Global rotation has high sensitivity in ACL lesions within stress MRI

Purpose: This study aims to objectively compare side-to-side differences of P-A laxity alone and this coupled with rotatory laxity within magnetic resonance imaging (MRI), in patients with total anterior cruciate ligament (ACL) rupture. Methods: This study prospective enrolled sixty-one patients with signs and symptoms of unilateral total anterior cruciate ligament rupture, which were referred to magnetic resonance evaluation with simultaneous instrumented laxity measurements. Sixteen of those patients were randomly selected to also have the contralateral healthy knee laxity profile tested. Images were acquired for the medial and lateral tibial plateaus without pressure, with postero-anterior translation, and postero-anterior translation coupled with maximum internal and external rotation, respectively. Results: All parameters measured were significantly different between healthy and injured knees (P < 0.05), with exception of lateral plateau without stress. The difference between injured and healthy knees for medial and lateral tibial plateaus anterior displacement (P < 0.05) and rotation (P < 0.001) was statistically significant. It was found a significant correlation between the global rotation of the lateral tibial plateau (lateral plateau with internal + external rotation) with pivot shift, and between the anterior global translation of both tibial plateaus (medial + lateral tibial plateau) with Lachman. The anterior global translation of both tibial plateaus was the most specific test with a cut-off point of 11.1 mm (93.8%), and the global rotation of the lateral tibial plateau was the most sensitive test with a correspondent cut-off point of 15.1mm (92.9%). Conclusion: Objective laxity quantification of ACL-injured knees showed increased sagittal laxity, and simultaneously in sagittal and transversal planes, when compared to their healthy contralateral knee. Moreover, when measuring instability from anterior cruciate ligament ruptures, the anterior global translation of both tibial plateaus and global rotation of the lateral tibial plateau add diagnostic specificity and sensitivity. This work strengthens the evidence that the anterior cruciate ligament plays an important biomechanical role in controlling the anterior translation, but also both internal and external rotation. The high sensitivity and specificity of this device in objectively identifying and measuring the multiplanar instability clearly guides stability restoration clinical procedures.The authors would like to sincerely acknowledge the SMIC Dragão Clinical Director, Dr Rui Aguiar, and all his team for their support in this study. They also thank Professor Cristina Almeida for her valuable help and discussions with the statistical data analysis, as well as the all the members of the physical therapy team of the Clínica do Dragão