2023 ISAKOS Biennial Congress ePoster
Posterior Cruciate Buckling Angle Variations are Associated With Different Patterns of Medial Meniscus Tears in Anterior Cruciate Deficient Knees: Results of a Prospective Comparative Magnetic Imaging Resonance Study
Simone Cerciello , DR, Rome ITALY
Gianluca Ciolli, MD ITALY
Dario Candura, Roma, Italia ITALY
Michele Mercurio, Prof., MD, Catanzaro ITALY
Fabrizio Mocini, MD, Rome ITALY
Lorenzo Proietti, MD, Rome ITALY
Catholic University of rome, Rome, ITALY
FDA Status Not Applicable
Summary
Posterior cruciate buckling angle variations are associated with different patterns of medial meniscus tears in anterior cruciate deficient knees: results of a prospective comparative magnetic imaging resonance study
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Abstract
Purpose.
The diagnosis of anterior cruciate ligament (ACL) tear relies on clinical evaluation and magnetic resonance imaging (MRI). Direct and indirect signs of ACL tear have been described with MRI evaluation. Posterior cruciate ligament (PCL) buckling has been described as an indirect radiographic sign of ACL tear. The aim of the present study was to assess the variations of PCL buckling angle in patients with ACL tears and in patients with isolated lesions posterior horn of the medial meniscus. In addition, the influence of different patterns of medial meniscus tears in ACL deficient knees was investigated. Finally, the influence of risk factors such as tibial slope, delay from injury to surgery, absence of medial meniscus tear, degree of Lachman and pivot shift testing were also assessed.
Methods.
154 patients (78 in the group with ACL tear and 76 in the control group) were assessed with MRI and lateral weight bearing X-ray to assess PCL buckling angle and tibial slope by two independent observers. The presence of a medial meniscus bucket handle or ramp lesion of the medial meniscus was assessed and recorded at the time of surgery.
Results.
PCL buckling angle measure was highly reliable with an ICC of 0.866 and 0.894, respectively in the study and the control group, for inter-observer reliability. The intra-rater reliability was found to be high in PCL buckling angle for the study [ICC = 0.955] and the control group [ICC = 0.943].
The mean angle value in patients with ACL tear was 110.7°±15.2° and 115.3°±16.2° (for the two examiners respectively) and 111.4°±12° and 114°±14.5° (for the two examiners respectively) in patients with an intact, healthy ACL. An association emerged between bucket handle tears of the medial meniscus (p=0.010) and decreased PCL buckling angle and between ramp lesions of the medial meniscus and increased PCL buckling angle both (p=0.024).
Conclusions.
Good inter- and intra-observer reliability for the measure of the PCL buckling angle was observed. Increased PCL buckling angle values were observed in patients with concomitant ACL and bucket handle tears of the medial meniscus, while decreased angle values were observed in those who had ACL tear and ramp lesion of the medial meniscus. No statistically significant difference in PCL buckling angle emerged between patients with ACL tears and in those who had a healthy, intact ACL.