Bicruciate lesion biomechanics, Part 1-Diagnosis: translations over 15 mm at 90 degrees of knee flexion are indicative of a complete tear

Author(s)

de Carvalho, Rogerio Teixeira ^{[1, 2]} ; Franciozi, Carlos Eduardo ^{[1, 2, 3]} ; Itami, Yasuo ^[4] ; McGarry, Michelle H. ^[5] ; McNeill Ingham, Sheila Jean ^{[6, 2, 3]} ; Abdalla, Rene Jorge ^{[2, 3]} ; Tibone, James Eugene ^[7] ; Lee, Thay Q. ^{[5, 8]}

Affiliation

^[1] Hosp Israelita Albert Einstein, Sao Paulo, SP - Brazil

^[2] Univ Fed Sao Paulo, Dept Orthopaed & Traumatol, Escola Paulista Med, Sao Paulo, SP - Brazil

^[3] Hosp Coracao HCor, Knee Inst, Sao Paulo, SP - Brazil

^[4] Osaka Med Coll, Dept Orthoped Surg, Takatsuki, Osaka - Japan

^[5] Long Beach VA Healthcare Syst, Orthopaed Biomech Lab, Long Beach, CA - USA

^[6] AACD, Sao Paulo, SP - Brazil

^[7] Univ Southern Calif, Keck Sch Med, Dept Orthopaed Surg, Los Angeles, CA 90033 - USA

^[8] Univ Calif Irvine, Dept Orthopaed Surg, Irvine, CA - USA

• Document type: Journal article
• Source: KNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY; v. 27, n. 9, p. 2927-2935, SEP 2019.
• Web of Science Citations: 0

Abstract

Purpose Understanding the pathomechanics of a bicruciate injury (BI) is critical for its correct diagnosis and treatment. The purpose of this biomechanical study aims to quantify the effects of sequential sectioning of the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) bundles on knee laxity. Methods Twelve cadaveric knees (six matched pairs) were used. Knee laxity measurements consisted of neutral tibial position, anterior-posterior translation, internal-external rotation, and varus-valgus angulation in different conditions: intact, ACL cut, incomplete BI (divided into two groups: anterolateral (AL) bundle intact or posteromedial (PM) bundle intact) and complete bicruciate tear. Data were collected using a Microscribe system at 0 degrees, 30 degrees, 60 degrees, and 90 degrees of knee flexion. Results In comparison to the intact knees, incomplete BI and complete BI showed a significant increase of total antero-posterior tibial translation. The largest significant increase was observed at 90 degrees of flexion after a complete bicruciate resection (p < 0.001). A threshold difference greater than 15 mm from the intact could be used to identify a complete BI from an incomplete BI evaluating the total antero-posterior translation at 90 degrees. All sectioned states had significant increases compared with the intact condition in internal-external rotation and varus-valgus stability at all tested flexion angles. Conclusion Both incomplete and complete BI led to an important AP translation instability at all angles; however, full extension was the most stable position at all injured models. Total antero-posterior translation at 90 degrees of knee flexion over 15 mm, in comparison to the intact condition, was indicative of a complete BI. Since the appropriate assessment of a combined ACL and PCL lesion remains a challenge, this study intends to assist its diagnosis. As BI's main antero-posterior instability occurred at 90 degrees, a total antero-posterior drawer test is proposed to evaluate BI in the clinical setting. Total antero-posterior translation at 90 degrees > 15 mm, in comparison to the intact condition or the contra-lateral non-injured knee, can be used to identify a complete from an incomplete BI. (AU)

• FAPESP's process: 15/10317-7 - Bi cruciate knee lesion evaluation
• Grantee: Rene Jorge Abdalla
• Support Opportunities: Regular Research Grants
• FAPESP's process: 15/08952-6 - Osteochondral lesions treatment with parylene
• Grantee: CARLOS EDUARDO DA SILVEIRA FRANCIOZI
• Support Opportunities: Scholarships abroad - Research