Laxity measurement of internal knee rotation after primary anterior cruciate ligament rupture versus rerupture

Hermann O Mayr; Georg Hellbruegge; Florian Haasters; Bastian Ipach; Hagen Schmal; Wolf C Prall

doi:10.1007/s00402-021-04269-1

Laxity measurement of internal knee rotation after primary anterior cruciate ligament rupture versus rerupture

Arch Orthop Trauma Surg. 2022 Oct;142(10):2839-2847. doi: 10.1007/s00402-021-04269-1. Epub 2021 Dec 6.

Authors

Hermann O Mayr¹, Georg Hellbruegge², Florian Haasters³, Bastian Ipach², Hagen Schmal⁴, Wolf C Prall³

Affiliations

¹ Department of Orthopedic and Trauma Surgery, University Hospital, Albert Ludwig University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany. hermann.mayr@uniklinik-freiburg.de.
² Schoen Clinic Munich Harlaching, Academic Teaching Hospital Munich University, Munich, Germany.
³ Department of General, Trauma and Reconstructive Surgery, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany.
⁴ Department of Orthopedic and Trauma Surgery, University Hospital, Albert Ludwig University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany.

Abstract

Purpose: The aim of the current study was to objectify the rotational laxity after primary anterior cruciate ligament (ACL) rupture and rerupture after ACL reconstruction by instrumented measurement. It was hypothesized that knees with recurrent instability feature a higher internal rotation laxity as compared to knees with a primary rupture of the native ACL.

Study design: Cross-sectional study, Level of evidence III.

Methods: In a clinical cross-sectional study successive patients with primary ACL rupture and rerupture after ACL reconstruction were evaluated clinically and by instrumented measurement of the rotational and antero-posterior laxity with a validated instrument and the KT1000^®, respectively. Clinical examination comprised IKDC 2000 forms, Lysholm Score, and Tegner Activity Scale. Power calculation and statistical analysis were performed (p value < 0.05).

Results: 24 patients with primary ACL rupture and 23 patients with ACL rerupture were included. There was no significant side-to-side difference in anterior translation. A side-to side difference of internal rotational laxity ≥ 10° was found significantly more frequent in reruptures (53.6%) compared to primary ruptures (19.4%; p < 0.001). A highly significant relationship between the extent of the pivot-shift phenomenon and side-to-side difference of internal rotation laxity could be demonstrated (p < 0.001). IKDC 2000 subjective revealed significantly better scores in patients with primary ACL tear compared to patients with ACL rerupture (56.4 ± 7.8 vs. 50.8 ± 6.2; p = 0.01). Patients with primary ACL tears scored significantly better on the Tegner Activity Scale (p = 0.02). No significant differences were seen in the Lysholm Score (p = 0.78).

Conclusion: Patients with ACL rerupture feature significantly higher internal rotation laxity of the knee compared to primary ACL rupture. The extend of rotational laxity can be quantified by instrumented measurements. This can be valuable data for the indication of an anterolateral ligament reconstruction in ACL revision surgery.

Keywords: ACL; ALL; Anterior cruciate ligament; Anterolateral ligament; Instrumented measurement; Rerupture; Rotational laxity.

MeSH terms

Anterior Cruciate Ligament / surgery
Anterior Cruciate Ligament Injuries* / surgery
Cross-Sectional Studies
Humans
Joint Instability* / diagnosis
Joint Instability* / etiology
Joint Instability* / surgery
Knee Joint / surgery
Range of Motion, Articular
Rupture / surgery