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First published on March 11, 2004, doi:10.1177/0095399703258771
This version was published on April 1, 2004
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The American Journal of Sports Medicine 32:720-726 (2004)
© 2004 American Orthopaedic Society for Sports Medicine

Tibiofemoral Kinematics of the Anterior Cruciate Ligament (ACL)-Deficient Weightbearing, Living Knee Employing Vertical Access Open "Interventional" Multiple Resonance Imaging

Martin Logan, MBChB, MRCS, Edward Dunstan, MBBS, FRCS, James Robinson, FRCS, Andrew Williams, MBBS, FRCS*, Wady Gedroyc, MBBS, FRCR and Michael Freeman, MD, FRCS

From the Interventional MR Unit, St. Mary’s Hospital, London

* Address correspondence to Andrew Williams, Consultant Orthopaedic Surgeon, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, United Kingdom (e-mail: andywilliamsortho{at}hotmail.com).

Background: Our current understanding of tibiofemoral kinematics in the anterior cruciate ligament (ACL)-deficient knee is very limited. Using vertical open-access MRI, it is possible to accurately analyze tibiofemoral motion in patients with isolated rupture of the ACL.

Study: Prospective cohort study.

Purpose: To assess if ACL rupture alters normal knee weightbearing kinematics.

Methods: Tibiofemoral motion was assessed through the arc of flexion from 0° to 90° in 10 patients with isolated rupture of the ACL in one knee and a normal contralateral knee. Midmedial and midlateral sagittal images were analyzed in all positions of flexion in both knees to assess the tibiofemoral relationship.

Results: In the lateral compartment of the knee, the tibial plateau is persistently subluxed anteriorly throughout the arc of flexion from 0° to 90° (flexion facet center to posterior tibial cortex distance of 15.8 mm ± 2.9 in ACL-deficient knees compared to 21.4 mm ± 1.4 in normal knees at 0° extension, P < .0001) when compared to normal knees. The medial tibiofemoral relationship is unchanged compared to normal knees.

Conclusion: Rupture of the ACL changes tibiofemoral kinematics producing anterior subluxation of the lateral tibial plateau.

Clinical Significance: Altered kinematics may explain, at least in part, the increased incidence of secondary osteoarthritis in patients with ACL rupture.

Key Words: anterior cruciate ligament • tibiofemoral motion • MRI • knee kinematics




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