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Flexion Gap in the Isolated Posterior Cruciate Ligament–Injured Knee Affects Symptom Relief After Conservative Treatment: A Case-Control Study

BACKGROUND: The posterior cruciate ligament (PCL) is a primary stabilizer of the knee in the posterior direction. However, PCL deficiency presents a clinical paradox because the outcome of PCL deficiency ranges from total disability to uninterrupted participation in competitive athletics. PURPOSE: T...

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Autores principales: Yonetani, Yasukazu, Matsui, Yoshio, Tanaka, Yoshinari, Horibe, Shuji
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2017
Materias:
53
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5697599/
https://www.ncbi.nlm.nih.gov/pubmed/29201924
http://dx.doi.org/10.1177/2325967117738239
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author Yonetani, Yasukazu
Matsui, Yoshio
Tanaka, Yoshinari
Horibe, Shuji
author_facet Yonetani, Yasukazu
Matsui, Yoshio
Tanaka, Yoshinari
Horibe, Shuji
author_sort Yonetani, Yasukazu
collection PubMed
description BACKGROUND: The posterior cruciate ligament (PCL) is a primary stabilizer of the knee in the posterior direction. However, PCL deficiency presents a clinical paradox because the outcome of PCL deficiency ranges from total disability to uninterrupted participation in competitive athletics. PURPOSE: To investigate whether posterior laxity (PL) and the flexion gap (FG) influence the results of the conservative treatment of isolated PCL injuries. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: A total of 27 patients (23 men, 4 women; mean age, 33 ± 14 years) with isolated PCL injuries between 2007 and 2013 were included in this study. All patients had been treated conservatively for more than 6 months. Nineteen patients achieved excellent relief of their symptoms (conservative treatment [C] group). Eight patients underwent PCL reconstruction owing to their symptoms (surgical treatment [S] group). Side-to-side differences of the FG and the PL were retrospectively measured on axial radiographs and on lateral radiographs with gravity sag views, respectively, and the degree of PCL injury was graded as I (PL, <5 mm) in 7 patients and II (PL, 5 to <10 mm) in 20 patients. RESULTS: The mean PL and FG were 6.9 ± 2.5 mm and 2.0 ± 1.8 mm, respectively. A mild positive correlation between the PL and the FG was observed (r = 0.47, P = .02). The mean PL and FG were 6.5 ± 2.9 mm and 1.2 ± 1.0 mm in the C group and 7.7 ± 1.3 mm and 3.8 ± 2.0 mm in the S group, respectively. The FG in the C group was significantly smaller than that in the S group (P < .05), although there was no significant difference between the groups for PL. All patients with grade I injury belonged to the C group, for which the FG was less than 2 mm in all cases. Eight of the patients with grade II injury were in the S group, and their FG was more than 2 mm, except in 1 patient. The FG performed better with an area under the receiver operating characteristic curve of 0.924 (95% CI, 0.000-1.000) compared with 0.599 (95% CI, 0.388-0.809) for the PL. Discrimination between the C and S groups with a cutoff set at 2.30 mm for the FG and 7.45 mm for the PL showed a sensitivity of 75.0% and 75.0% and a specificity of 89.5% and 52.6%, respectively. CONCLUSION: Considering that the FG affects the outcome of conservative treatment, it could be a factor in the indication for the surgical treatment of isolated PCL injuries.
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spelling pubmed-56975992017-12-01 Flexion Gap in the Isolated Posterior Cruciate Ligament–Injured Knee Affects Symptom Relief After Conservative Treatment: A Case-Control Study Yonetani, Yasukazu Matsui, Yoshio Tanaka, Yoshinari Horibe, Shuji Orthop J Sports Med 53 BACKGROUND: The posterior cruciate ligament (PCL) is a primary stabilizer of the knee in the posterior direction. However, PCL deficiency presents a clinical paradox because the outcome of PCL deficiency ranges from total disability to uninterrupted participation in competitive athletics. PURPOSE: To investigate whether posterior laxity (PL) and the flexion gap (FG) influence the results of the conservative treatment of isolated PCL injuries. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: A total of 27 patients (23 men, 4 women; mean age, 33 ± 14 years) with isolated PCL injuries between 2007 and 2013 were included in this study. All patients had been treated conservatively for more than 6 months. Nineteen patients achieved excellent relief of their symptoms (conservative treatment [C] group). Eight patients underwent PCL reconstruction owing to their symptoms (surgical treatment [S] group). Side-to-side differences of the FG and the PL were retrospectively measured on axial radiographs and on lateral radiographs with gravity sag views, respectively, and the degree of PCL injury was graded as I (PL, <5 mm) in 7 patients and II (PL, 5 to <10 mm) in 20 patients. RESULTS: The mean PL and FG were 6.9 ± 2.5 mm and 2.0 ± 1.8 mm, respectively. A mild positive correlation between the PL and the FG was observed (r = 0.47, P = .02). The mean PL and FG were 6.5 ± 2.9 mm and 1.2 ± 1.0 mm in the C group and 7.7 ± 1.3 mm and 3.8 ± 2.0 mm in the S group, respectively. The FG in the C group was significantly smaller than that in the S group (P < .05), although there was no significant difference between the groups for PL. All patients with grade I injury belonged to the C group, for which the FG was less than 2 mm in all cases. Eight of the patients with grade II injury were in the S group, and their FG was more than 2 mm, except in 1 patient. The FG performed better with an area under the receiver operating characteristic curve of 0.924 (95% CI, 0.000-1.000) compared with 0.599 (95% CI, 0.388-0.809) for the PL. Discrimination between the C and S groups with a cutoff set at 2.30 mm for the FG and 7.45 mm for the PL showed a sensitivity of 75.0% and 75.0% and a specificity of 89.5% and 52.6%, respectively. CONCLUSION: Considering that the FG affects the outcome of conservative treatment, it could be a factor in the indication for the surgical treatment of isolated PCL injuries. SAGE Publications 2017-11-16 /pmc/articles/PMC5697599/ /pubmed/29201924 http://dx.doi.org/10.1177/2325967117738239 Text en © The Author(s) 2017 http://creativecommons.org/licenses/by-nc-nd/4.0/ This article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 License (http://www.creativecommons.org/licenses/by-nc-nd/4.0/) which permits non-commercial use, reproduction and distribution of the work as published without adaptation or alteration, without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle 53
Yonetani, Yasukazu
Matsui, Yoshio
Tanaka, Yoshinari
Horibe, Shuji
Flexion Gap in the Isolated Posterior Cruciate Ligament–Injured Knee Affects Symptom Relief After Conservative Treatment: A Case-Control Study
title Flexion Gap in the Isolated Posterior Cruciate Ligament–Injured Knee Affects Symptom Relief After Conservative Treatment: A Case-Control Study
title_full Flexion Gap in the Isolated Posterior Cruciate Ligament–Injured Knee Affects Symptom Relief After Conservative Treatment: A Case-Control Study
title_fullStr Flexion Gap in the Isolated Posterior Cruciate Ligament–Injured Knee Affects Symptom Relief After Conservative Treatment: A Case-Control Study
title_full_unstemmed Flexion Gap in the Isolated Posterior Cruciate Ligament–Injured Knee Affects Symptom Relief After Conservative Treatment: A Case-Control Study
title_short Flexion Gap in the Isolated Posterior Cruciate Ligament–Injured Knee Affects Symptom Relief After Conservative Treatment: A Case-Control Study
title_sort flexion gap in the isolated posterior cruciate ligament–injured knee affects symptom relief after conservative treatment: a case-control study
topic 53
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5697599/
https://www.ncbi.nlm.nih.gov/pubmed/29201924
http://dx.doi.org/10.1177/2325967117738239
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