Concomittant injury of the anterolateral extra-articular structures of the knee in patients with anterior cruciate ligament rupture
Author(s):
Jeske H. (Austria)
,
Jeske H. (Austria)
Affiliations:
Kranewitter C.
,
Kranewitter C.
Affiliations:
Kittl C.
,
Kittl C.
Affiliations:
Giesinger J.
,
Giesinger J.
Affiliations:
Thaler M.
,
Thaler M.
Affiliations:
Henninger B.
,
Henninger B.
Affiliations:
Liebensteiner M.
Liebensteiner M.
Affiliations:
ESSKA Academy. Jeske H. 05/09/18; 209268; P02-208 Topic: Sports Related Injuries
Prof. Dr. Hans-Christian Jeske
Prof. Dr. Hans-Christian Jeske
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Abstract
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Objectives: Due to a lack of evidence it was the aim of the study to investigate injury rate of a) the anterolateral ligament (ALL) and b) the deep portions of the iliotibial tract (ITT) in knees with anterior cruciate ligament (ACL) rupture via MRI and to calculate inter- and intraobserver agreement. It was hypothesized to find Cohen's Kappa values for intra- and interobserver reproducibility above 0.70 indicating substantial agreement between the ratings

Methods: Knee MRI data from patients with ACL ruptures were analyzed by two musculoskeletal radiologists separately and twice.
The analysis was performed as suggested by Claes et al. for ALL injury. An ALL lesion was diagnosed in case of discontinued fibers, irregular structure of the ALL or presence of intra- or peri-ligamentous edema. It was also classified whether the rupture was proximal (above meniscus level), distal (below meniscus level) or a tibial avulsion (Segond type). The same criteria were applied to the deep portions of the ITT. It was classified whether the lesion was a) proximal at the deep attachments of the ITT to the distal femur (Kaplan fibres) or b) at the capsulo-osseous layer of the ITT.

Results: Sixtysix patients (31 men, 35 women, age 38.4) were available.
The proximal part of the ALL was determined ruptured in 44%. The distal part of the ALL had an injury rate of 30.3%. In none of the cases there was a segond lesion. Irrespective of the level of ALL lesions (proximal or distal of the meniscus) the injury rate of the ALL at it's entire length was 59.1%.
The deep attachments of the ITT to the distal femur (Kaplan fibres) were found injured in 18.2%. The capsulo-osseous layer of the ITT was determined 'not visible' in 100% of the knees.
The inter- and intraobserver agreements were above 94% and 95% respectively (kappa values 0.907 - 0.954 and 0.930 - 0.954, respectively). Our hypothesis to find substantial agreement is therefore regarded confirmed.

Conclusions: The injury rate of the anterolateral extra-articular structures (ALL and deep portions of the ITT) in knees with ACL rupture could be determined with substantial inter- and intraobserver agreement with MRI (kappa values 0.907 - 0.954 and 0.930 - 0.954, respectively). The injury rates of the ALL and the deep portions of the ITT were 59.1% and 18.2%, respectively.

Keywords:
anterolateral rotatory instability, anterolateral, ligament, iliotibial tract
Objectives: Due to a lack of evidence it was the aim of the study to investigate injury rate of a) the anterolateral ligament (ALL) and b) the deep portions of the iliotibial tract (ITT) in knees with anterior cruciate ligament (ACL) rupture via MRI and to calculate inter- and intraobserver agreement. It was hypothesized to find Cohen's Kappa values for intra- and interobserver reproducibility above 0.70 indicating substantial agreement between the ratings

Methods: Knee MRI data from patients with ACL ruptures were analyzed by two musculoskeletal radiologists separately and twice.
The analysis was performed as suggested by Claes et al. for ALL injury. An ALL lesion was diagnosed in case of discontinued fibers, irregular structure of the ALL or presence of intra- or peri-ligamentous edema. It was also classified whether the rupture was proximal (above meniscus level), distal (below meniscus level) or a tibial avulsion (Segond type). The same criteria were applied to the deep portions of the ITT. It was classified whether the lesion was a) proximal at the deep attachments of the ITT to the distal femur (Kaplan fibres) or b) at the capsulo-osseous layer of the ITT.

Results: Sixtysix patients (31 men, 35 women, age 38.4) were available.
The proximal part of the ALL was determined ruptured in 44%. The distal part of the ALL had an injury rate of 30.3%. In none of the cases there was a segond lesion. Irrespective of the level of ALL lesions (proximal or distal of the meniscus) the injury rate of the ALL at it's entire length was 59.1%.
The deep attachments of the ITT to the distal femur (Kaplan fibres) were found injured in 18.2%. The capsulo-osseous layer of the ITT was determined 'not visible' in 100% of the knees.
The inter- and intraobserver agreements were above 94% and 95% respectively (kappa values 0.907 - 0.954 and 0.930 - 0.954, respectively). Our hypothesis to find substantial agreement is therefore regarded confirmed.

Conclusions: The injury rate of the anterolateral extra-articular structures (ALL and deep portions of the ITT) in knees with ACL rupture could be determined with substantial inter- and intraobserver agreement with MRI (kappa values 0.907 - 0.954 and 0.930 - 0.954, respectively). The injury rates of the ALL and the deep portions of the ITT were 59.1% and 18.2%, respectively.

Keywords:
anterolateral rotatory instability, anterolateral, ligament, iliotibial tract
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