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Quantitative evaluation of rotational instability in ACL deficient knee complicated with anterolateral capsule injury and lateral meniscus root tear
Author(s):
Nozaki M. (Japan)
,
Nozaki M. (Japan)
Affiliations:
Kobayashi M.
,
Kobayashi M.
Affiliations:
Yasuma S.
,
Yasuma S.
Affiliations:
Kawanishi Y.
,
Kawanishi Y.
Affiliations:
Nagaya Yuko
,
Nagaya Yuko
Affiliations:
Goto H.
,
Goto H.
Affiliations:
Iguchi H.
,
Iguchi H.
Affiliations:
Otsuka T.
Otsuka T.
Affiliations:
ESSKA Academy. Nozaki M. 05/09/18; 209373; P04-1656 Topic: Arthroscopic Surgery
Masahiro Nozaki
Masahiro Nozaki
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Abstract
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Objectives: Recently, there has been notable interest in lateral knee structure including anterolateral knee ligament (ALL) and anterolateral capsule (ALC) for the control of rotational instability in anterior cruciate ligament (ACL) injury knee. Other studies also have demonstrated the importance of repairing meniscus root injuries in ACL reconstructed knee. Therefore the purpose of this study was to evaluate the effect of ALC injury and lateral meniscus (LM) root injury on rotational knee instability in ACL injured knee.

Methods: Six fresh frozen cadaveric knees were used for this study. All specimens underwent arthroscopic and open surgical procedure to resect ACL, ALC (anterolateral capsular resection) and LM root. Specimens were tested under 4 conditions; (1) intact, (2) ACL deficient (ACLD), (3) ACL and ALC deficient (ALCD), (4) ACL and ALC deficient and LM root tear (LMT). In each condition, anterior tibial translation (ATT) was evaluated. Furthermore, rotational knee stability in the pivot shift test was evaluated using an inertial sensor which was attached on the tibia tubercle and can measure both acceleration and rotational angular velocity. Statistical analysis was performed using ANOVA and differences among the groups were analyzed by using Student-Newman-Keuls multiple comparison (post hoc test). Statistical significance was defined as P < .05.

Results: The ATT was 4.2 ± 1.5mm for ACLD, 6.4 ± 0.5mm ALCD, and 9.0 ± 0.8mm for LMT. The ATT of ACLD, ALCD, and LMT were significantly higher than those of the intact knee. Furthermore the ATT of LMT was significantly higher than that of ACLD and ALCD. The AP acceleration in the pivot shit test was 3.3 ± 3.5 m/s2 for intact, 20.5 ± 9.5 m/s2 for ACLD, 22.3 ± 7.1 m/s2 for ALCD, and 30.7 ± 9.6 m/s2 for LMT. The acceleration of ACLD, ALCD, and LMT were significantly higher than those of the intact knee. Furthermore the acceleration of LMT was significantly higher than that of ACLD and ALCD. The external rotational angular velocity in the pivot shift test was 75.9 ± 39.3 degrees (deg)/s for intact, 193.5 ± 68.0 deg/s for ACLD,326.6 ± 256.3 deg/s for ALCD, and 416.7 ± 236.6 deg/s for LMT. The external rotational angular velocity of ALCD, and LMT were significantly higher than those of intact and ACLD.

Conclusions: In this study, we evaluated knee rotational instability in ACL and ALC deficient and LM root tear statement using an inertial sensor. We found that ALC injury and LM root tear increase rotational instability in the pivot shift test in ACL deficient knee. However, ALC injury increased external rotational angular velocity in the pivot shift test, while LM root tear increased acceleration in the pivot shift test.
This indicates that although both ALC injury and LM root tear increased rotational knee instability in the pivot shift test in ACL deficient knee, ALC injury increased external rotational instability in the pivot shift in ACL deficient knee and LM root tear increased AP instability in the pivot shift in ACL deficient knee.

Keywords:
anterior cruciate ligamant injury, anterolateral capsular injury, lateral meniscus root tear
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