2025 ISAKOS Biennial Congress ePoster
The Utility Of Stress Ultrasound In The Assessment Of ACL Insufficiency
Miho J. Tanaka, MD, PhD, Boston, MA UNITED STATES
Nikitha Crasta, MBBS, Cambridge, MA UNITED STATES
Maria Virginia Velasquez-Hammerle, MD, Boston, MA UNITED STATES
Kyle K Grover, BS, New Hartford, NY UNITED STATES
Massachusetts General Hospital, Harvard Medical School, Boston, MA, UNITED STATES
FDA Status Not Applicable
Summary
Using the TELOS stress testing device, we found that stress ultrasound identified ACL deficiency with moderate accuracy.
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Abstract
The ultrasound (US)-assisted Lachman test has been described in a recent cadaveric study to detect anterior cruciate ligament (ACL) insufficiency with high accuracy. During this test ,the anterior translation of the tibia relative to the femur can be quantified. Given its utility in a cadaveric setting, the purpose of this study was to identify the role of stress ultrasound in identifying ACL insufficiency in a clinical population.
In patients with unilateral ACL injury, stress ultrasound was performed using the TELOS device. The knee at positioned at 20 degrees of knee flexion, and US measurements were performed over the anteromedial knee as previously described. Using the TELOS device, US measurements were obtained in both the unloaded state and with 90N of anteriorizing load on the tibia. US guided measurements were compared between the noninjured knee, the ACL deficient knee, as well 6 months after ACL reconstruction. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the ability of ultrasound measurements to identify ACL insufficiency.
64 patients were included in this study (19M, 45F) with a mean age of 27.9+/-7.8 years. No significant difference was noted between the unloaded states for the normal, injured and postoperative knees (0.1+/-2.3mm, 0.3+/-2.6mm, 0.6+/-1.8mm, p=0.596). In the loaded state (90N), anterior translation of the tibia in the ACL deficient state (1.8+/-2.6mm) was greater than the normal state (0.8+/-1.9mm, p=0.107) and the postoperative state (0.4+/-2.0mm, p=0.020). No difference was noted between the uninjured and postoperative states. Using a cutoff of >2mm in the loaded state, ROC curve demonstrated an area under the curve of 0.70.
Using the TELOS stress testing device, we found that stress ultrasound detected significantly greater anterior translation in the ACL-deficient state when compared to the normal knee, and that this corrected to normal after ACL reconstruction. A measurement >2mm loaded at 90N identified ACL deficiency with moderate accuracy. Further studies are needed to assess the utility of stress ultrasound for the evaluation of ACL injuries and reconstruction.