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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 MRI 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
    Search for articles by this author
  • 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

      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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