ABSTRACT
This retrospective analysis of 182 consecutive patients who underwent anterior cruciate ligament (ACL) reconstruction aimed to assess the clinical examination under anaesthetic and the MRI diagnostic accuracy of arthroscopically-proven, complete ACL ruptures, depending on the morphology of the torn ligament. Patients were then assigned to Group 1 (ACL not reattached) or Group 2 (ACL re-attached abnormally). Of 104 patients (57.1%) in Group 2, 94 (51.7%) had an abnormal re-attachment of the torn ACL to the posterior cruciate ligament (PCL). There was no significant difference between the groups on MRI reporting of a complete ACL tear (p = 0.123) and pivot shift test. On Lachman testing, more patients in Group 1 had an increased laxity compared with Group 2 (p = 0.014); similarly, more patients in Group 1 had an absent endpoint compared with Group 2 (p = 0.008). An ACL-deficient knee with an abnormal re-attachment of the torn ligament appears to be more difficult to diagnose than if there has been no re-attachment.
Subject(s)
Anterior Cruciate Ligament Injuries , Knee Injuries/diagnosis , Wound Healing , Adult , Anterior Cruciate Ligament/pathology , Female , Humans , Joint Instability/diagnosis , Joint Instability/pathology , Knee Injuries/pathology , Magnetic Resonance Imaging , Male , Retrospective Studies , RuptureABSTRACT
Magnetic resonance imaging (MRI) is widely believed to be highly accurate in diagnosing injuries of the posterior cruciate ligament (PCL). The aim of this study was to determine the accuracy of MRI in diagnosing chronic PCL injury. MRI was performed on 10 knees with a clinical and arthroscopic diagnosis of a PCL injury sustained at least 6 months previously. Seven experienced musculoskeletal radiologists subsequently reviewed the scans. Their accuracy in diagnosing a PCL injury was 57% (40-80%). Thus, although MRI may be reliable in diagnosing acute PCL injury, MRI is not so reliable in evaluating chronic injuries. We postulate that, in the case of a chronic PCL injury, healing in continuity may occur, producing an intact but lax ligament. As demonstrated by our study, MRI may then be less accurate. This should be borne in mind when assessing the MRI scans of a suspected chronic PCL injury.
Subject(s)
Knee Injuries/diagnosis , Magnetic Resonance Imaging/standards , Posterior Cruciate Ligament/injuries , Adult , Chronic Disease , Female , Humans , Male , Middle Aged , Posterior Cruciate Ligament/pathology , Sensitivity and SpecificityABSTRACT
Dysfunction of the patellofemoral mechanism presents in many ways. Results from different realignment procedures show great variability in patient outcome. A surgical technique is presented that attempts to correct all the abnormalities of patellofemoral maltracking. The procedure consists of a lateral release, a vastus medialis (obliquus) tendon advancement, and a tibial tubercle transfer. Along with being moved medially, the tubercle also is moved distally to correct patella alta and elevated anteriorly to reduce patellofemoral joint reaction forces. One hundred seven knees in 84 patients were reviewed. Fifty-five percent of patients had frank dislocation. The remaining patients had anterior knee pain and had abnormal patella tracking on examination. The mean followup was 5.6 years. Seventy-nine percent of patients had a good to excellent functional outcome and 84% of patients stated they would have the operation again. Two patients with marked generalized ligamentous laxity had recurrent dislocation of the patella.