifty-four eligible patients were included in a prospective multicenter
cohort study with 2-year follow-up. Inclusion criteria were (1) ACL rupture diagnosed
by physical examination and MRI, (2) MRI within 6 months after trauma, and (3) age
18 to 45 years. Laxity tests and MRI were performed at baseline and at 2-year follow-up.
Fifty of 143 patients, for whom all MRI data was available, were treated nonoperatively
and were included for this study. Nine ACL features were scored using MRI: fiber continuity,
signal intensity, slope of ACL with respect to the Blumensaat line, distance between
the Blumensaat line and the ACL, tension, thickness, clear boundaries, assessment
of original insertions, and assessment of the intercondylar notch. A total score was
determined by summing scores for each feature.
Results
Fiber continuity improved in 30 patients (60%), and the empty intercondylar notch
resolved for 22 patients (44%). Improvement in other ACL features ranged from 4% to
28%. Sixteen patients (32%) improved on the Lachman test (change from soft to firm
end points [n = 14]; decreased anterior translation [n = 2]), one patient (2%) showed
improvement with the KT-1000 arthrometer (MEDmetric, San Diego, CA) and 4 patients
(8%) improved on the pivot shift test. Improvement on the Lachman test was moderately
negatively associated with the total score of ACL features at follow-up. Analyzing
ACL features separately showed that only signal intensity improvement, clear boundaries,
and intercondylar notch assessment were positively associated with improvement on
the Lachman test.
Conclusions
Two years after ACL rupture and nonoperative management, patients experienced partial
recovery on MRI, and some knee laxity improvement was present. Improvement of ACL
features on MRI correlates moderately with improved laxity.
Level of Evidence
Level II, Prospective comparative study.
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Article info
Publication history
Published online: June 17, 2014
Accepted:
April 22,
2014
Received:
November 26,
2013
Footnotes
The authors report that they have no conflicts of interest in the authorship and publication of this article.
Identification
Copyright
© 2014 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
