RESUMO
BACKGROUND: The diagnosis of anterior cruciate ligament (ACL) tear relies on clinical evaluation and magnetic resonance imaging (MRI). Direct and indirect signs of ACL tear have been described with MRI evaluation. Posterior cruciate ligament (PCL) buckling has been described as an indirect radiographic sign of an ACL tear. PURPOSE: The aim of the present study was to assess the variations in PCL buckling angles in patients with ACL tears and in patients with isolated lesions in the posterior horn of the medial meniscus. In addition, the influence of different patterns of medial meniscus tears in ACL-deficient knees was investigated. Finally, the influences of risk factors such as tibial slope, delay from injury to surgery, absence of medial meniscus tear, degree of Lachman and pivot shift testing were also assessed. STUDY DESIGN: This was a cohort study. METHODS: A total of 154 patients (78 in the group with ACL tear and 76 in the control group) were assessed with MRI and lateral weight-bearing X-ray to assess PCL buckling angle and tibial slope by two independent observers. The presence of a medial meniscus bucket handle or ramp lesion of the medial meniscus was assessed and recorded at the time of surgery. RESULTS: PCL buckling angle measurement was highly reliable, with an ICC of 0.866 and 0.894, respectively, in the study group and the control group for interobserver reliability. The intrarater reliability was found to be high in PCL buckling angle for the study group [ICC = 0.955] and the control group [ICC = 0.943]. The mean angle in patients with ACL tear was 110.7 ± 15.2° and 115.3 ± 16.2° (for the two examiners) and 111.4 ± 12° and 114 ± 14.5° (for the two examiners) in patients with an intact, healthy ACL. An association emerged between bucket handle tears of the medial meniscus (p = 0.010) and a decreased PCL buckling angle and between ramp lesions of the medial meniscus and increased PCL buckling angle both (p = 0.024). CONCLUSIONS: Good inter- and intraobserver reliability for the measurement of the PCL buckling angle was observed. Increased PCL buckling angle values were observed in patients with concomitant ACL and bucket handle tears of the medial meniscus, while decreased angle values were observed in those who had ACL tear and ramp lesion of the medial meniscus. No statistically significant difference in the PCL buckling angle emerged between patients with ACL tears and those who had a healthy, intact ACL.
RESUMO
BACKGROUND: Popliteomeniscal fascicles (PMF) are considered the posterolateral meniscocapsular extensions which connect the lateral meniscus to the edge of the tibia. PMFs disruption leads to hypermobility of the lateral meniscus with pain and locking sensation. Recognition and treatment of PMFs tear remain very challenging. The aim of this systematic review is to collect and analyse the articles concerning popliteomeniscal fascicle disruption from diagnosis to surgical approach. METHODS: PubMed, Scopus, Web of Science and EMBASE were searched. Various combinations of the keywords "Popliteomeniscal Fascicles", "Lateral Meniscus", "Popliteal Hiatus", "Posterolateral Corner", "Tear" and "Surgical Repair" were used. The original literature search identified a total of 85 articles comprising of duplicates. The PRISMA guidilines were followed. Studies in English language and published in peer-reviewed journals were included. Articles with level of evidence I to IV were included RESULTS: A total of three articles were included in the qualitative analysis. All the articles included are retrospective case series, with a level of evidence IV. Studies concerning patients with pre-operative imaging MRI and clinical assessment, reporting surgical technique and clinical outcomes assessed by physical examination and/or subjective evaluation scales were analysed. CONCLUSIONS: MRI and the Figure-4 test allow to assess PMF tears pre-operatively. Arthroscopic evaluation constitutes the gold standard to confirm the diagnosis. Although surgery is considered resolutive for symptoms, there is still controversy about the most appropriate technique. Further higher quality studies are required.