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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Adding A Lateral Extra-Articular Tenodesis Significantly Reduces Acl Graft Rupture Rates In Pediatric And Adolescent Patients When Compared To Isolated Acl Reconstruction Abstract Presentation 5 minutes Andrea Ferretti, Prof., ITALY Adnan Saithna, MD, FRCS, UNITED STATES Alessandro Carrozzo, MD, ITALY Alessandro Annibaldi, MD, ITALY Fabio Marzilli, MD, ITALY Edoardo Monaco, MD, ITALY
Coach Education Improves Implementation Of ACL Injury Prevention Programs: A Cluster-Randomized Controlled Trial Abstract Presentation 5 minutes Daphne Ling, PhD, MPH, TAIWAN Caroline Boyle, UNITED STATES Brandon Schneider, MS, UNITED STATES Joseph Janosky, DrPHc, MS, PT, ATC, UNITED STATES James Kinderknecht, UNITED STATES Robert G. Marx, MD, UNITED STATES
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
Quantitative Evaluation of Lateral Articular Cartilage Quality on Magnetic Resonance Imaging at 2-years following Anterior Cruciate Ligament Reconstruction With Or Without A Lateral Extra-Articular Tenodesis Abstract Presentation 6 minutes Andrew Firth, PhD, CANADA Dianne M. Bryant, PhD, CANADA Jaques Milner , CANADA Stephany Pritchett, MD, FRCPC, DABR, CANADA David Holdsworth, PhD, Canada Stability Study Group, CANADA Alan Getgood, MD, FRCS(Tr&Orth), DipSEM, QATAR
Quadriceps Tendon Autograft Has Lower MRI Signal Than Hamstring Tendon Autograft In Anterior Cruciate Ligament Reconstructions Of Adolescent Athletes Abstract Presentation 5 minutes David Alcoloumbre, MD, UNITED STATES Alexandra Hunter Aitchison, UNITED STATES Douglas Mintz, MD, UNITED STATES Frank A. Cordasco, MD, MS, UNITED STATES Daniel W. Green, MD, MS, UNITED STATES
Comparison of three different Quadriceps Tendon ACL graft to BTB and Semi-T grafts: A biomechanical study ePoster Presentation Marc Jacob Strauss, MD, NORWAY Jonathan Miles, M.S, UNITED STATES Mitchell Iung Kennedy, BS, UNITED STATES Gilbert Moatshe, MD, PhD, NORWAY Grant J Dornan, MS, UNITED STATES Martin Lind, MD, PhD, Prof., DENMARK Lars Engebretsen, MD, PhD, NORWAY Robert F. LaPrade, MD, PhD, UNITED STATES
Predicting Subsequent Revision ACL Reconstruction: A Machine Learning Analysis of the Norwegian Knee Ligament Register Abstract Presentation 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
Risk Factor Analysis for Graft Failure after Anterior Cruciate Ligament Reconstruction with or without mLET Abstract Presentation 7 minutes Filip R Hendrikx, MD, BELGIUM Koen Lagae, MD, BELGIUM Annemieke Van Haver, PhD, MSc, BELGIUM Peter Verdonk, MD, PhD, BELGIUM

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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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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