Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Archives of Orthopaedic and Trauma Surgery
Published in: Archives of Orthopaedic and Trauma Surgery 10/2022

Open Access 06-12-2021 | Arthroscopy and Sports Medicine

Laxity measurement of internal knee rotation after primary anterior cruciate ligament rupture versus rerupture

Authors: Hermann O. Mayr, Georg Hellbruegge, Florian Haasters, Bastian Ipach, Hagen Schmal, Wolf C. Prall

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 10/2022

Login to get access

Abstract

Purpose

The aim of the current study was to objectify the rotational laxity after primary anterior cruciate ligament (ACL) rupture and rerupture after ACL reconstruction by instrumented measurement. It was hypothesized that knees with recurrent instability feature a higher internal rotation laxity as compared to knees with a primary rupture of the native ACL.

Study design

Cross-sectional study, Level of evidence III.

Methods

In a clinical cross-sectional study successive patients with primary ACL rupture and rerupture after ACL reconstruction were evaluated clinically and by instrumented measurement of the rotational and antero-posterior laxity with a validated instrument and the KT1000®, respectively. Clinical examination comprised IKDC 2000 forms, Lysholm Score, and Tegner Activity Scale. Power calculation and statistical analysis were performed (p value < 0.05).

Results

24 patients with primary ACL rupture and 23 patients with ACL rerupture were included. There was no significant side-to-side difference in anterior translation. A side-to side difference of internal rotational laxity ≥ 10° was found significantly more frequent in reruptures (53.6%) compared to primary ruptures (19.4%; p < 0.001). A highly significant relationship between the extent of the pivot-shift phenomenon and side-to-side difference of internal rotation laxity could be demonstrated (p < 0.001). IKDC 2000 subjective revealed significantly better scores in patients with primary ACL tear compared to patients with ACL rerupture (56.4 ± 7.8 vs. 50.8 ± 6.2; p = 0.01). Patients with primary ACL tears scored significantly better on the Tegner Activity Scale (p = 0.02). No significant differences were seen in the Lysholm Score (p = 0.78).

Conclusion

Patients with ACL rerupture feature significantly higher internal rotation laxity of the knee compared to primary ACL rupture. The extend of rotational laxity can be quantified by instrumented measurements. This can be valuable data for the indication of an anterolateral ligament reconstruction in ACL revision surgery.
Literature
1.
Alam M, Bull AM, Thomas R, Amis AA (2013) A clinical device for measuring internal-external rotational laxity of the knee. Am J Sports Med 41(1):87–94PubMedCrossRef
2.
Almquist PO, Arnbjornsson A, Zatterstrom R, Ryd L, Ekdahl C, Friden T (2002) Evaluation of an external device measuring knee joint rotation: an in vivo study with simultaneous Roentgen stereometric analysis. J Orthop Res 20(3):427–432PubMedCrossRef
3.
Ayeni OR, Chahal M, Tran MN, Sprague S (2012) Pivot shift as an outcome measure for ACL reconstruction: a systematic review. Knee Surg Sports Traumatol Arthrosc 20(4):767–777PubMedCrossRef
4.
Benjaminse A, Gokeler A, van der Schans CP (2006) Clinical diagnosis of an anterior cruciate ligament rupture: a meta-analysis. J Orthop Sports Phys Ther 36(5):267–288PubMedCrossRef
5.
Carr JB 2nd, Yildirim B, Richter D et al (2018) Primary anterolateral ligament rupture in patients requiring revision anterior cruciate ligament reconstruction: a retrospective case-control magnetic resonance imaging review. Arthroscopy 34(11):3055–3062PubMedCrossRef
6.
Chen J, Wang C, Xu C et al (2021) Effects of anterolateral structure augmentation on the in vivo kinematics of anterior cruciate ligament-reconstructed knees. Am J Sports Med 49(3):656–666PubMedCrossRef
7.
Claes S, Luyckx T, Vereecke E, Bellemans J (2014) The segond fracture: a bony injury of the anterolateral ligament of the knee. Arthroscopy 30(11):1475–1482PubMedCrossRef
8.
9.
Colatruglio M, Flanigan DC, Long J, DiBartola AC, Magnussen RA (2020) Outcomes of 1- Versus 2-Stage Revision Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis. Am J Sports Med:363546520923090
10.
11.
Espregueira-Mendes J, Andrade R, Leal A et al (2017) Global rotation has high sensitivity in ACL lesions within stress MRI. Knee Surg Sports Traumatol Arthrosc 25(10):2993–3003PubMedCrossRef
12.
Espregueira-Mendes J, Pereira H, Sevivas N et al (2012) Assessment of rotatory laxity in anterior cruciate ligament-deficient knees using magnetic resonance imaging with porto-knee testing device. Knee Surg Sports Traumatol Arthrosc 20(4):671–678PubMedCrossRef
13.
Farthing C, Lang G, Feucht MJ, Sudkamp NP, Izadpanah K (2018) Modified Lemaire extra-articular stabilisation of the knee for the treatment of anterolateral instability combined with diffuse pigmented villonodular synovitis: a case report. BMC Musculoskelet Disord 19(1):330PubMedPubMedCentralCrossRef
14.
Getgood A, Bryant D, Firth A, Stability G (2019) The Stability study: a protocol for a multicenter randomized clinical trial comparing anterior cruciate ligament reconstruction with and without Lateral extra-articular tenodesis in individuals who are at high risk of graft failure. BMC Musculoskelet Disord 20(1):216PubMedPubMedCentralCrossRef
15.
Gurpinar T, Polat B, Polat AE, Mutlu IN, Tuzuner T (2018) Is anterolateral ligament rupture a reason for persistent rotational instability after anterior cruciate ligament reconstruction? Knee 25(6):1033–1039PubMedCrossRef
16.
Helito CP, Sobrado MF, Giglio PN et al (2019) Combined reconstruction of the anterolateral ligament in patients with anterior cruciate ligament injury and ligamentous hyperlaxity leads to better clinical stability and a lower failure rate than isolated anterior cruciate ligament reconstruction. Arthroscopy 35(9):2648–2654PubMedCrossRef
17.
Irrgang JJ, Anderson AF, Boland AL et al (2001) Development and validation of the international knee documentation committee subjective knee form. Am J Sports Med 29(5):600–613PubMedCrossRef
18.
Isberg J, Faxen E, Brandsson S, Eriksson BI, Karrholm J, Karlsson J (2006) KT-1000 records smaller side-to-side differences than radiostereometric analysis before and after an ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 14(6):529–535PubMedCrossRef
19.
Jaecker V, Shafizadeh S, Naendrup JH, Ibe P, Herbort M, Pfeiffer TR (2020) Tactile techniques are associated with a high variability of tunnel positions in lateral extra-articular tenodesis procedures. Arch Orthop Trauma Surg 140(4):495–501PubMedCrossRef
20.
21.
22.
23.
Lee DW, Lee JK, Kwon SH et al (2021) Adolescents show a lower healing rate of anterolateral ligament injury and a higher rotational laxity than adults after anterior cruciate ligament reconstruction. Knee 30:113–124PubMedCrossRef
24.
Mayr HO, Benecke P, Hoell A et al (2016) Single-bundle versus double-bundle anterior cruciate ligament reconstruction: a comparative 2-year follow-up. Arthroscopy 32(1):34–42PubMedCrossRef
25.
Mayr HO, Bruder S, Hube R, Bernstein A, Suedkamp NP, Stoehr A (2018) Single-bundle versus double-bundle anterior cruciate ligament reconstruction-5-year results. Arthroscopy 34(9):2647–2653PubMedCrossRef
26.
Mayr HO, Hoell A, Bernstein A et al (2011) Validation of a measurement device for instrumented quantification of anterior translation and rotational assessment of the knee. Arthroscopy 27(8):1096–1104PubMedCrossRef
27.
Mehl J, Otto A, Baldino JB et al (2019) The ACL-deficient knee and the prevalence of meniscus and cartilage lesions: a systematic review and meta-analysis (CRD42017076897). Arch Orthop Trauma Surg 139(6):819–841PubMedCrossRef
28.
Moewis P, Duda GN, Jung T, et al. (2016) The Restoration of Passive Rotational Tibio-Femoral Laxity after Anterior Cruciate Ligament Reconstruction. PLoS One, 11(7):e0159600
29.
Naendrup JH, Zlotnicki JP, Murphy CI, Patel NK, Debski RE, Musahl V (2019) Influence of knee position and examiner-induced motion on the kinematics of the pivot shift. J Exp Orthop 6(1):11PubMedPubMedCentralCrossRef
30.
Nielsen ET, Stentz-Olesen K, de Raedt S et al (2018) Influence of the anterolateral ligament on knee laxity: a biomechanical cadaveric study measuring knee kinematics in 6 degrees of freedom using dynamic radiostereometric analysis. Orthop J Sports Med 6(8):2325967118789699PubMedPubMedCentralCrossRef
31.
Noyes FR, Grood ES, Cummings JF, Wroble RR (1991) An analysis of the pivot shift phenomenon. The knee motions and subluxations induced by different examiners. Am J Sports Med 19(2):148–155PubMedCrossRef
32.
Noyes FR, Huser LE, West J, Jurgensmeier D, Walsh J, Levy MS (2018) Two different knee rotational instabilities occur with anterior cruciate ligament and anterolateral ligament injuries: a robotic study on anterior cruciate ligament and extra-articular reconstructions in restoring rotational stability. Arthroscopy 34(9):2683–2695PubMedCrossRef
33.
Olewnik L, Gonera B, Kurtys K et al (2018) The anterolateral ligament of the knee: a proposed classification system. Clin Anat 31(7):966–973PubMedCrossRef
34.
Ra HJ, Kim JH, Lee DH (2020) Comparative clinical outcomes of anterolateral ligament reconstruction versus lateral extra-articular tenodesis in combination with anterior cruciate ligament reconstruction: systematic review and meta-analysis. Arch Orthop Trauma Surg 140(7):923–931PubMedCrossRef
35.
Roessler PP, Schuttler KF, Heyse TJ, Wirtz DC, Efe T (2016) The anterolateral ligament (ALL) and its role in rotational extra-articular stability of the knee joint: a review of anatomy and surgical concepts. Arch Orthop Trauma Surg 136(3):305–313PubMedCrossRef
36.
Rowan FE, Huq SS, Haddad FS (2019) Lateral extra-articular tenodesis with ACL reconstruction demonstrates better patient-reported outcomes compared to ACL reconstruction alone at 2 years minimum follow-up. Arch Orthop Trauma Surg 139(10):1425–1433PubMedCrossRef
37.
Saita Y, Schoenhuber H, Thiebat G et al (2019) Knee hyperextension and a small lateral condyle are associated with greater quantified antero-lateral rotatory instability in the patients with a complete anterior cruciate ligament (ACL) rupture. Knee Surg Sports Traumatol Arthrosc 27(3):868–874PubMedCrossRef
38.
Saithna A, Thaunat M, Delaloye JR, Ouanezar H, Fayard JM, Sonnery-Cottet B (2018) Combined ACL and Anterolateral Ligament Reconstruction. JBJS Essent Surg Tech, 8(1):e2
39.
Slichter ME, Wolterbeek N, Auw Yang KG, Zijl JAC, Piscaer TM (2018) A novel test for assessment of anterolateral rotatory instability of the knee: the tibial internal rotation test (TIR test). J Exp Orthop 5(1):29PubMedPubMedCentralCrossRef
40.
Slichter ME, Wolterbeek N, Auw Yang KG, Zijl JAC, Piscaer TM (2018) Rater agreement reliability of the dial test in the ACL-deficient knee. J Exp Orthop 5(1):18PubMedPubMedCentralCrossRef
41.
Song Y, Yang JH, Choi WR, Lee JK (2019) Magnetic resonance imaging-based prevalence of anterolateral ligament abnormalities and associated injuries in knees with acute anterior cruciate ligament injury. J Knee Surg 32(9):866–871PubMedCrossRef
42.
Sonnery-Cottet B, Lutz C, Daggett M et al (2016) The involvement of the anterolateral ligament in rotational control of the knee. Am J Sports Med 44(5):1209–1214PubMedCrossRef
43.
Sonnery-Cottet B, Vieira TD, Ouanezar H (2019) Anterolateral ligament of the knee: diagnosis, indications, technique. Outcomes Arthroscopy 35(2):302–303PubMedCrossRef
44.
45.
Ueki H, Katagiri H, Otabe K et al (2019) Contribution of additional anterolateral structure augmentation to controlling pivot shift in anterior cruciate ligament reconstruction. Am J Sports Med 47(9):2093–2101PubMedCrossRef
46.
Weiler A, Schmeling A, Stohr I, Kaab MJ, Wagner M (2007) Primary versus single-stage revision anterior cruciate ligament reconstruction using autologous hamstring tendon grafts: a prospective matched-group analysis. Am J Sports Med 35(10):1643–1652PubMedCrossRef
47.
Wroble RR, Grood ES, Cummings JS, Henderson JM, Noyes FR (1993) The role of the lateral extraarticular restraints in the anterior cruciate ligament-deficient knee. Am J Sports Med 21(2):257–262 (Discussion 263)PubMedCrossRef
48.
49.
Zens M, Niemeyer P, Bernstein A et al (2015) Novel approach to dynamic knee laxity measurement using capacitive strain gauges. Knee Surg Sports Traumatol Arthrosc 23(10):2868–2875PubMedCrossRef
Metadata
Title
Laxity measurement of internal knee rotation after primary anterior cruciate ligament rupture versus rerupture
Authors
Hermann O. Mayr
Georg Hellbruegge
Florian Haasters
Bastian Ipach
Hagen Schmal
Wolf C. Prall
Publication date
06-12-2021
Publisher
Springer Berlin Heidelberg
Published in
Archives of Orthopaedic and Trauma Surgery / Issue 10/2022
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI
https://doi.org/10.1007/s00402-021-04269-1

Other articles of this Issue 10/2022

Archives of Orthopaedic and Trauma Surgery 10/2022 Go to the issue

Arthroscopy and Sports Medicine

Clinical outcomes of anterior tibiofibular ligament’s distal fascicle transfer versus ligament reconstruction with InternalBrace™ for chronic ankle instability patients

Hip Arthroplasty

Acetabular cup position differs in spinopelvic mobility types: a prospective observational study of primary total hip arthroplasty patients

Trauma Surgery

Comorbidities, substance abuse, weight and age are independent risk factors for postoperative complications following operation for proximal humerus fractures: a retrospective analysis of 1109 patients

Trauma Surgery

The importance of reconstruction nailing for diaphyseal atypical femoral fractures: a comparative study with standard nailing

Trauma Surgery

Risk factors for a second nonsimultaneous hip fracture in a prospective cohort study

Orthopaedic Surgery

The effect of gastrocnemius resection on knee flexion in a total knee arthroplasty model