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
Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 11/2019

01-11-2019 | Magnetic Resonance Imaging | KNEE

MRI-determined anterolateral capsule injury did not affect the pivot-shift in anterior cruciate ligament-injured knees

Authors: Nobuaki Miyaji, Yuichi Hoshino, Toshikazu Tanaka, Kyohei Nishida, Daisuke Araki, Noriyuki Kanzaki, Takehiko Matsushita, Ryosuke Kuroda

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 11/2019

Login to get access

Abstract

Purpose

The purpose of this study was to quantitatively compare the results of pivot-shift test between knees with anterior cruciate ligament (ACL) injury with and without anterolateral capsule (ALC) injury detected on MRI. ALC injury was hypothesized to worsen rotatory knee laxity.

Methods

82 patients with unilateral ACL injury were enrolled in this study. The pivot-shift test was performed under anesthesia before ACL reconstruction. Two evaluations were conducted simultaneously: IKDC clinical grading and the quantitative evaluation using an electromagnetic measurement system that determined tibial acceleration (m/s2). Two examiners identified the ALC injury on magnetic resonance imaging (MRI) and stratified patients into two groups: ALC-injured (ALC+) and ALC-intact (ALC−). ALC injury was diagnosed if the signal intensity on coronal T2-weighted sequences is increased. After confirming the reliability of the MRI, the difference in the pivot-shift between two groups was assessed.

Results

Because of the poor agreement between examiners with respect to the ALC evaluations (κ coefficient of 0.25 and 58.5% concordance), the result from each examiner was analyzed separately. Examiner 1 found ALC injury in 42/82 knees (51%). The two groups had similar clinical grading (glide/clunk/gross: ALC+ group 21/18/3cases vs. ALC− group 21/16/3cases) (n.s.). Tibial acceleration during pivot-shift was also similar in the ALC+ (1.4 ± 1.2 m/s2) and ALC− (1.7 ± 1.3 m/s2) groups (n.s.). Examiner 2 found ALC injury in 28/82 knees (34%). Differences in clinical grading were not observed (glide/clunk/gross: ALC+ group 16/9/3 vs. ALC− group 26/25/3) (n.s.). However, the tibial acceleration in the ALC+ group (1.2 ± 0.8 m/s2) was significantly lower than that in the ALC− group (1.7 ± 1.3 m/s2, p = 0.03).

Conclusion

Concomitant ALC injury in knees with ACL injury was not consistently detected on MRI and did not affect rotatory knee laxity.

Level of evidence

Case–control study, level III.
Literature
1.
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):767–777CrossRef
2.
Bull AM, Andersen HN, Basso O, Targett J, Amis AA (1999) Incidence and mechanism of the pivot shift. An in vitro study. Clin Orthop Relat Res 363:219–231CrossRef
3.
Cianca J, John J, Pandit S, Chiou-Tan FY (2014) Musculoskeletal ultrasound imaging of the recently described anterolateral ligament of the knee. Am J Phys Med Rehabil 93(2):186CrossRef
4.
Claes S, Vereecke E, Maes M, Victor J, Verdonk P, Bellemans J (2013) Anatomy of the anterolateral ligament of the knee. J Anat 223(4):321–328CrossRef
5.
Crawford SN, Waterman BR, Lubowitz JH (2013) Long-term failure of anterior cruciate ligament reconstruction. Arthroscopy 29(9):1566–1571CrossRef
6.
Devitt BM, O’Sullivan R, Feller JA, Lash N, Porter TJ, Webster KE et al (2017) MRI is not reliable in diagnosing of concomitant anterolateral ligament and anterior cruciate ligament injuries of the knee. Knee Surg Sports Traumatol Arthrosc 25(4):1345–1351CrossRef
7.
Dodds AL, Halewood C, Gupte CM, Williams A, Amis AA (2014) The anterolateral ligament: anatomy, length changes and association with the Segond fracture. Bone Jt J 96-b(3):325–331CrossRef
8.
Dombrowski ME, Costello JM, Ohashi B, Murawski CD, Rothrauff BB, Arilla FV et al (2016) Macroscopic anatomical, histological and magnetic resonance imaging correlation of the lateral capsule of the knee. Knee Surg Sports Traumatol Arthrosc 24(9):2854–2860CrossRef
9.
Ferretti A, Monaco E, Fabbri M, Maestri B, De Carli A (2017) Prevalence and classification of injuries of anterolateral complex in acute anterior cruciate ligament tears. Arthroscopy 33(1):147–154CrossRef
10.
Grood ES, Suntay WJ (1983) A joint coordinate system for the clinical description of three-dimensional motions: application to the knee. J Biomech Eng 105(2):136–144CrossRef
11.
Guenther D, Rahnemai-Azar AA, Bell KM, Irarrazaval S, Fu FH, Musahl V et al (2017) The anterolateral capsule of the knee behaves like a sheet of fibrous tissue. Am J Sports Med 45(4):849–855CrossRef
12.
Helito CP, Helito PV, Costa HP, Bordalo-Rodrigues M, Pecora JR, Camanho GL et al (2014) MRI evaluation of the anterolateral ligament of the knee: assessment in routine 1.5-T scans. Skelet Radiol 43(10):1421–1427CrossRef
13.
Helito CP, Helito PVP, Costa HP, Demange MK, Bordalo-Rodrigues M (2017) Assessment of the anterolateral ligament of the knee by magnetic resonance imaging in acute injuries of the anterior cruciate ligament. Arthroscopy 33(1):140–146CrossRef
14.
Hoshino Y, Araujo P, Ahlden M, Samuelsson K, Muller B, Hofbauer M et al (2013) Quantitative evaluation of the pivot shift by image analysis using the iPad. Knee Surg Sports Traumatol Arthrosc 21(4):975–980CrossRef
15.
Hoshino Y, Kuroda R, Nagamune K, Yagi M, Mizuno K, Yamaguchi M et al (2007) In vivo measurement of the pivot-shift test in the anterior cruciate ligament-deficient knee using an electromagnetic device. Am J Sports Med 35(7):1098–1104CrossRef
16.
Inderhaug E, Strand T, Fischer-Bredenbeck C, Solheim E (2013) Long-term results after reconstruction of the ACL with hamstrings autograft and transtibial femoral drilling. Knee Surg Sports Traumatol Arthrosc 21(9):2004–2010CrossRef
17.
Irrgang JJ, Ho H, Harner CD, Fu FH (1998) Use of the International Knee Documentation Committee guidelines to assess outcome following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 6(2):107–114CrossRef
18.
Karanicolas PJ, Bhandari M, Kreder H, Moroni A, Richardson M, Walter SD et al (2009) Evaluating agreement: conducting a reliability study. J Bone Jt Surg Am 91(Suppl 3):99–106CrossRef
19.
Kittl C, El-Daou H, Athwal KK, Gupte CM, Weiler A, Williams A et al (2016) The role of the anterolateral structures and the ACL in controlling laxity of the intact and ACL-deficient knee. Am J Sports Med 44(2):345–354CrossRef
20.
Kocher MS, Steadman JR, Briggs KK, Sterett WI, Hawkins RJ (2004) Relationships between objective assessment of ligament stability and subjective assessment of symptoms and function after anterior cruciate ligament reconstruction. Am J Sports Med 32(3):629–634CrossRef
21.
Labbe DR, de Guise JA, Mezghani N, Godbout V, Grimard G, Baillargeon D et al (2010) Feature selection using a principal component analysis of the kinematics of the pivot shift phenomenon. J Biomech 43(16):3080–3084CrossRef
22.
Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33(1):159–174CrossRef
23.
Lopomo N, Signorelli C, Bonanzinga T, Marcheggiani Muccioli GM, Visani A, Zaffagnini S (2012) Quantitative assessment of pivot-shift using inertial sensors. Knee Surg Sports Traumatol Arthrosc 20(4):713–717CrossRef
24.
Maeyama A, Hoshino Y, Debandi A, Kato Y, Saeki K, Asai S et al (2011) Evaluation of rotational instability in the anterior cruciate ligament deficient knee using triaxial accelerometer: a biomechanical model in porcine knees. Knee Surg Sports Traumatol Arthrosc 19(8):1233–1238CrossRef
25.
Monaco E, Ferretti A, Labianca L, Maestri B, Speranza A, Kelly MJ et al (2012) Navigated knee kinematics after cutting of the ACL and its secondary restraint. Knee Surg Sports Traumatol Arthrosc 20(5):870–877CrossRef
26.
Musahl V, Getgood A, Neyret P, Claes S, Burnham JM, Batailler C et al (2017) Contributions of the anterolateral complex and the anterolateral ligament to rotatory knee stability in the setting of ACL Injury: a roundtable discussion. Knee Surg Sports Traumatol Arthrosc 25(4):997–1008CrossRef
27.
Musahl V, Hoshino Y, Ahlden M, Araujo P, Irrgang JJ, Zaffagnini S et al (2012) The pivot shift: a global user guide. Knee Surg Sports Traumatol Arthrosc 20(4):724–731CrossRef
28.
Musahl V, Hoshino Y, Becker R, Karlsson J (2012) Rotatory knee laxity and the pivot shift. Knee Surg Sports Traumatol Arthrosc 20(4):601–602CrossRef
29.
Musahl V, Rahnemai-Azar AA, Costello J, Arner JW, Fu FH, Hoshino Y et al (2016) The influence of meniscal and anterolateral capsular injury on knee laxity in patients with anterior cruciate ligament injuries. Am J Sports Med 44(12):3126–3131CrossRef
30.
Nagai K, Hoshino Y, Nishizawa Y, Araki D, Matsushita T, Matsumoto T et al (2015) Quantitative comparison of the pivot shift test results before and after anterior cruciate ligament reconstruction by using the three-dimensional electromagnetic measurement system. Knee Surg Sports Traumatol Arthrosc 23(10):2876–2881CrossRef
31.
Parsons EM, Gee AO, Spiekerman C, Cavanagh PR (2015) The biomechanical function of the anterolateral ligament of the knee. Am J Sports Med 43(3):669–674CrossRef
32.
Rahnemai-Azar AA, Miller RM, Guenther D, Fu FH, Lesniak BP, Musahl V et al (2016) Structural properties of the anterolateral capsule and iliotibial band of the knee. Am J Sports Med 44(4):892–897CrossRef
33.
Rasmussen MT, Nitri M, Williams BT, Moulton SG, Cruz RS, Dornan GJ et al (2016) An in vitro robotic assessment of the anterolateral ligament, part 1: secondary role of the anterolateral ligament in the setting of an anterior cruciate ligament injury. Am J Sports Med 44(3):585–592CrossRef
34.
Spencer L, Burkhart TA, Tran MN, Rezansoff AJ, Deo S, Caterine S et al (2015) Biomechanical analysis of simulated clinical testing and reconstruction of the anterolateral ligament of the knee. Am J Sports Med 43(9):2189–2197CrossRef
35.
Taneja AK, Miranda FC, Braga CA, Gill CM, Hartmann LG, Santos DC et al (2015) MRI features of the anterolateral ligament of the knee. Skelet Radiol 44(3):403–410CrossRef
36.
Vincent JP, Magnussen RA, Gezmez F, Uguen A, Jacobi M, Weppe F et al (2012) The anterolateral ligament of the human knee: an anatomic and histologic study. Knee Surg Sports Traumatol Arthrosc 20(1):147–152CrossRef
Metadata
Title
MRI-determined anterolateral capsule injury did not affect the pivot-shift in anterior cruciate ligament-injured knees
Authors
Nobuaki Miyaji
Yuichi Hoshino
Toshikazu Tanaka
Kyohei Nishida
Daisuke Araki
Noriyuki Kanzaki
Takehiko Matsushita
Ryosuke Kuroda
Publication date
01-11-2019
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 11/2019
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-019-05376-8

Other articles of this Issue 11/2019

Knee Surgery, Sports Traumatology, Arthroscopy 11/2019 Go to the issue

KNEE

No correlation between femoral tunnel orientation and clinical outcome at long-term follow-up after non-anatomic anterior cruciate ligament reconstruction

KNEE

Single-stage revision anterior cruciate ligament reconstruction using bone grafting for posterior or widening tibial tunnels restores stability of the knee and improves clinical outcomes

KNEE

Femoral offset guide facilitates accurate and precise femoral tunnel placement for single-bundle anterior cruciate ligament reconstruction

KNEE

The kneeling test is a valid method of assessing kneeling tolerance

KNEE

Superior knee flexor strength at 2 years with all-inside short-graft anterior cruciate ligament reconstruction vs a conventional hamstring technique

KNEE

A more flattened bone tunnel has a positive effect on tendon–bone healing in the early period after ACL reconstruction