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Original Article| Volume 38, ISSUE 10, P2852-2860, October 2022

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Anterior Tibial Subluxation of Lateral Compartment Is Associated With High-Grade Rotatory Instability for Acute But Not Chronic Anterior Cruciate Ligament Injuries: An Magnetic Resonance Imaging Case-Control Study

  • An Liu
    Affiliations
    Department of Orthopedics, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China, Orthopedics Research Institute of Zhejiang University, Hangzhou, China
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  • Wushi Cui
    Affiliations
    Department of Orthopedics, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China, Orthopedics Research Institute of Zhejiang University, Hangzhou, China
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  • Weinan Yang
    Affiliations
    Department of Orthopedics, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China, Orthopedics Research Institute of Zhejiang University, Hangzhou, China
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  • Congsun Li
    Affiliations
    Department of Orthopedics, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China, Orthopedics Research Institute of Zhejiang University, Hangzhou, China
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  • Shigui Yan
    Affiliations
    Department of Orthopedics, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China, Orthopedics Research Institute of Zhejiang University, Hangzhou, China
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  • Zengfeng Xin
    Correspondence
    Zengfeng Xin, M.D., Department of Orthopedics, The Second Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Hangzhou, China. Orthopedics Research Institute of Zhejiang University, Hangzhou, China.
    Affiliations
    Department of Orthopedics, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China, Orthopedics Research Institute of Zhejiang University, Hangzhou, China
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  • Haobo Wu
    Correspondence
    Address correspondence to Haobo Wu, M.D., Department of Orthopedics, The Second Affiliated Hospital, Zhejiang University School of Medicine, No.88 Jiefang Road, Hangzhou, China. Orthopedics Research Institute of Zhejiang University, Hangzhou, China.
    Affiliations
    Department of Orthopedics, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China, Orthopedics Research Institute of Zhejiang University, Hangzhou, China
    Search for articles by this author
Published:May 09, 2022DOI:https://doi.org/10.1016/j.arthro.2022.04.012
Anterior Tibial Subluxation of Lateral Compartment Is Associated With High-Grade Rotatory Instability for Acute But Not Chronic Anterior Cruciate Ligament Injuries: An Magnetic Resonance Imaging Case-Control Study
Previous ArticleEditorial Commentary: Hip Joint Laxity, Microinstability, or Instability Require Precise Definition: No Matter What You Call It, It's Here to Stay!
Next ArticleEditorial Commentary: Magnetic Resonance Imaging Is Helpful in Predicting High-Grade Knee Rotatory Instability: But When in Doubt, Always Examine the Patient

      Purpose

      To investigate whether anterior tibial subluxation obtained from magnetic resonance imaging (MRI) could be a predictor of high-grade rotatory instability for anterior cruciate ligament (ACL) injuries, including acute and chronic cases.

      Methods

      From September 2016 to August 2018, we retrospectively investigated 163 patients with ACL injuries who subsequently underwent primary ACL reconstruction. Among them, 30 patients with high-grade rotatory instability (grade II/III pivot shift) were included in the high-grade group, and their age and sex were matched 1:2 to low-grade cases (<grade II pivot shift). On preoperative MRI, we measured anterior tibial subluxation, posterior tibial slope, as well as the time from injury to surgery. Meniscal lesions were documented from arthroscopy. Multivariable logistic regression was used to determine predictors of high-grade rotatory instability. Furthermore, subgroup comparisons between 2 groups were divided into acute (≤3 months) and chronic (>3 months) phases.

      Results

      The high-grade group had a larger anterior tibial subluxation of lateral compartment (8.1 mm vs 5.9 mm; P =.004) than the low-grade group, whereas no significant difference was found in anterior tibial subluxation of medial compartment (P > .05). Moreover, high-grade anterior tibial subluxation of lateral compartment (≥6 mm) was found to be an independent predictor (odds ratio, 12.992; P = .011) associated with concomitant meniscal tears after ACL injuries. Anterior tibial subluxation of lateral compartment demonstrated statistical significance between the two groups when comparing subgroups within 3 months but not beyond 3 months.

      Conclusion

      In ACL-injured patients, high-grade anterior tibial subluxation of lateral compartment (≥6 mm) could be a unique predictor of high-grade knee rotatory instability for acute but not chronic injuries. Prolonged time from injury to surgery and lateral meniscus tears were risk factors for high-grade rotatory laxity in chronic patients.

      Level of Evidence

      Level III, retrospective prognostic trial.
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      References

        • Liu A.
        • Sun M.
        • Ma C.
        • et al.
        Clinical outcomes of transtibial versus anteromedial drilling techniques to prepare the femoral tunnel during anterior cruciate ligament reconstruction.
        Knee Surg Sports Traumatol Arthrosc. 2017; 25: 2751-2759
        View in Article
        • Horvath A.
        • Meredith S.J.
        • Nishida K.
        • Hoshino Y.
        • Musahl V.
        Objectifying the pivot shift test.
        Sports Med Arthrosc Rev. 2020; 28: 36-40
        View in Article
        • Song G.Y.
        • Zhang H.
        • Zhang J.
        • et al.
        Greater static anterior tibial subluxation of the lateral compartment after an acute anterior cruciate ligament injury is associated with an increased posterior tibial slope.
        Am J Sports Med. 2018; 46: 1617-1623
        View in Article
        • Vaudreuil N.J.
        • Rothrauff B.B.
        • de Sa D.
        • Musahl V.
        The pivot shift: Current experimental methodology and clinical utility for anterior cruciate ligament rupture and associated injury.
        Curr Rev Musculoskel Med. 2019; 12: 41-49
        View in Article
        • Noyes F.R.
        • Huser L.E.
        • Jurgensmeier D.
        • Walsh J.
        • Levy M.S.
        Is an anterolateral ligament reconstruction required in ACL-reconstructed knees with associated injury to the anterolateral structures? A robotic analysis of rotational knee stability.
        Am J Sports Med. 2017; 45: 1018-1027
        View in Article
        • Vundelinckx B.
        • Herman B.
        • Getgood A.
        • Litchfield R.
        Surgical indications and technique for anterior cruciate ligament reconstruction combined with lateral extra-articular tenodesis or anterolateral ligament reconstruction.
        Clin Sports Med. 2017; 36: 135-153
        View in Article
        • van Eck C.F.
        • van den Bekerom M.P.J.
        • Fu F.H.
        • Poolman R.W.
        • Kerkhoffs G.M.M.J.
        Methods to diagnose acute anterior cruciate ligament rupture: A meta-analysis of physical examinations with and without anaesthesia.
        Knee Surg Sports Traumatol Arthrosc. 2013; 21: 1895-1903
        View in Article
        • Ferretti A.
        • Monaco E.
        • Gaj E.
        • et al.
        Risk factors for grade 3 pivot shift in knees with acute anterior cruciate ligament injuries: A comprehensive evaluation of the importance of osseous and soft tissue parameters from the SANTI Study Group.
        Am J Sports Med. 2020; 48: 2408-2417
        View in Article
        • Golan E.J.
        • Tisherman R.
        • Byrne K.
        • Diermeier T.
        • Vaswani R.
        • Musahl V.
        Anterior cruciate ligament injury and the anterolateral complex of the knee-importance in rotatory knee instability?.
        Curr Rev Musculoskelet Med. 2019; 12: 472-478
        View in Article
        • Song G.Y.
        • Zhang H.
        • Wang Q.
        • Zhang J.
        • Li Y.
        • Feng H.
        Risk factors associated with grade 3 pivot shift after acute anterior cruciate ligament injuries.
        Am J Sports Med. 2016; 44: 362-369
        View in Article
        • Grassi A.
        • Macchiarola L.
        • Barrientos F.U.
        • et al.
        Steep posterior tibial slope, anterior tibial subluxation, deep posterior lateral femoral condyle, and meniscal deficiency are common findings in multiple anterior cruciate ligament failures: An MRI case-control study.
        Am J Sports Med. 2019; 47: 285-295
        View in Article
        • Almekinders L.C.
        • Chiavetta J.B.
        • Clarke J.P.
        Radiographic evaluation of anterior cruciate ligament graft failure with special reference to tibial tunnel placement.
        Arthroscopy. 1998; 14: 206-211
        View in Article
        • Bedi A.
        • Musahl V.
        • Lane C.
        • Citak M.
        • Warren R.F.
        • Pearle A.D.
        Lateral compartment translation predicts the grade of pivot shift: A cadaveric and clinical analysis.
        Knee Surg Sports Traumatol Arthrosc. 2010; 18: 1269-1276
        View in Article
        • Lian J.
        • Novaretti J.V.
        • Sheean A.J.
        • et al.
        Static lateral tibial plateau subluxation predicts high-grade rotatory knee laxity in anterior cruciate ligament–deficient knees.
        Am J Sports Med. 2019; 47: 277-284
        View in Article
        • McDonald L.S.
        • van der List J.P.
        • Jones K.J.
        • et al.
        Passive anterior tibial subluxation in the setting of anterior cruciate ligament injuries.
        Am J Sports Med. 2017; 45: 1537-1546
        View in Article
        • Nishida K.
        • Matsushita T.
        • Araki D.
        • et al.
        Analysis of anterior tibial subluxation to the femur at maximum extension in anterior cruciate ligament-deficient knees.
        J Orthop Surg. 2019; 272309499019833606
        View in Article
        • Tanaka M.J.
        • Jones K.J.
        • Gargiulo A.M.
        • et al.
        Passive anterior tibial subluxation in anterior cruciate ligament-deficient knees.
        Am J Sports Med. 2013; 41: 2347-2352
        View in Article
        • Hudek R.
        • Schmutz S.
        • Regenfelder F.
        • Fuchs B.
        • Koch P.P.
        Novel measurement technique of the tibial slope on conventional MRI.
        Clin Orthop Relat Res. 2009; 467: 2066-2072
        View in Article
        • Devitt B.M.
        • O`Sullivan R.
        • Feller J.A.
        • et al.
        MRI is not reliable in diagnosing of concomitant anterolateral ligament and anterior cruciate ligament injuries of the knee.
        Knee Surg Sports Traumatol Arthrosc. 2017; 25: 1345-1351
        View in Article
        • Duran S.
        • Gunaydin E.
        • Aksahin E.
        • Dasar U.
        • Bicimoglu A.
        • Sakman B.
        Evaluation of the anterolateral ligament of the knee by magnetic resonance imaging in patients with chronic anterior cruciate ligament rupture.
        J Clin Orthop Trauma. 2019; 10: 706-709
        View in Article
        • Guenther D.
        • Rahnemai-Azar A.A.
        • Bell K.M.
        • et al.
        The anterolateral capsule of the knee behaves like a sheet of fibrous tissue.
        Am J Sports Med. 2017; 45: 849-855
        View in Article
        • Zheng T.
        • Song G.Y.
        • Feng H.
        • et al.
        Lateral meniscus posterior root lesion influences anterior tibial subluxation of the lateral compartment in extension after anterior cruciate ligament injury.
        Am J Sports Med. 2020; 48: 838-846
        View in Article
        • Garth Jr., W.P.
        • Greco J.
        • House M.A.
        The lateral notch sign associated with acute anterior cruciate ligament disruption.
        Am J Sports Med. 2020; 28: 68-73
        View in Article
        • Knapik D.M.
        • Salata M.J.
        • Voos J.E.
        • Greis P.E.
        • Karns M.R.
        Role of the meniscofemoral ligaments in the stability of the posterior lateral meniscus root after injury in the ACL-deficient knee.
        JBJS Rev. 2020; 8e0071
        View in Article
        • Mouton C.
        • Magosch A.
        • Pape D.
        • Hoffmann A.
        • Nührenbörger C.
        • Seil R.
        Ramp lesions of the medial meniscus are associated with a higher grade of dynamic rotatory laxity in ACL-injured patients in comparison to patients with an isolated injury.
        Knee Surg Sports Traumatol Arthrosc. 2020; 28: 1023-1028
        View in Article
        • Praz C.
        • Vieira T.D.
        • Saithna A.
        • et al.
        Risk factors for lateral meniscus posterior root tears in the anterior cruciate ligament-injured knee: An epidemiological analysis of 3956 patients from the SANTI Study Group.
        Am J Sports Med. 2019; 47: 598-605
        View in Article
        • Zheng T.
        • Song G.
        • Li Y.
        • et al.
        Clinical, radiographic, and arthroscopic outcomes of surgical repair for radial and avulsed lesions on the lateral meniscus posterior root during ACL reconstruction: A systematic review.
        Orthop J Sports Med. 2021; 92325967121989678
        View in Article
        • Hoshino Y.
        • Hiroshima Y.
        • Miyaji N.
        • et al.
        Unrepaired lateral meniscus tears lead to remaining pivot-shift in ACL-reconstructed knees.
        Knee Surg Sports Traumatol Arthrosc. 2020; 28: 3504-3510
        View in Article
        • Nishida K.
        • Matsushita T.
        • Hoshino Y.
        • et al.
        The influences of chronicity and meniscal injuries on pivot shift in anterior cruciate ligament-deficient knees: Quantitative evaluation using an electromagnetic measurement system.
        Arthroscopy. 2020; 36: 1398-1406
        View in Article

      Article info

      Publication history

      Published online: May 09, 2022
      Accepted: April 19, 2022
      Received: September 9, 2021
      See commentary on page 2861

      Footnotes

      An Liu and Wushi Cui contributed equally to this work.

      The authors report the following potential conflicts of interest or sources of funding: Supported by the National Natural Science Foundation of China (81802170, 81972077). Full ICMJE author disclosure forms are available for this article online, as supplementary material.

      Identification

      DOI: https://doi.org/10.1016/j.arthro.2022.04.012

      Copyright

      © 2022 by the Arthroscopy Association of North America

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