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High Rate of Initially Overlooked Kaplan Fiber Complex Injuries in Patients With Isolated Anterior Cruciate Ligament Injury

2021 Congress Paper Abstracts

High Rate of Initially Overlooked Kaplan Fiber Complex Injuries in Patients With Isolated Anterior Cruciate Ligament Injury

Ryan M Bell, BS, UNITED STATES Daniel P. Berthold, MD, GERMANY Lukas Willinger, MD, GERMANY Matthew R. Levasseur, MD, UNITED STATES Daniel Marrero, MD, UNITED STATES Lukas Nawid Muench, MD, GERMANY Andreas B. Imhoff, MD, Prof.emerit., GERMANY Elmar Herbst, MD, PhD, GERMANY Mark P. Cote, PT, DPT, MSCTR, UNITED STATES Robert A. Arciero, MD, UNITED STATES Cory M. Edgar, MD, PhD, UNITED STATES

University of Connecticut School of Medicine, Farmington, CT, UNITED STATES


2021 Congress   Abstract Presentation   5 minutes   Not yet rated

 

Anatomic Location

Anatomic Structure

Diagnosis / Condition

Ligaments

ACL

Patient Populations

Diagnosis Method

MRI

Sports Medicine

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Summary: To retrospectively determine the rate of initially overlooked Kaplan Fiber Complex injuries in isolated primary ACL-deficient knees on routine MRI.


Background

Injuries to the Kaplan fibers complex (KFC) are not routinely assessed in the anterior cruciate ligament (ACL)-deficient knee using preoperative magnetic resonance imaging (MRI). As injuries to the KFC lead to anterolateral rotatory instability (ALRI) in the ACL-deficient knee, preoperative detection of these injuries on MRI may help surgeons to individualize treatment and improve outcomes along with reduction of failure rates.

Purpose

To retrospectively determine the rate of initially overlooked Kaplan Fiber Complex injuries in isolated primary ACL-deficient knees on routine MRI.

Methods

Patients who underwent isolated ACL reconstruction between 08/2013 and 12/2019 were identified. Preoperative knee MRIs (minimum 1.5 T) were reviewed and injuries to proximal and distal Kaplan fibers (KFs) were recorded by 3 independent reviewers. KF length and distance to nearby anatomic landmarks (lateral joint line and lateral femoral epicondyle) were measured. Additional radiological findings including bleeding, lateral femoral notch sign, and bone marrow edema (BME) were identified to detect correlations with KFC injury.

Results

The intact KFC could reliably be identified by all three reviewers (85.9% agreement; Kappa 0.716). Fifty-three – Fifty-six % of the patients with initially diagnosed isolated ACL-ruptures showed initially overlooked injuries to the KFC. Injuries to the distal KFs were more frequent (48.1%, 53.8 % and 43.3% for Reviewer 1, 2 and 3, respectively) than injuries to the proximal KFs (35.6 %, 47.1 %, and 45.2% for Reviewer 1, 2 and 3, respectively). Bleeding in the lateral supracondylar region was associated with KFC injuries (p=0.023). Additionally, there was a positive correlation between distal KFs injuries and lateral tibial plateau BME (p=0.035). No associations were found with lateral femoral notch sign or other patterns of BME, including pivot-shift BME.

Conclusion

KF integrity and injury can be reliably detected on routine knee MRI. Fifty-three – Fifty-six % of the patients presenting with initially diagnosed isolated ACL ruptures had concomitant injuries to the KFC. This is of clinical relevance, as current routine MRI diagnostic may come along with a high number of occult or hidden KFC injuries. As injuries to the KFC contribute to persistent ALRI, which may influence ACL failure or reoperation rates, significant improvements in pre-operative diagnostic are required, in order to determine the exact injury pattern and to assist in surgical decision-making.


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