LAUSR

Objectives: In anterior cruciate ligament-deficient (ACL-D) knees, injury pattern and bony morphology have been shown to influence both static anterior tibial subluxation relative to the femur and dynamic rotatory knee laxity. Therefore, the relationship between static anterior tibial subluxation and dynamic rotatory knee laxity was investigated. The goal of this study was to determine if static tibial subluxation as measured on magnetic resonance imaging (MRI) was associated with the grade of rotatory knee laxity in ACL-D knees. Methods: Two-hundred and fifty-eight knees underwent preoperative, image-guided assessment of lateral knee compartment translation during quantitative pivot shift (QPS). Subluxations of the medial and lateral tibial plateaus were measured on preoperative MRI in a subset of primary ACL-D knees meeting criteria for high-grade (QPS > 5.2 mm) and low-grade (QPS < 2.4 mm) rotatory laxity. Tibial subluxations on MRI were compared between patients with high- and low-grade rotatory laxity using pairwise t-test, and analyzed using uni- and multivariate logistic regression. Significance was set at p<0.05. Results: On MRI, greater anterior subluxation of the lateral tibial plateau was observed in patients with high-grade compared to low-grade rotatory knee laxity (4.5 mm vs. 2.3 mm; p<0.05). No similar relationship was observed for the medial tibial plateau (-0.9 mm vs. -0.4 mm; p>0.05). Univariate logistic regression demonstrated that static subluxation of the lateral tibial plateau was associated with high-grade rotatory knee laxity (Odds ratio [OR] 1.2; p<0.05). An optimal cut-off of 2.95 mm of static lateral tibial subluxation was associated with high-grade rotatory knee laxity (sensitivity: 75%; specificity: 63%). Lateral meniscus injury was the first variable to enter a multivariate regression analysis and proved to be most associated with high-grade rotatory knee laxity ([OR] 6.8; p < 0.05). When lateral meniscus injury was excluded from multivariate regression analysis, static anterior subluxation of the lateral tibial plateau alone was associated with high-grade rotatory knee laxity ([OR] 1.2; p<0.05). Conclusion: Data from this MRI study of two distinct rotatory knee laxity groups showed that static anterior subluxation of the lateral tibial plateau of 2.95 mm or greater was associated with high-grade rotatory knee laxity, and each millimeter increase of lateral tibial plateau subluxation was associated with a 1.2-fold odds of high-grade rotatory knee laxity. Anterior subluxation of the lateral tibial plateau on MRI was not independently associated with high-grade rotatory knee laxity in the presence of concomitant lateral meniscus injury. Static measurements made pre-operatively may aid in predicting high-grade rotatory knee laxity and refining the indications for individualized knee surgery.