Diagnostic efficacy of standard knee magnetic resonance imaging and radiography in evaluating integrity of anterior cruciate ligament before unicompartmental knee arthroplasty

Year 2015, Volume: 49 Issue: 3, 274 - 279, 14.07.2015

Levent Altinel Mehmet Serhan , Emre Kacar Recep Abdullah Erten

Abstract

Objective: The purpose of this study was to investigate the diagnostic efficacy of standard magnetic resonance imaging (MRI) and plain radiographs in determining the status of anterior cruciate ligament (ACL) for surgical decision-making processes in cases of medial unicompartmental knee arthroplasty (UKA).
Methods: A total of 59 knees of 36 consecutive patients who underwent knee replacement surgery were analyzed retrospectively. MRI scans were assessed independently by 3 observers (radiologists), while the plain radiographs were evaluated by an independent radiologist. Results were compared with the intraoperative ACL status. Cross tabulation was used for descriptive statistics to analyze sensitivity, specificity, and accuracy of MRI and plain radiographs.
Results: When the same observer assessed and classified the MRI twice, the reproducibility of the classification system varied from moderate to excellent. However, the interobserver concordance was moderate. The sensitivity of MRI was 73% and the specificity was 81%, while the sensitivity and specificity of plain radiographs was 36% and 79%, respectively. The accuracy of MRI was 80%, while that of the radiographs was 71%.
Conclusion: Detection of intact ACL may be possible on available plain radiographs without necessity for additional means such as MRI, which may cause increase costs and loss of time. In cases where there is uncertainty regarding ACL integrity in degenerative knees, although standard MRI provides additional information on ACL status, it is not of sufficient diagnostic value.

Keywords

Anterior cruciate ligament; arthroplasty; knee; magnetic resonance imaging; osteoarthritis; replacement.

References

• Atik OS. Unicompartmental or total knee arthro- plasty?. [Article in Turkish] Eklem Hastalik Cerrahisi 2011;22:118–9.
• Morris MJ, Molli RG, Berend KR, Lombardi AV Jr. Mor- tality and perioperative complications after unicompart- mental knee arthroplasty. Knee 2013;20:218–20. CrossRef
• Keyes GW, Carr AJ, Miller RK, Goodfellow JW. The ra- diographic classification of medial gonarthrosis. Correla- tion with operation methods in 200 knees. Acta Orthop Scand 1992;63:497–501. CrossRef
• White SH, Ludkowski PF, Goodfellow JW. Antero- medial osteoarthritis of the knee. J Bone Joint Surg Br 1991;73:582–6.
• Sharpe I, Tyrrell PN, White SH. Magnetic resonance im- aging assessment for unicompartmental knee replacement: a limited role. Knee 2001;8:213–8. CrossRef
• Johnson AJ, Howell SM, Costa CR, Mont MA. The ACL in the arthritic knee: how often is it present and can pre- operative tests predict its presence? Clin Orthop Relat Res 2013;471:181–8. CrossRef
• Hong SH, Choi JY, Lee GK, Choi JA, Chung HW, Kang HS. Grading of anterior cruciate ligament injury. Diagnos- tic efficacy of oblique coronal magnetic resonance imaging of the knee. J Comput Assist Tomogr 2003;27:814–9. CrossRef
• Mukherjee K, Pandit H, Dodd CA, Ostlere S, Murray DW. The Oxford unicompartmental knee arthroplasty: a radiological perspective. Clin Radiol 2008;63:1169–76.
• Ha TP, Li KC, Beaulieu CF, Bergman G, Ch’en IY, Eller DJ, Cheung LP, et al. Anterior cruciate ligament injury: fast spin-echo MR imaging with arthroscopic correlation in 217 examinations. AJR Am J Roentgenol 1998;170:1215– 9. CrossRef
• Fischer SP, Fox JM, Del Pizzo W, Friedman MJ, Snyder SJ, Ferkel RD. Accuracy of diagnoses from magnetic reso- nance imaging of the knee. A multi-center analysis of one thousand and fourteen patients. J Bone Joint Surg Am 1991;73:2–10.
• Boeree NR, Watkinson AF, Ackroyd CE, Johnson C. Mag- netic resonance imaging of meniscal and cruciate injuries of the knee. J Bone Joint Surg Br 1991;73:452–7.
• Kwon JW, Yoon YC, Kim YN, Ahn JH, Choe BK. Which oblique plane is more helpful in diagnosing an anterior cru- ciate ligament tear? Clin Radiol 2009;64:291–7. CrossRef
• Buckwalter KA, Pennes DR. Anterior cruciate ligament: oblique sagittal MR imaging. Radiology 1990;175:276–7.
• Kosaka M, Nakase J, Toratani T, Ohashi Y, Kitaoka K, Ya- mada H, et al. Oblique coronal and oblique sagittal MRI for diagnosis of anterior cruciate ligament tears and evalu- ation of anterior cruciate ligament remnant tissue. Knee 2014;21:54–7. CrossRef
• Vahey TN, Broome DR, Kayes KJ, Shelbourne KD. Acute and chronic tears of the anterior cruciate ligament: differ- ential features at MR imaging. Radiology 1991;181:251– 3. CrossRef
• Link TM, Steinbach LS, Ghosh S, Ries M, Lu Y, Lane N, et al. Osteoarthritis: MR imaging findings in different stages of disease and correlation with clinical findings. Ra- diology 2003;226:373–81. CrossRef
• Goodfellow J, O’Connor J. The anterior cruciate ligament in knee arthroplasty. A risk-factor with unconstrained menis- cal prostheses. Clin Orthop Relat Res 1992;276:245–52.
• Deschamps G, Lapeyre B. Rupture of the anterior cruci- ate ligament: a frequently unrecognized cause of failure of unicompartmental knee prostheses. Apropos of a series of 79 Lotus prostheses with a follow-up of more than 5 years. [Article in French] Rev Chir Orthop Reparatrice Appar Mot 1987;73:544–51. [Abstract]
• Feng EL, Stulberg SD, Wixson RL. Progressive sub- luxation and polyethylene wear in total knee replace- ments with flat articular surfaces. Clin Orthop Relat Res 1994;299:60–71. CrossRef
• Goodfellow JW, Kershaw CJ, Benson MK, O’Connor JJ. The Oxford Knee for unicompartmental osteoarthritis. The first 103 cases. J Bone Joint Surg Br 1988;70:692– 701.
• Newman JH, Ackroyd CE, Shah NA. Unicompartmental or total knee replacement? Five-year results of a prospective, randomised trial of 102 osteoarthritic knees with unicom- partmental arthritis. J Bone Joint Surg Br 1998;80:862–5.
• Weidow J, Cederlund CG, Ranstam J, Kärrholm J. Ahl- bäck grading of osteoarthritis of the knee: poor reproduc- ibility and validity based on visual inspection of the joint. Acta Orthop 2006;77:262–6. CrossRef
• van den Dorpel A, Swart NM. Letter to the editor: the ACL in the arthritic knee: how often is it present and can preoperative tests predict its presence? Clin Orthop Relat Res 2013;471:1054.
• Douglas MJ, Hutchison JD, Sutherland AG. Anterior cru- ciate ligament integrity in osteoarthritis of the knee in pa- tients undergoing total knee replacement. J Orthop Trau- matol 2010;11:149–54. CrossRef
• Dodd M, Trompeter A, Harrison T, Palmer S. The piv- ot shift test is of limited clinical relevance in the arthritic anterior cruciate ligament-deficient knee. J Knee Surg 2010;23:131–5. CrossRef
• Feller JA, Webster KE. Clinical value of magnetic reso- nance imaging of the knee. ANZ J Surg 2001;71:534–7.