J Knee Surg 2019; 32(07): 620-623
DOI: 10.1055/s-0038-1666827
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Value of Preoperative MRI and Examination under Anesthesia for Differentiating Complete from Partial Anterior Cruciate Ligament Tears

Leonardo Cavinatto
1   Jefferson 3B Orthopaedic Institute, Philadelphia, Pennsylvania
,
Sunny Gupta
1   Jefferson 3B Orthopaedic Institute, Philadelphia, Pennsylvania
,
Craig Morgan
2   Morgan-Kalman Clinic, Wilmington, Delaware
,
Arthur R. Bartolozzi
1   Jefferson 3B Orthopaedic Institute, Philadelphia, Pennsylvania
› Author Affiliations
Further Information

Publication History

13 November 2017

26 May 2018

Publication Date:
10 July 2018 (online)

Abstract

Partial tears of the anterior cruciate ligament (ACL) recently regained attention due to a better understanding of the two distinct bundles of the ligament and the possibility of single-bundle reconstruction procedures. An accurate diagnosis is important as it influences treatment options and patient prognosis. The aim of this study was to evaluate the value of examination under anesthesia (EUA) and magnetic resonance imaging (MRI) for differentiating partial from complete ACL tears. For this purpose, this prospective case series included 95 consecutive patients undergoing primary ACL reconstruction surgeries. MRI, EUA, and MRI combined with EUA were performed preoperatively, and results were compared with arthroscopy. Our data showed that ACL lesions were diagnosed as partial tears in 42.1% (n = 40) of EUA, 23.2% (n = 22) of MRI, and 11.6% (n = 11) of arthroscopies. EUA and MRI demonstrated sensitivity of 100 and 90.1%, and specificity of 65.5 and 85.6%, respectively. Combined EUA and MRI demonstrated sensitivity of 100% and specificity of 83.1%. Our study revealed that preoperatively MRI and EUA may help surgeons early identify partial ACL tears and influence treatment decisions.

 
  • References

  • 1 Mall NA, Chalmers PN, Moric M. , et al. Incidence and trends of anterior cruciate ligament reconstruction in the United States. Am J Sports Med 2014; 42 (10) 2363-2370
  • 2 Sonnery-Cottet B, Colombet P. Partial tears of the anterior cruciate ligament. Orthop Traumatol Surg Res 2016; 102 (1, Suppl): S59-S67
  • 3 DeFranco MJ, Bach Jr BR. A comprehensive review of partial anterior cruciate ligament tears. J Bone Joint Surg Am 2009; 91 (01) 198-208
  • 4 Dejour D, Ntagiopoulos PG, Saggin PR, Panisset JC. The diagnostic value of clinical tests, magnetic resonance imaging, and instrumented laxity in the differentiation of complete versus partial anterior cruciate ligament tears. Arthroscopy 2013; 29 (03) 491-499
  • 5 Christel PS, Akgun U, Yasar T, Karahan M, Demirel B. The contribution of each anterior cruciate ligament bundle to the Lachman test: a cadaver investigation. J Bone Joint Surg Br 2012; 94 (01) 68-74
  • 6 Hole RL, Lintner DM, Kamaric E, Moseley JB. Increased tibial translation after partial sectioning of the anterior cruciate ligament. The posterolateral bundle. Am J Sports Med 1996; 24 (04) 556-560
  • 7 Lintner DM, Kamaric E, Moseley JB, Noble PC. Partial tears of the anterior cruciate ligament. Are they clinically detectable?. Am J Sports Med 1995; 23 (01) 111-118
  • 8 Van Dyck P, De Smet E, Veryser J. , et al. Partial tear of the anterior cruciate ligament of the knee: injury patterns on MR imaging. Knee Surg Sports Traumatol Arthrosc 2012; 20 (02) 256-261
  • 9 Umans H, Wimpfheimer O, Haramati N, Applbaum YH, Adler M, Bosco J. Diagnosis of partial tears of the anterior cruciate ligament of the knee: value of MR imaging. Am J Roentgenol 1995; 165 (04) 893-897
  • 10 Siebold R, Fu FH. Assessment and augmentation of symptomatic anteromedial or posterolateral bundle tears of the anterior cruciate ligament. Arthroscopy 2008; 24 (11) 1289-1298
  • 11 Weiss JR, Irrgang JJ, Sawhney R, Dearwater S, Fu FH. A functional assessment of anterior cruciate ligament deficiency in an acute and clinical setting. J Orthop Sports Phys Ther 1990; 11 (08) 372-373
  • 12 Musahl V, Hoshino Y, Ahlden M. , et al. The pivot shift: a global user guide. Knee Surg Sports Traumatol Arthrosc 2012; 20 (04) 724-731
  • 13 Markolf KL, Graff-Radford A, Amstutz HC. In vivo knee stability. A quantitative assessment using an instrumented clinical testing apparatus. J Bone Joint Surg Am 1978; 60 (05) 664-674
  • 14 Yao L, Gentili A, Petrus L, Lee JK. Partial ACL rupture: an MR diagnosis?. Skeletal Radiol 1995; 24 (04) 247-251