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Tibial and Femoral Anatomical Features: In-Vivo Study of the Influence on Laxity in ACL Deficient knee.
Author(s):
Zaffagnini S. (Italy)
,
Zaffagnini S. (Italy)
Affiliations:
Signorelli Cecilia
,
Signorelli Cecilia
Affiliations:
Urrizola F.
,
Urrizola F.
Affiliations:
Raggi F.
,
Raggi F.
Affiliations:
Roberti di Sarsina T.
,
Roberti di Sarsina T.
Affiliations:
Stefanelli F.
,
Stefanelli F.
Affiliations:
Bonanzinga T.
,
Bonanzinga T.
Affiliations:
Grassi A.
Grassi A.
Affiliations:
ESSKA Academy. Zaffagnini S. May 9, 2018; 209445; P05-688 Topic: Knee
Prof. Dr. Stefano Zaffagnini
Prof. Dr. Stefano Zaffagnini
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Abstract
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Objectives: There is a lack of an objective and comprehensive in-vivo analysis on the correlation between bony morphological features of a joint and subsequent laxity values after an isolated anterior cruciate ligament (ACL) tear.
The study aims to answer the following questions: (1) what is the correlation between the morphological parameter of the knee joint and the static and dyamic laxity values after an isolated ACL injury? (2) Is there any parameter that can be considerate a specific risk factor of high pre-operative laxity values in a patient suffering an isolated ACL tear?

Methods: 42 patients who underwent navigated ACL-reconstruction were prospectively enrolled. Static laxity was evaluated with an intraoperative navigation system as: anterior displacement and internal-external rotation at 30° and 90° of flexion (AP30, AP90, IE30, IE90), varus-valgus rotation at 0° and 30° of flexion (VV0,VV30). Pivot-Shift (PS) test defined the dynamic laxity.
Using MRIs, they were evaluated the transepicondylar distance (TE), the width of the lateral and medial femoral condyles (LFCw and MFCw) and tibial plateau (LTPw and MTPw), the Notch Width Index (NWI) and the ratio of width and height of the fermoral notch (N-ratio), the ratio between the height and depth of the lateral and medial femoral condyle (LFC-ratio and MFC-ratio), the lateral and medial posterior tibial slopes (LTPs and MTPs) and the anterior subluxation of the lateral and medial tibial plateau respect to femoral condyles (LTPsublx and MTPsublx).
For each kinematics test, the univariate analysis with Perarson's method was used to identify those anatomical variables significantly correlated with the laxity values. The multivariate regression, with backward elimination, including only the previously identified anatomical variables, defined the independent predictors. Significance was set P<0.05.

Results: MRI measurement had a high intra-observer reliability, mean ± SD ICC was 0.75±0.19 .
Concerning the AP30, LTPs (P=0.047) and MTPsublx (P=0.039) resulted as independent predictors while for the AP90 only LTPs (P=0.049).
The LTPs (P=0.039) resulted an independent predictor for IE90 laxity, while for the VV0 test it was identified the LFCw (P=0.007). For PS, TE resulted a significant parameter (P=0.004).

Conclusions: In this study the relationship between anatomical bone features and knee joint laxity has been quantified in an ACL-deficient condition.
Based on the evaluation with computer navigation of patients with isolated ACL injury and no meniscal lesion, a paradox higher antero-posterior laxity at 30° and 90° of flexion was found in those with a lateral tibial slope <5.5°, while a minimal contribution of transepicondylar length was instead reported in the Pivot-Shift magnitude. Therefore osseous anatomy in the ACL deficient-knee has a limited effect in determining static and dynamic laxities when both menisci are intact.

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