Summary: To retrospectively determine the rate of initially overlooked Kaplan Fiber Complex injuries in isolated primary ACL-deficient knees on routine MRI.

Background

Injuries to the Kaplan fibers complex (KFC) are not routinely assessed in the anterior cruciate ligament (ACL)-deficient knee using preoperative magnetic resonance imaging (MRI). As injuries to the KFC lead to anterolateral rotatory instability (ALRI) in the ACL-deficient knee, preoperative detection of these injuries on MRI may help surgeons to individualize treatment and improve outcomes along with reduction of failure rates.

Purpose

To retrospectively determine the rate of initially overlooked Kaplan Fiber Complex injuries in isolated primary ACL-deficient knees on routine MRI.

Methods

Patients who underwent isolated ACL reconstruction between 08/2013 and 12/2019 were identified. Preoperative knee MRIs (minimum 1.5 T) were reviewed and injuries to proximal and distal Kaplan fibers (KFs) were recorded by 3 independent reviewers. KF length and distance to nearby anatomic landmarks (lateral joint line and lateral femoral epicondyle) were measured. Additional radiological findings including bleeding, lateral femoral notch sign, and bone marrow edema (BME) were identified to detect correlations with KFC injury.

Results

The intact KFC could reliably be identified by all three reviewers (85.9% agreement; Kappa 0.716). Fifty-three – Fifty-six % of the patients with initially diagnosed isolated ACL-ruptures showed initially overlooked injuries to the KFC. Injuries to the distal KFs were more frequent (48.1%, 53.8 % and 43.3% for Reviewer 1, 2 and 3, respectively) than injuries to the proximal KFs (35.6 %, 47.1 %, and 45.2% for Reviewer 1, 2 and 3, respectively). Bleeding in the lateral supracondylar region was associated with KFC injuries (p=0.023). Additionally, there was a positive correlation between distal KFs injuries and lateral tibial plateau BME (p=0.035). No associations were found with lateral femoral notch sign or other patterns of BME, including pivot-shift BME.

Conclusion

KF integrity and injury can be reliably detected on routine knee MRI. Fifty-three – Fifty-six % of the patients presenting with initially diagnosed isolated ACL ruptures had concomitant injuries to the KFC. This is of clinical relevance, as current routine MRI diagnostic may come along with a high number of occult or hidden KFC injuries. As injuries to the KFC contribute to persistent ALRI, which may influence ACL failure or reoperation rates, significant improvements in pre-operative diagnostic are required, in order to determine the exact injury pattern and to assist in surgical decision-making.

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Analysis Of The Blood Supply To The Femoral Attachment Of The Anterior Cruciate Ligament After Acl Injury Abstract Presentation 4 minutes Jedrzej Jerzy Lesman, PhD MD, POLAND Marcin E. Domzalski, MD, Prof., POLAND Krzysztof Nowak, MD, PhD, POLAND Sebastian Zygmunt Żabierek, PhD, POLAND Radoslaw Grabowski, MD, POLAND Ilona Wagner-Olszewska, MD, POLAND
Risk Factors for Grade 3 Pivot Shift in Acute ACL-Injured Knees Abstract Presentation 5 minutes Adnan Saithna, MD, FRCS, UNITED STATES Edoardo Monaco, MD, ITALY Edoardo Gaj, MD, ITALY Valerio Andreozzi, ITALY Alessandro Annibaldi, MD, ITALY Alessandro Carrozzo, MD, ITALY Thais Dutra Vieira, MD, FRANCE Bertrand Sonnery-Cottet, MD, PhD, FRANCE Andrea Ferretti, Prof., ITALY
Changes In Muscle Strength And Hop Performance After ACL Reconstruction. A Randomized Controlled Trial Comparing Patellar Tendon And Hamstring Tendon Autografts With Standard Or Accelerated Rehabilitation Abstract Presentation 6 minutes Riccardo Cristiani, MD, PhD, SWEDEN Christina Mikkelsen, PT, SWEDEN Peter Olov Wange, MD, SWEDEN Daniel Olsson, PhD, SWEDEN Anders Stalman, MD, PhD, associate professor, SWEDEN Bjorn Engstrom, MD, PhD, Assoc. Prof., SWEDEN
Tranexamic Acid Has No Effect On Post-Operative Hemarthrosis Or Pain Control Following Acl Reconstruction Using Bone Patella Tendon Bone Autograft: A Double-Blinded Randomized Control Trial Abstract Presentation 5 minutes Jordan W Fried, BM, UNITED STATES David Bloom, BA, UNITED STATES Eoghan T. Hurley, MB, BCh, MCh, IRELAND Samuel Baron, MD, UNITED STATES Kirk Anthony Campbell, MD, UNITED STATES Eric Jason Strauss, MD Laith M. Jazrawi, MD, UNITED STATES Michael J Alaia, MD, UNITED STATES
Quadriceps Tendon Vs. Hamstring Tendon Autograft In Primary Anterior Cruciate Ligament Reconstruction: A Matched-Pairs Study With A Mean Follow-Up Of 6.5 Years Award Winner 5 minutes Armin Runer, PD MD, GERMANY Aline Suter, MD, AUSTRIA Tommaso Roberti di Sarsina, MD, ITALY Caroline Hepperger, PhD, AUSTRIA Peter Gföller, MD, AUSTRIA Christian Hoser, MD, AUSTRIA Robert Csapo, PhD, AUSTRIA Christian Fink, MD, Prof., AUSTRIA
Predicting Subjective Failure of ACL Reconstruction: A Machine Learning Analysis of the Norwegian Knee Ligament Register and Patient Reported Outcomes Award Winner 5 minutes R. Kyle Martin, MD, FRCSC, UNITED STATES Solvejg Wastvedt, BA, UNITED STATES Ayoosh Pareek, MD, UNITED STATES Andreas Persson, MD, PhD, NORWAY Havard Visnes, MD, PT, PhD, NORWAY Anne Marie Fenstad, MSc, NORWAY Gilbert Moatshe, MD, PhD, NORWAY Julian Wolfson, PhD, UNITED STATES Lars Engebretsen, MD, PhD, NORWAY
Return To Sports After Paediatric Anterior Cruciate Ligament Reconstruction (ACLR): Normal Population Vs An ACLR Cohort Abstract Presentation 6 minutes Alexander S. Nicholls, MSc, FRACS, AUSTRALIA Jillian Lee, BHB, MBChB, FRACS (Ortho), NEW ZEALAND Yoong Lim, BEng, PhD, AUSTRALIA Quang Dao, FRACS, AUSTRALIA

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High Rate of Initially Overlooked Kaplan Fiber Complex Injuries in Patients With Isolated Anterior Cruciate Ligament Injury

High Rate of Initially Overlooked Kaplan Fiber Complex Injuries in Patients With Isolated Anterior Cruciate Ligament Injury

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Purpose

Methods

Results

Conclusion

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High Rate of Initially Overlooked Kaplan Fiber Complex Injuries in Patients With Isolated Anterior Cruciate Ligament Injury

High Rate of Initially Overlooked Kaplan Fiber Complex Injuries in Patients With Isolated Anterior Cruciate Ligament Injury

Background

Purpose

Methods

Results

Conclusion

More ISAKOS 2021: Global Content