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      Is conventional magnetic resonance imaging superior to radiography in the functional integrity evaluation of anterior cruciate ligament in patients with knee osteoarthritis?

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          Abstract

          Background

          The functional integrity of the anterior cruciate ligament (ACL) influences surgical decision-making in patients with knee osteoarthritis (KOA). This study aimed to compare the diagnostic value of radiography and magnetic resonance imaging (MRI) in determining the functional status of ACL.

          Methods

          We analyzed 306 knees retrospectively using preoperative hip-to-ankle anteroposterior standing (APS) radiographs, anteroposterior (AP) and lateral knee radiographs, AP valgus stress (VS) force radiographs, and standard orthogonal MRI. Based on the intraoperative visualization, the knees were grouped into ACL functionally-intact and ACL functionally-deficient (ACLD) groups. The diagnostic validity and reliability were calculated based on the radiograph parameters such as hip-knee-ankle angle (HKA), medial proximal tibial angle (MPTA), lateral distal femoral angle (LDFA), posterior tibial slope (PTS), sagittal tibiofemoral subluxation (STFS), coronal tibiofemoral subluxation (CTFS), joint line convergence angle (JLCA), the maximum wear point of the proximal tibia plateau (MWPPT%), and MRI parameters including ACL grades and MWPPT%.

          Results

          HKA, MPTA, PTS, STFS, JLCA, and CTFS on APS and AP radiographs, and MWPPT% on radiographs and MRI showed a significant diagnostic value ( P < 0.05). There were no statistically significant differences in the single parameters from radiographs and MRI. After constructing the logistic regression models, MRI showed higher sensitivity, specificity, and accuracy, reaching 96.8%, 79.9%, and 83.3%, respectively ( P < 0.001).

          Conclusions

          In patients with KOA, the diagnostic value of single radiographic or MRI parameter in assessing the functional integrity of the ACL are equivalent. However, by constructing predictive models, MRI could significantly improve diagnostic validity compared with radiography.

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          Most cited references25

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          Osteoarthritis: MR imaging findings in different stages of disease and correlation with clinical findings.

          Ying Lu, Michael E. Ries, Sharmila Majumdar … (2003)
          To determine whether knee pain, stiffness, and limited function in patients with different stages of osteoarthritis correlate with the degree of disease assessed on magnetic resonance (MR) images and radiographs. Radiographs in 50 patients with varying degrees of osteoarthritis of the knee were assessed by using the the Western Ontario and McMaster University (WOMAC) osteoarthritis index and the Kellgren-Lawrence (KL) scale. MR images were obtained and analyzed by two readers for cartilage lesions, bone marrow edema pattern, and ligamentous and meniscal lesions. Thirteen of 16 knees with a KL score of 4 showed full-thickness cartilage lesions and bone marrow edema pattern. Cruciate ligament tears were found in five of 12 knees with a KL score of 3 and in nine of 16 knees with a KL score of 4. While the KL score correlated significantly (P .05). Significant differences between WOMAC scores were found only for the grades of cartilage lesions (P <.05). Cartilage lesions, bone marrow edema pattern, and meniscal and ligamentous lesions were frequently demonstrated on MR images in patients with advanced osteoarthritis. Clinical findings showed no significant correlations with KL score and extent of findings at MR imaging.
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            Anterior cruciate ligament anatomy and function relating to anatomical reconstruction.

            Jon K. Sekiya, Volker Musahl, Wolf Petersen … (2006)
            Recently, the interest in surgical techniques that reconstruct the anteromedial (AM) and the posterolateral (PL) bundles of the anterior cruciate ligament (ACL) has risen. This review focuses on the structural as well as the mechanical properties of the ACL and the anatomical details of the femoral origin, midsubstance, and tibial insertion of AM and PL bundles of the ACL. The terminology of AM and PL bundles is chosen according to the tibial insertion and determined by their functional tensioning pattern throughout knee flexion. Close to extension the AM is moderately loose and the PL is tight. As the knee is flexed, the femoral attachment of the ACL becomes more horizontally oriented, causing the AM bundle to tighten and the PM bundle to loosen up. The ACL has been described to be restraint to anterior tibial displacement and internal tibial rotation. The rotational component might be represented by the PL bundle. The femoral origin has an oval shape with the center of the AM close to over-the-top position and the center of the PL close to the anterior and inferior cartilage margin. Tibial and femoral insertions of the ACL are over 3.5 times larger when compared to the midsubstance and tunnel placement is more challenging because of the limited size of potential grafts selection of tunnel site placement. For reconstruction, both bone-patellar tendon-bone (BPTB) and quadrupled hamstring grafts are used. Structural properties of a 10 mm wide BPTB or quadrupled hamstring graft have been reported to be comparable with those of the native ACL.
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              The Oxford Knee for unicompartmental osteoarthritis. The first 103 cases.

              Owen O’Connor, W C Kershaw, Paul Goodfellow … (1988)
              The Oxford Knee, a resurfacing prosthesis with a meniscal bearing, can be used for either bicompartmental or unicompartmental arthritis. The first 103 unicompartmental cases are presented at a mean time since operation of 36 months (range 21 to 56 months). In those cases with surviving arthroplasties, pain was relieved in 96%. The full range of pre-operative flexion was maintained and flexion deformity was improved from a mean of 6.7 to 5.4 degrees. Stability and alignment were restored to normal in nearly all the knees. Absence of the anterior cruciate ligament was associated with a significantly greater incidence of failure. Six failures occurred in 37 knees lacking a normal anterior cruciate ligament (16.2%); three occurred in 63 knees with a normal anterior cruciate ligament (4.8%) (p less than 0.02). Criteria for the future selection of patients have been deduced from our experience. The operation is recommended for knees with severe unicompartmental osteoarthritis in which all the ligaments are still intact.
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                Author and article information

                Contributors
                Fenglong Sun: sunfenglong@ccmu.edu.cn
                Journal
                Journal ID (nlm-ta): Arthroplasty
                Journal ID (iso-abbrev): Arthroplasty
                Title: Arthroplasty
                Publisher: BioMed Central (London )
                ISSN (Electronic): 2524-7948
                Publication date (Electronic): 20 June 2024
                Publication date PMC-release: 20 June 2024
                Publication date Collection: 2024
                Volume: 6
                Electronic Location Identifier: 37
                Affiliations
                [1 ]Department of Orthopedics II, Beijing Rehabilitation Hospital, Capital Medical University, ( https://ror.org/013xs5b60) Xixiazhuang, Shijingshan District, Beijing, 100144 China
                [2 ]Department of Dermatology, Peking University Third Hospital, ( https://ror.org/04wwqze12) No.49 North Garden Road, Haidian District, Beijing, 100191 China
                Article
                Publisher ID: 262
                DOI: 10.1186/s42836-024-00262-2
                PMC ID: 11188244
                PubMed ID: 38902806
                SO-VID: 3925f1f1-e916-4e34-87d4-dbf12cecaa4b
                Copyright © © The Author(s) 2024
                License:

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                Date received : 15 February 2024
                Date accepted : 16 May 2024
                Funding
                Funded by: Beijing Rehabilitation Hospital Research Fund
                Award ID: 2021R-007
                Award Recipient :
                Categories
                Subject: Research
                Custom metadata
                issue-copyright-statement © Arthroplasty Society in Asia 2024

                Keywords: diagnostic validity,anterior cruciate ligament,magnetic resonance imaging,radiography,knee osteoarthritis
                Data availability:
                Keywords: diagnostic validity, anterior cruciate ligament, magnetic resonance imaging, radiography, knee osteoarthritis

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