Cargando…

Non-anatomical Anterior Cruciate Ligament Remnants Do Not Contribute Dynamic Knee Stability ˜Quantitative Measurement Of The Pivot Shift Test˜

OBJECTIVES: In anterior cruciate ligament (ACL) injured patients, thick ACL remnants were frequently observed and bridged between the tibia and either femur or posterior cruciate ligament (PCL) at the arthroscopic inspection. There were several reports regarding the biomechanical function of ACL rem...

Descripción completa

Detalles Bibliográficos
Autores principales: Nagai, Kanto, Kuroda, Ryosuke, Araki, Daisuke, Nishizawa, Yuichiro, Matsushita, Takehiko, Hoshino, Yuichi, Matsumoto, Tomoyuki, Takayama, Koji, Nagamune, Kouki, Kurosaka, Masahiro
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4597573/
http://dx.doi.org/10.1177/2325967114S00107
_version_ 1782393952322715648
author Nagai, Kanto
Kuroda, Ryosuke
Araki, Daisuke
Nishizawa, Yuichiro
Matsushita, Takehiko
Hoshino, Yuichi
Matsumoto, Tomoyuki
Takayama, Koji
Nagamune, Kouki
Kurosaka, Masahiro
author_facet Nagai, Kanto
Kuroda, Ryosuke
Araki, Daisuke
Nishizawa, Yuichiro
Matsushita, Takehiko
Hoshino, Yuichi
Matsumoto, Tomoyuki
Takayama, Koji
Nagamune, Kouki
Kurosaka, Masahiro
author_sort Nagai, Kanto
collection PubMed
description OBJECTIVES: In anterior cruciate ligament (ACL) injured patients, thick ACL remnants were frequently observed and bridged between the tibia and either femur or posterior cruciate ligament (PCL) at the arthroscopic inspection. There were several reports regarding the biomechanical function of ACL remnants, however, its biomechanical function has not been fully examined. Therefore, the purpose of this study is to quantitatively evaluate the biomechanical function of ACL remnants in antero-posterior (A-P) and dynamic knee stability in ACL injured patients. It is hypothesized that the ACL remnants, which are attached to the non-anatomical ACL insertion sites, did not contribute to the knee stability. METHODS: 121 unilateral ACL injury patients who underwent primary ACL reconstruction were examined. Partial ACL tears, in which intact anteromedial or posterolateral bundles were observed, were excluded. The patients who had severe collateral ligament injury, PCL injury or contralateral knee injury were also excluded. All patients were evaluated under general anesthesia before ACL reconstruction. Anterior tibial translation (ATT) was measured using the KT-1000 Knee Ligament Arthrometer with the knee at 30 degrees of flexion in both injured and contralateral knee, and the mean side-to-side difference in ATT was calculated. ATT during the Lachman test, and tibial acceleration during the pivot shift test were also measured with electromagnetic measurement system as we previously reported. The mean side-to-side difference in ATT during the Lachman test was also calculated. Subsequently, arthroscopic evaluation was performed, and the ACL remnants were classified into 4 morphologic patterns as follows, group 1: bridging between PCL and tibia, group2: bridging between the roof of intercondylar notch and tibia, group3: bridging between the lateral wall of the intercondylar notch and tibia, group 4: no substantial ACL remnants. All values were showed as mean ± standard deviation. One way Analysis of variance (ANOVA) was used to compare each value between 4 groups, and post hoc analysis was performed using Fisher’s protected least significance difference test. A P-value <0.05 was considered statistically significant. RESULTS: The patterns of ACL remnants were as follows, group1: 27 knees, group 2: 34 knees, group 3: 27 knees, group 4: 33 knees (Table 1). The mean side-to-side difference of ATT using KT-1000 arthromerter was 5.2±3.4, 5.7±3.1, 3.4±2.0, 5.9±3.0 (mm) in group 1, 2, 3, and 4 respectively. In group 3, the mean side-to-side difference of ATT using KT-1000 arthrometer was significantly smaller than those in group 2, 4 (p<0.05). That in group 1 was larger than that in group 3, but there was not statistically significant difference. The mean side-to-side difference of ATT during the Lachman test in group 3 was significantly small compared with those in group 1, 2 and 4 (p<0.05) (Figure 1A). On the other hand, there was no statistically significant difference in tibial acceleration between each group (Figure 1B). CONCLUSION: The main finding of this study was that ACL remnants of group 3 partially contributed A-P stability, whereas they did not contribute dynamic knee stability evaluated by tibial acceleration during the pivot shift test. These findings suggest that ACL remnants may not have enough contribution to the stabilization of the knee joint.
format Online
Article
Text
id pubmed-4597573
institution National Center for Biotechnology Information
language English
publishDate 2014
publisher SAGE Publications
record_format MEDLINE/PubMed
spelling pubmed-45975732015-11-03 Non-anatomical Anterior Cruciate Ligament Remnants Do Not Contribute Dynamic Knee Stability ˜Quantitative Measurement Of The Pivot Shift Test˜ Nagai, Kanto Kuroda, Ryosuke Araki, Daisuke Nishizawa, Yuichiro Matsushita, Takehiko Hoshino, Yuichi Matsumoto, Tomoyuki Takayama, Koji Nagamune, Kouki Kurosaka, Masahiro Orthop J Sports Med Article OBJECTIVES: In anterior cruciate ligament (ACL) injured patients, thick ACL remnants were frequently observed and bridged between the tibia and either femur or posterior cruciate ligament (PCL) at the arthroscopic inspection. There were several reports regarding the biomechanical function of ACL remnants, however, its biomechanical function has not been fully examined. Therefore, the purpose of this study is to quantitatively evaluate the biomechanical function of ACL remnants in antero-posterior (A-P) and dynamic knee stability in ACL injured patients. It is hypothesized that the ACL remnants, which are attached to the non-anatomical ACL insertion sites, did not contribute to the knee stability. METHODS: 121 unilateral ACL injury patients who underwent primary ACL reconstruction were examined. Partial ACL tears, in which intact anteromedial or posterolateral bundles were observed, were excluded. The patients who had severe collateral ligament injury, PCL injury or contralateral knee injury were also excluded. All patients were evaluated under general anesthesia before ACL reconstruction. Anterior tibial translation (ATT) was measured using the KT-1000 Knee Ligament Arthrometer with the knee at 30 degrees of flexion in both injured and contralateral knee, and the mean side-to-side difference in ATT was calculated. ATT during the Lachman test, and tibial acceleration during the pivot shift test were also measured with electromagnetic measurement system as we previously reported. The mean side-to-side difference in ATT during the Lachman test was also calculated. Subsequently, arthroscopic evaluation was performed, and the ACL remnants were classified into 4 morphologic patterns as follows, group 1: bridging between PCL and tibia, group2: bridging between the roof of intercondylar notch and tibia, group3: bridging between the lateral wall of the intercondylar notch and tibia, group 4: no substantial ACL remnants. All values were showed as mean ± standard deviation. One way Analysis of variance (ANOVA) was used to compare each value between 4 groups, and post hoc analysis was performed using Fisher’s protected least significance difference test. A P-value <0.05 was considered statistically significant. RESULTS: The patterns of ACL remnants were as follows, group1: 27 knees, group 2: 34 knees, group 3: 27 knees, group 4: 33 knees (Table 1). The mean side-to-side difference of ATT using KT-1000 arthromerter was 5.2±3.4, 5.7±3.1, 3.4±2.0, 5.9±3.0 (mm) in group 1, 2, 3, and 4 respectively. In group 3, the mean side-to-side difference of ATT using KT-1000 arthrometer was significantly smaller than those in group 2, 4 (p<0.05). That in group 1 was larger than that in group 3, but there was not statistically significant difference. The mean side-to-side difference of ATT during the Lachman test in group 3 was significantly small compared with those in group 1, 2 and 4 (p<0.05) (Figure 1A). On the other hand, there was no statistically significant difference in tibial acceleration between each group (Figure 1B). CONCLUSION: The main finding of this study was that ACL remnants of group 3 partially contributed A-P stability, whereas they did not contribute dynamic knee stability evaluated by tibial acceleration during the pivot shift test. These findings suggest that ACL remnants may not have enough contribution to the stabilization of the knee joint. SAGE Publications 2014-08-01 /pmc/articles/PMC4597573/ http://dx.doi.org/10.1177/2325967114S00107 Text en © The Author(s) 2014 http://creativecommons.org/licenses/by-nc-nd/3.0/ This open-access article is published and distributed under the Creative Commons Attribution - NonCommercial - No Derivatives License (http://creativecommons.org/licenses/by-nc-nd/3.0/), which permits the noncommercial use, distribution, and reproduction of the article in any medium, provided the original author and source are credited. You may not alter, transform, or build upon this article without the permission of the Author(s). For reprints and permission queries, please visit SAGE’s Web site at http://www.sagepub.com/journalsPermissions.nav.
spellingShingle Article
Nagai, Kanto
Kuroda, Ryosuke
Araki, Daisuke
Nishizawa, Yuichiro
Matsushita, Takehiko
Hoshino, Yuichi
Matsumoto, Tomoyuki
Takayama, Koji
Nagamune, Kouki
Kurosaka, Masahiro
Non-anatomical Anterior Cruciate Ligament Remnants Do Not Contribute Dynamic Knee Stability ˜Quantitative Measurement Of The Pivot Shift Test˜
title Non-anatomical Anterior Cruciate Ligament Remnants Do Not Contribute Dynamic Knee Stability ˜Quantitative Measurement Of The Pivot Shift Test˜
title_full Non-anatomical Anterior Cruciate Ligament Remnants Do Not Contribute Dynamic Knee Stability ˜Quantitative Measurement Of The Pivot Shift Test˜
title_fullStr Non-anatomical Anterior Cruciate Ligament Remnants Do Not Contribute Dynamic Knee Stability ˜Quantitative Measurement Of The Pivot Shift Test˜
title_full_unstemmed Non-anatomical Anterior Cruciate Ligament Remnants Do Not Contribute Dynamic Knee Stability ˜Quantitative Measurement Of The Pivot Shift Test˜
title_short Non-anatomical Anterior Cruciate Ligament Remnants Do Not Contribute Dynamic Knee Stability ˜Quantitative Measurement Of The Pivot Shift Test˜
title_sort non-anatomical anterior cruciate ligament remnants do not contribute dynamic knee stability ˜quantitative measurement of the pivot shift test˜
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4597573/
http://dx.doi.org/10.1177/2325967114S00107
work_keys_str_mv AT nagaikanto nonanatomicalanteriorcruciateligamentremnantsdonotcontributedynamickneestabilityquantitativemeasurementofthepivotshifttest
AT kurodaryosuke nonanatomicalanteriorcruciateligamentremnantsdonotcontributedynamickneestabilityquantitativemeasurementofthepivotshifttest
AT arakidaisuke nonanatomicalanteriorcruciateligamentremnantsdonotcontributedynamickneestabilityquantitativemeasurementofthepivotshifttest
AT nishizawayuichiro nonanatomicalanteriorcruciateligamentremnantsdonotcontributedynamickneestabilityquantitativemeasurementofthepivotshifttest
AT matsushitatakehiko nonanatomicalanteriorcruciateligamentremnantsdonotcontributedynamickneestabilityquantitativemeasurementofthepivotshifttest
AT hoshinoyuichi nonanatomicalanteriorcruciateligamentremnantsdonotcontributedynamickneestabilityquantitativemeasurementofthepivotshifttest
AT matsumototomoyuki nonanatomicalanteriorcruciateligamentremnantsdonotcontributedynamickneestabilityquantitativemeasurementofthepivotshifttest
AT takayamakoji nonanatomicalanteriorcruciateligamentremnantsdonotcontributedynamickneestabilityquantitativemeasurementofthepivotshifttest
AT nagamunekouki nonanatomicalanteriorcruciateligamentremnantsdonotcontributedynamickneestabilityquantitativemeasurementofthepivotshifttest
AT kurosakamasahiro nonanatomicalanteriorcruciateligamentremnantsdonotcontributedynamickneestabilityquantitativemeasurementofthepivotshifttest