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Are Magnetic Resonance Imaging Recovery and Laxity Improvement Possible After Anterior Cruciate Ligament Rupture in Nonoperative Treatment?

      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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      References

        • Moses B.
        • Orchard J.
        • Orchard J.
        Systematic review: Annual incidence of ACL injury and surgery in various populations.
        Res Sports Med. 2012; 20: 157-179
        • Kocabey Y.
        • Tetik O.
        • Isbell W.M.
        • Atay O.A.
        • Johnson D.L.
        The value of clinical examination versus magnetic resonance imaging in the diagnosis of meniscal tears and anterior cruciate ligament rupture.
        Arthroscopy. 2004; 20: 696-700
      1. Geraets SE, Meuffels DE, van Meer BL, Breedveldt Boer HP, Bierma-Zeinstra SM, Reijman M. Diagnostic value of medical history and physical examination of anterior cruciate ligament injury: Comparison between primary care physician and orthopaedic surgeon. Knee Surg Sports Traumatol Arthrosc in press, available on 15 November 2013 http://dx.doi.org/10.1007/s00167-013-2769-4.

        • Meuffels D.E.
        • Poldervaart M.T.
        • Diercks R.L.
        • et al.
        Guideline on anterior cruciate ligament injury.
        Acta Orthop. 2012; 83: 379-386
        • Crawford R.
        • Walley G.
        • Bridgman S.
        • Maffulli N.
        Magnetic resonance imaging versus arthroscopy in the diagnosis of knee pathology, concentrating on meniscal lesions and ACL tears: A systematic review.
        Br Med Bull. 2007; 84: 5-23
        • Oei E.H.
        • Nikken J.J.
        • Verstijnen A.C.
        • Ginai A.Z.
        • Myriam Hunink M.G.
        MR imaging of the menisci and cruciate ligaments: A systematic review.
        Radiology. 2003; 226: 837-848
        • Bray R.C.
        • Leonard C.A.
        • Salo P.T.
        Correlation of healing capacity with vascular response in the anterior cruciate and medial collateral ligaments of the rabbit.
        J Orthop Res. 2003; 21: 1118-1123
        • Hefti F.L.
        • Kress A.
        • Fasel J.
        • Morscher E.W.
        Healing of the transected anterior cruciate ligament in the rabbit.
        J Bone Joint Surg Am. 1991; 73: 373-383
        • Murray M.M.
        • Martin S.D.
        • Martin T.L.
        • Spector M.
        Histological changes in the human anterior cruciate ligament after rupture.
        J Bone Joint Surg Am. 2000; 82-A: 1387-1397
        • Drogset J.O.
        • Grontvedt T.
        • Robak O.R.
        • Molster A.
        • Viset A.T.
        • Engebretsen L.
        A sixteen-year follow-up of three operative techniques for the treatment of acute ruptures of the anterior cruciate ligament.
        J Bone Joint Surg Am. 2006; 88: 944-952
        • Kaplan N.
        • Wickiewicz T.L.
        • Warren R.F.
        Primary surgical treatment of anterior cruciate ligament ruptures. A long-term follow-up study.
        Am J Sports Med. 1990; 18: 354-358
        • Boks S.S.
        • Vroegindeweij D.
        • Koes B.W.
        • Hunink M.G.
        • Bierma-Zeinstra S.M.
        Follow-up of posttraumatic ligamentous and meniscal knee lesions detected at MR imaging: Systematic review.
        Radiology. 2006; 238: 863-871
        • Chung H.W.
        • Ahn J.H.
        • Ahn J.M.
        • et al.
        Anterior cruciate ligament tear: Reliability of MR imaging to predict stability after conservative treatment.
        Korean J Radiol. 2007; 8: 236-241
        • Costa-Paz M.
        • Ayerza M.A.
        • Tanoira I.
        • Astoul J.
        • Muscolo D.L.
        Spontaneous healing in complete ACL ruptures: A clinical and MRI study.
        Clin Orthop Relat Res. 2012; 470: 979-985
        • Fujimoto E.
        • Sumen Y.
        • Ochi M.
        • Ikuta Y.
        Spontaneous healing of acute anterior cruciate ligament (ACL) injuries—conservative treatment using an extension block soft brace without anterior stabilization.
        Arch Orthop Trauma Surg. 2002; 122: 212-216
        • Ihara H.
        • Miwa M.
        • Deya K.
        • Torisu K.
        MRI of anterior cruciate ligament healing.
        J Comput Assist Tomogr. 1996; 20: 317-321
        • Malanga G.A.
        • Giradi J.
        • Nadler S.F.
        The spontaneous healing of a torn anterior cruciate ligament.
        Clin J Sport Med. 2001; 11: 118-120
        • Van Dyck P.
        • Gielen J.L.
        • Vanhoenacker F.M.
        • Wouters K.
        • Dossche L.
        • Parizel P.M.
        Stable or unstable tear of the anterior cruciate ligament of the knee: An MR diagnosis?.
        Skeletal Radiol. 2012; 41: 273-280
        • Tung G.A.
        • Davis L.M.
        • Wiggins M.E.
        • Fadale P.D.
        Tears of the anterior cruciate ligament: Primary and secondary signs at MR imaging.
        Radiology. 1993; 188: 661-667
        • Torg J.S.
        • Conrad W.
        • Kalen V.
        Clinical diagnosis of anterior cruciate ligament instability in the athlete.
        Am J Sports Med. 1976; 4: 84-93
        • Irrgang J.J.
        • Ho H.
        • Harner C.D.
        • Fu F.H.
        Use of the International Knee Documentation Committee guidelines to assess outcome following anterior cruciate ligament reconstruction.
        Knee Surg Sports Traumatol Arthrosc. 1998; 6: 107-114
        • Daniel D.M.
        • Stone M.L.
        • Sachs R.
        • Malcom L.
        Instrumented measurement of anterior knee laxity in patients with acute anterior cruciate ligament disruption.
        Am J Sports Med. 1985; 13: 401-407
        • Sernert N.
        • Kartus J.
        • Kohler K.
        • Ejerhed L.
        • Karlsson J.
        Evaluation of the reproducibility of the KT-1000 arthrometer.
        Scand J Med Sci Sports. 2001; 11: 120-125
        • Galway H.R.
        • MacIntosh D.L.
        The lateral pivot shift: A symptom and sign of anterior cruciate ligament insufficiency.
        Clin Orthop Relat Res. 1980; 147: 45-50
        • Byrt T.
        • Bishop J.
        • Carlin J.B.
        Bias, prevalence and kappa.
        J Clin Epidemiol. 1993; 46: 423-429
        • Landis J.R.
        • Koch G.G.
        The measurement of observer agreement for categorical data.
        Biometrics. 1977; 33: 159-174
        • Karanicolas P.J.
        • Bhandari M.
        • Kreder H.
        • et al.
        Evaluating agreement: Conducting a reliability study.
        J Bone Joint Surg Am. 2009; 9: 99-106
        • Yoon J.P.
        • Chang C.B.
        • Yoo J.H.
        • et al.
        Correlation of magnetic resonance imaging findings with the chronicity of an anterior cruciate ligament tear.
        J Bone Joint Surg Am. 2010; 92: 353-360
        • Tsai K.J.
        • Chiang H.
        • Jiang C.C.
        Magnetic resonance imaging of anterior cruciate ligament rupture.
        BMC Musculoskelet Disord. 2004; 5: 21
        • Vahey T.N.
        • Broome D.R.
        • Kayes K.J.
        • Shelbourne K.D.
        Acute and chronic tears of the anterior cruciate ligament: differential features at MR imaging.
        Radiology. 1991; 181: 251-253
        • Crain E.H.
        • Fithian D.C.
        • Paxton E.W.
        • Luetzow W.F.
        Variation in anterior cruciate ligament scar pattern: Does the scar pattern affect anterior laxity in anterior cruciate ligament-deficient knees?.
        Arthroscopy. 2005; 21: 19-24
        • Dejour D.
        • Ntagiopoulos P.G.
        • Saggin P.R.
        • Panisset J.C.
        The diagnostic value of clinical tests, magnetic resonance imaging, and instrumented laxity in the differentiation of complete versus partial anterior cruciate ligament tears.
        Arthroscopy. 2013; 29: 491-499
        • Van Dyck P.
        • De Smet E.
        • Veryser J.
        • et al.
        Partial tear of the anterior cruciate ligament of the knee: injury patterns on MR imaging.
        Knee Surg Sports Traumatol Arthrosc. 2012; 20: 256-261
        • Van Dyck P.
        • Vanhoenacker F.M.
        • Lambrecht V.
        • et al.
        Prospective comparison of 1.5 and 3.0-T MRI for evaluating the knee menisci and ACL.
        J Bone Joint Surg Am. 2013; 95: 916-924