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The effects of time from injury to surgery and meniscal injury on rotational knee laxity in anterior cruciate ligament-deficient knees
ESSKA Academy. Nishida K. May 11, 2018; 218135
Kyohei Nishida
Kyohei Nishida
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Abstract
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Objectives: The factors affecting knee rotational knee laxity, which potentially affects outcomes of anterior cruciate ligament (ACL) reconstruction, has not yet been fully examined. The pivot shift is the most specific clinical test to assess rotational knee laxity in ACL-deficient knees. We have previously developed an electromagnetic measurement system (EMS) to quantitatively evaluate the pivot shift test. This study aimed to investigate the relationship between time from injury to surgery and knee rotational knee laxity in ACL-deficient knees using the EMS retrospectively. We hypothesized rotational knee laxity would increase with time.

Methods: Ninety-two patients who underwent ACL reconstruction for unilateral ACL deficiency at our hospital were examined (44 males, 48 females. Mean age: 27.3 ± 11.8 years, range: 15 to 55 years). All the patients had a complete rupture of the ACL, which was confirmed during surgery. Knee rotational knee laxity was evaluated by measuring tibial acceleration during the pivot shift test using the EMS (JIMI Kobe) under general anesthesia before operation. Patients were divided into four groups according to the time from injury to surgery: group 1, within 3 months after injury (22 patients); group 2, between 3 and 6 months after injury (29 patients); group 3, between 6 and 12 months after injury (23 patients); and group 4, more than 12 months after injury (18 patients). The presence of meniscal injuries was examined arthroscopically during ACL reconstruction. Unstable meniscal tears that needed partial meniscectomy or meniscal repair were defined as a meniscal tear, and stable meniscal tears were not included as a meniscal tear. The effects of the presence of a medial or a lateral meniscal injury on tibial acceleration were also assessed in each 4 groups. One-way analysis of variance and Fisher's exact test were used for the statistical analysis.

Results: The mean tibial acceleration during the pivot shift test in group 1, 2, 3 and 4 were 1.46 ± 0.76, 1.48 ± 0.68, 1.24 ± 0.87, 2.32 ± 1.61 (m/s2) respectively. The mean tibial acceleration in group 4 was significantly greater than in other groups. There was a positive correlation between tibial acceleration and the time from injury to surgery (r = 0.46). In group 1, 2 and 3, the mean tibial acceleration in patients with a lateral meniscal injury was significantly greater than in patients with a medial meniscal injury and in patients without meniscal injury. In group 4, the mean tibial acceleration in the patients with a medial meniscal injury and patients without meniscal injury was significantly greater compared with other groups.

Conclusions: In the ACL-deficient knees, rotational laxity increased with time and the increased rotational laxity was evident more than 1 year after injury while lateral meniscal injuries also independently increased rotational laxity within 1 year after injury. Earlier intervention may be preferable to avoid excessive rotational laxity at the time of surgery.

Keywords:
anterior cruciate ligament, knee rotational knee laxity, electromagnetic measurement system, time from injury to surgery, meniscal injury
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