J Knee Surg 2013; 26(04): 239-248
DOI: 10.1055/s-0032-1329717
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Radiographic Findings in Revision Anterior Cruciate Ligament Reconstructions from the MARS Cohort

MARS Group
Further Information

Publication History

29 September 2011

12 September 2012

Publication Date:
12 February 2013 (online)

Abstract

The Multicenter ACL (anterior cruciate ligament) Revision Study (MARS) group was developed to investigate revision ACL reconstruction outcomes. An important part of this is obtaining and reviewing radiographic studies. The goal for this radiographic analysis is to establish radiographic findings for a large revision ACL cohort to allow comparison with future studies. The study was designed as a cohort study. Various established radiographic parameters were measured by three readers. These included sagittal and coronal femoral and tibial tunnel position, joint space narrowing, and leg alignment. Inter- and intraobserver comparisons were performed. Femoral sagittal position demonstrated 42% were more than 40% anterior to the posterior cortex. On the sagittal tibia tunnel position, 49% demonstrated some impingement on full-extension lateral radiographs. Limb alignment averaged 43% medial to the medial edge of the tibial plateau. On the Rosenberg view (45-degree flexion view), the minimum joint space in the medial compartment averaged 106% of the opposite knee, but it ranged down to a minimum of 4.6%. Lateral compartment narrowing at its minimum on the Rosenberg view averaged 91.2% of the opposite knee, but it ranged down to a minimum of 0.0%. On the coronal view, verticality as measured by the angle from the center of the tibial tunnel aperture to the center of the femoral tunnel aperture measured 15.8 degree ± 6.9% from vertical. This study represents the radiographic findings in the largest revision ACL reconstruction series ever assembled. Findings were generally consistent with those previously demonstrated in the literature.

 
  • References

  • 1 George MS, Dunn WR, Spindler KP. Current concepts review: revision anterior cruciate ligament reconstruction. Am J Sports Med 2006; 34 (12) 2026-2037
  • 2 Kamath GV, Redfern JC, Greis PE, Burks RT. Revision anterior cruciate ligament reconstruction. Am J Sports Med 2011; 39 (1) 199-217
  • 3 Wright RW, Dunn WR, Amendola A , et al; MOON Cohort. Anterior cruciate ligament revision reconstruction: two-year results from the MOON cohort. J Knee Surg 2007; 20 (4) 308-311
  • 4 Vergis A, Gillquist J. Graft failure in intra-articular anterior cruciate ligament reconstructions: a review of the literature. Arthroscopy 1995; 11 (3) 312-321
  • 5 Wright RW, Huston LJ, Spindler KP , et al; MARS Group. Descriptive epidemiology of the Multicenter ACL Revision Study (MARS) cohort. Am J Sports Med 2010; 38 (10) 1979-1986
  • 6 Rosenberg TD, Paulos LE, Parker RD, Coward DB, Scott SM. The forty-five-degree posteroanterior flexion weight-bearing radiograph of the knee. J Bone Joint Surg Am 1988; 70 (10) 1479-1483
  • 7 Khalfayan EE, Sharkey PF, Alexander AH, Bruckner JD, Bynum EB. The relationship between tunnel placement and clinical results after anterior cruciate ligament reconstruction. Am J Sports Med 1996; 24 (3) 335-341
  • 8 Harilainen A, Sandelin J. Revision anterior cruciate ligament surgery. A review of the literature and results of our own revisions. Scand J Med Sci Sports 2001; 11 (3) 163-169
  • 9 Topliss C, Webb J. An audit of tunnel position in anterior cruciate ligament reconstruction. Knee 2001; 8 (1) 59-63
  • 10 Harner CD, Marks PH, Fu FH, Irrgang JJ, Silby MB, Mengato R. Anterior cruciate ligament reconstruction: endoscopic versus two-incision technique. Arthroscopy 1994; 10 (5) 502-512
  • 11 Järvelä T, Paakkala T, Järvelä K, Kannus P, Järvinen M. Graft placement after the anterior cruciate ligament reconstruction: a new method to evaluate the femoral and tibial placements of the graft. Knee 2001; 8 (3) 219-227
  • 12 Howell SM, Barad SJ. Knee extension and its relationship to the slope of the intercondylar roof. Implications for positioning the tibial tunnel in anterior cruciate ligament reconstructions. Am J Sports Med 1995; 23 (3) 288-294
  • 13 Picard F, DiGioia AM, Moody J , et al. Accuracy in tunnel placement for ACL reconstruction. Comparison of traditional arthroscopic and computer-assisted navigation techniques. Comput Aided Surg 2001; 6 (5) 279-289
  • 14 Howell SM, Clark JA. Tibial tunnel placement in anterior cruciate ligament reconstructions and graft impingement. Clin Orthop Relat Res 1992; (283) 187-195
  • 15 Howell SM, Berns GS, Farley TE. Unimpinged and impinged anterior cruciate ligament grafts: MR signal intensity measurements. Radiology 1991; 179 (3) 639-643
  • 16 Howell SM, Taylor MA. Failure of reconstruction of the anterior cruciate ligament due to impingement by the intercondylar roof. J Bone Joint Surg Am 1993; 75 (7) 1044-1055
  • 17 Morgan CD, Kalman VR, Grawl DM. Definitive landmarks for reproducible tibial tunnel placement in anterior cruciate ligament reconstruction. Arthroscopy 1995; 11 (3) 275-288
  • 18 Buckland-Wright C. Radiographic assessment of osteoarthritis: comparison between existing methodologies. Osteoarthritis Cartilage 1999; 7 (4) 430-433
  • 19 Mazzuca SA, Brandt KD, Buckwalter KA. Detection of radiographic joint space narrowing in subjects with knee osteoarthritis: longitudinal comparison of the metatarsophalangeal and semiflexed anteroposterior views. Arthritis Rheum 2003; 48 (2) 385-390
  • 20 Ravaud P, Auleley GR, Chastang C , et al. Knee joint space width measurement: an experimental study of the influence of radiographic procedure and joint positioning. Br J Rheumatol 1996; 35 (8) 761-766
  • 21 Oksendahl HL, Gomez N, Thomas CS , et al. Digital radiographic assessment of tibiofemoral joint space width: a variance component analysis. J Knee Surg 2009; 22 (3) 205-212
  • 22 Pinczewski LA, Salmon LJ, Jackson WF, von Bormann RB, Haslam PG, Tashiro S. Radiological landmarks for placement of the tunnels in single-bundle reconstruction of the anterior cruciate ligament. J Bone Joint Surg Br 2008; 90 (2) 172-179
  • 23 Sommer C, Friederich NF, Müller W. Improperly placed anterior cruciate ligament grafts: correlation between radiological parameters and clinical results. Knee Surg Sports Traumatol Arthrosc 2000; 8 (4) 207-213
  • 24 Watanabe BM, Howell SM. Arthroscopic findings associated with roof impingement of an anterior cruciate ligament graft. Am J Sports Med 1995; 23 (5) 616-625
  • 25 Jackson DW, Gasser SI. Tibial tunnel placement in ACL reconstruction. Arthroscopy 1994; 10 (2) 124-131
  • 26 Miller MD, Olszewski AD. Posterior tibial tunnel placement to avoid anterior cruciate ligament graft impingement by the intercondylar roof. An in vitro and in vivo study. Am J Sports Med 1997; 25 (6) 818-822
  • 27 Howell SM, Gittins ME, Gottlieb JE, Traina SM, Zoellner TM. The relationship between the angle of the tibial tunnel in the coronal plane and loss of flexion and anterior laxity after anterior cruciate ligament reconstruction. Am J Sports Med 2001; 29 (5) 567-574
  • 28 Raffo CS, Pizzarello P, Richmond JC, Pathare N. A reproducible landmark for the tibial tunnel origin in anterior cruciate ligament reconstruction: avoiding a vertical graft in the coronal plane. Arthroscopy 2008; 24 (7) 843-845
  • 29 Jepsen CF, Lundberg-Jensen AK, Faunoe P. Does the position of the femoral tunnel affect the laxity or clinical outcome of the anterior cruciate ligament-reconstructed knee? A clinical, prospective, randomized, double-blind study. Arthroscopy 2007; 23 (12) 1326-1333
  • 30 Lee MC, Seong SC, Lee S , et al. Vertical femoral tunnel placement results in rotational knee laxity after anterior cruciate ligament reconstruction. Arthroscopy 2007; 23 (7) 771-778
  • 31 Sudhahar TA, Glasgow MM, Donell ST. Comparison of expected vs. actual tunnel position in anterior cruciate ligament reconstruction. Knee 2004; 11 (1) 15-18
  • 32 Hoser C, Tecklenburg K, Kuenzel KH, Fink C. Postoperative evaluation of femoral tunnel position in ACL reconstruction: plain radiography versus computed tomography. Knee Surg Sports Traumatol Arthrosc 2005; 13 (4) 256-262
  • 33 Bruyere O, Richy F, Reginster JY. Three year joint space narrowing predicts long term incidence of knee surgery in patients with osteoarthritis: an eight year prospective follow up study. Ann Rheum Dis 2005; 64 (12) 1727-1730
  • 34 Wright RW, Boyce RH, Michener T, Shyr Y, McCarty EC, Spindler KP. Radiographs are not useful in detecting arthroscopically confirmed mild chondral damage. Clin Orthop Relat Res 2006; 442: 245-251
  • 35 Mason RB, Horne JG. The posteroanterior 45 degrees flexion weight-bearing radiograph of the knee. J Arthroplasty 1995; 10 (6) 790-792
  • 36 Dervin GF, Feibel RJ, Rody K, Grabowski J. 3-Foot standing AP versus 45 degrees PA radiograph for osteoarthritis of the knee. Clin J Sport Med 2001; 11 (1) 10-16