2017 ISAKOS Biennial Congress ePoster #1020

 

Complete Posterior Lateral Meniscal Root Lesion Could Lead to High-Grade Pivot-Shift Phenomenon in Acute Anterior Cruciate Ligament Injuries: A Retrospective Comparative Study

Guanyang Song, MD, Beijing, Beijing CHINA
Hua Feng, MD, Beijing CHINA

Sports Medicine Service, Beijing Jishuitan Hospital, Beijing, CHINA

FDA Status Not Applicable

Summary

Complete PLMRL may Lead to High-grade Pivot-shift Phenomenon in Acute ACL Injuries

Abstract

Purpose

To investigate the relationship between concomitant posterior lateral meniscal root lesion (PLMRL) and high-grade (grade II & III) pivot-shift phenomenon in acute anterior cruciate ligament (ACL) injuries.

Methods

A database of 726 patients undergoing primary ACL reconstruction from January 2014 to April 2016 after acute ACL injuries was retrospectively reviewed. Among them, 68 patients were arthroscopically verified to have concomitant PLMRLs. Study exclusion criteria included partial ACL rupture, multiligamentous injury, associated medial/lateral meniscal lesions other than PLMRL, severe osteoarthritis of knee joint (Outerbridge grade III or IV), general joint laxity, history of knee surgery, and lack of available pre-operative magnetic resonance imaging (MRI). Patients with either = 10.0° of lateral posterior tibial slope (LPTS) or anterolateral ligament (ALL) abnormality presented on pre-operative MRI scans were additionally excluded. This left 40 patients in the study group (ACL + PLMRL group), who were matched in a 1:1 fashion to 40 control participants (isolated ACL group) during the same study period. Patients were matched by age, sex, and body mass index (BMI). Grades of the pre-operative pivot-shift tests performed under anesthesia were first compared between the study group and the control group. Moreover, univariable and multivariable logistic regression analysis was performed within the study group to identify the PLMRL-related risk factors, including the degree of PLMRLs, integrity of meniscofemoral ligaments (MFLs), status of lateral meniscal extrusion (LME), and KT-1000 arthrometer side-to-side difference (SSD), that may be associated with the high-grade pivot-shift results.

Results

Overall, the proportion of patients with high-grade pivot-shift test grade in the study group was significantly larger than that in the control group. In addition, complete PLMRL was significantly (odds ratio [OR], 8.019; 95% confidential interval [CI], 2.703 – 79.237; P = .011) associated with high-grade pivot-shift phenomenon in acute ACL injury. Furthermore, patients in the study group with complete PLMRL showed larger proportion of high-grade pivot-shift test grade than those of their matched control group, whereas for the remaining patients with partial PLMRL, the results were similar to their matched control group.

Conclusions

Complete but not the partial PLMRL could lead to high-grade pivot-shift phenomenon in acute ACL injuries.