A paucity of information is available regarding the clinical outcomes of patients with radiological evidence of Kaplan fiber (KF) injury who undergo anterior cruciate ligament (ACL) reconstruction (ACLR).
Purpose/Hypothesis:
The purpose was to compare clinical and functional outcomes in patients undergoing acute primary ACLR with and without magnetic resonance imaging (MRI) evidence of KF injury. The hypothesis was that there would be no difference in clinical or functional outcomes in patients with versus those without radiological evidence of KF injury.
Study Design:
Cohort study; Level of evidence, 3.
Methods:
MRI analysis was conducted on patients in a longitudinal prospective study of ACL injury. Only patients who had an MRI scan and had undergone isolated primary ACLR within 60 days of injury were included. MRI was performed using standard knee protocols, and diagnostic criteria were applied to identify KF injury. A total of 32 patients with KF injury (mean age, 24.2 years; 21 male, 11 female) were identified and matched for sex, age, graft type, and preinjury activity with 90 patients who had intact KF. Patients were followed up at 12 months with KT-1000 arthrometer measurements of side-to-side difference in anterior knee laxity, single- and triple-hop limb symmetry index (LSI), Marx activity and International Knee Documentation Committee (IKDC) scores, and return to sport (RTS) rates at 12 months and 24 months.
Results:
No differences were found in anterior knee laxity and single- and triple-hop LSI values between the KF-intact and KF-injured cohorts at 12 months. No differences in Marx and IKDC scores were found between the groups at 12 months and 2 years. The overall rate of RTS within 24 months was 75% (92/122), and 5 patients (2 KF-injured; 3 KF-intact) had a subsequent graft rupture.
Conclusion:
We found no difference in clinical or functional outcomes in patients with and without radiological evidence of KF injury who underwent acute primary ACLR. Based on these findings, the radiological presence of KF injury at the time of acute ACL injury should not be regarded as a risk factor for a negative prognosis after ACLR.
Al’KhafajiIDevittBMFellerJA. The modified Ellison technique: a distally fixed iliotibial band transfer for lateral extra-articular augmentation of the knee. Arthrosc Tech. 2022;11(2):e257-e262.
2.
AustinPC. Statistical criteria for selecting the optimal number of untreated subjects matched to each treated subject when using many-to-one matching on the propensity score. Am J Epidemiol. 2010;172(9):1092-1097.
3.
AyeniORChahalMTranMNSpragueS. Pivot shift as an outcome measure for ACL reconstruction: a systematic review. Knee Surg Sports Traumatol Arthrosc. 2012;20(4):767-777.
4.
BalendraGWillingerLPaiV, et al. Anterolateral complex injuries occur in the majority of “isolated” anterior cruciate ligament ruptures. Knee Surg Sports Traumatol Arthrosc. 2022;30(1):176-183.
5.
BattyLMurgierJO’SullivanR, et al. The Kaplan fibers of the iliotibial band can be identified on routine knee magnetic resonance imaging. Am J Sports Med. 2019;47(12):2895-2903.
6.
BattyLMMurgierJFellerJA, et al. Radiological identification of injury to the Kaplan fibers of the iliotibial band in association with anterior cruciate ligament injury. Am J Sports Med. 2020;48(9):2213-2220.
7.
BertholdDPWillingerLLeVasseurMR, et al. High rate of initially overlooked Kaplan fiber complex injuries in patients with isolated anterior cruciate ligament injury. Am J Sports Med. 2021;49(8): 2117-2124.
8.
BertholdDPWillingerLMuenchLN, et al. Visualization of proximal and distal Kaplan fibers using 3-dimensional magnetic resonance imaging and anatomic dissection. Am J Sports Med. 2020;48(8):1929-1936.
9.
BlacheYDumasRde GuiseJ, et al. Technical considerations in lateral extra-articular reconstruction coupled with anterior cruciate ligament reconstruction: a simulation study evaluating the influence of surgical parameters on control of knee stability. Clin Biomech (Bristol, Avon). 2019;61:136-143.
10.
BranchTPMayrHOBrowneJE, et al. Instrumented examination of anterior cruciate ligament injuries: minimizing flaws of the manual clinical examination. Arthroscopy. 2010;26(7):997-1004.
11.
CavaignacESaithnaAMonacoE, et al. Is treatment of Segond fracture necessary with combined anterior cruciate ligament reconstruction? Letter to the editor. Am J Sports Med. 2018; 46(5):NP13-NP14.
12.
ClaesSVereeckeEMaesM, et al. Anatomy of the anterolateral ligament of the knee. J Anat. 2013;223(4):321-328.
13.
DevittBMAl’khafajiIBlucherN, et al. Association between radiological evidence of Kaplan fiber injury, intraoperative findings, and pivot-shift grade in the setting of acute anterior cruciate ligament injury. Am J Sports Med. 2021;49(5):1262-1269.
14.
DevittBMBattyLM. High rate of initially overlooked Kaplan fiber complex injuries in patients with isolated anterior cruciate ligament injury. Letter to the editor. Am J Sports Med. 2022;50(1):NP1-NP3.
15.
DevittBMBellSWArdernCL, et al. The role of lateral extra-articular tenodesis in primary anterior cruciate ligament reconstruction: a systematic review with meta-analysis and best-evidence synthesis. Orthop J Sports Med. 2017;5(10):2325967117731767.
16.
FellerJADevittBMWebsterKEKlemmHJ. Augmentation of primary ACL reconstruction with a modified Ellison lateral extra-articular tenodesis in high-risk patients: a pilot study. Orthop J Sports Med. 2021;9(8):23259671211021351.
17.
FerrettiAMonacoEFabbriMMaestriBDe CarliA. Prevalence and classification of injuries of anterolateral complex in acute anterior cruciate ligament tears. Arthroscopy. 2017;33(1):147-154.
18.
GeeslinAGChahlaJMoatsheG, et al. Anterolateral knee extra-articular stabilizers: a robotic sectioning study of the anterolateral ligament and distal iliotibial band Kaplan fibers. Am J Sports Med. 2018;46(6):1352-1361.
19.
GeeslinAGMoatsheGChahlaJ, et al. Anterolateral knee extra-articular stabilizers: a robotic study comparing anterolateral ligament reconstruction and modified Lemaire lateral extra-articular tenodesis. Am J Sports Med. 2018;46(3):607-616.
20.
GetgoodABrownCLordingT, et al. The anterolateral complex of the knee: results from the International ALC Consensus Group Meeting. Knee Surg Sports Traumatol Arthrosc. 2019;27(1):166-176.
21.
GetgoodAHewisonCBryantD, et al. No difference in functional outcomes when lateral extra-articular tenodesis is added to anterior cruciate ligament reconstruction in young active patients: the Stability study. Arthroscopy. 2020;36(6):1690-1701.
22.
GetgoodAMJBryantDMLitchfieldR, et al. Lateral extra-articular tenodesis reduces failure of hamstring tendon autograft anterior cruciate ligament reconstruction: 2-year outcomes from the STABILITY Study Randomized Clinical Trial. Am J Sports Med. 2020;48(2):285-297.
23.
HettrichCMDunnWRReinkeEKGroupMSpindlerKP. The rate of subsequent surgery and predictors after anterior cruciate ligament reconstruction: two- and 6-year follow-up results from a multicenter cohort. Am J Sports Med. 2013;41(7):1534-1540.
24.
HewisonCETranMNKanikiN, et al. Lateral extra-articular tenodesis reduces rotational laxity when combined with anterior cruciate ligament reconstruction: a systematic review of the literature. Arthroscopy. 2015;31(10):2022-2034.
25.
HuangHNagaoMAritaH, et al. Validation and defining the minimal clinically important difference of the Japanese version of the IKDC Subjective Knee Form. J Orthop Sci. 2021;26(1):149-155.
26.
InderhaugEStephenJMWilliamsAAmisAA. Biomechanical comparison of anterolateral procedures combined with anterior cruciate ligament reconstruction. Am J Sports Med. 2017;45(2):347-354.
27.
KhannaMGupteCDoddsAWilliamsAWalkerM. Magnetic resonance imaging appearances of the capsulo-osseous layer of the iliotibial band and femoral attachments of the iliotibial band in the normal and pivot-shift ACL injured knee. Skeletal Radiol. 2019;48(5):729-740.
28.
KittlCEl-DaouHAthwalKK, et al. The role of the anterolateral structures and the ACL in controlling laxity of the intact and ACL-deficient knee. Am J Sports Med. 2016;44(2):345-354.
29.
LewallenSCourtrightP. Epidemiology in practice: case-control studies. Community Eye Health. 1998;11(28):57-58.
30.
MagnusonJAStrnadGSmithC, et al. Comparison of standard and right/left International Knee Documentation Committee Subjective Knee Form Scores. Am J Sports Med. 2019;47(5):1203-1208.
31.
MaromNGreditzerHGRouxM, et al. The incidence of Kaplan fiber injury associated with acute anterior cruciate ligament tear based on magnetic resonance imaging. Am J Sports Med. 2020;48(13):3194-3199.
32.
MeluginHPJohnsonNRWuIT, et al. Is treatment of Segond fracture necessary with combined anterior cruciate ligament reconstruction?Am J Sports Med. 2018;46(4):832-838.
33.
NeriTDabirrahmaniDBeachA, et al. Different anterolateral procedures have variable impact on knee kinematics and stability when performed in combination with anterior cruciate ligament reconstruction. J ISAKOS. 2021;6(2):74-81.
34.
NoyesFRHuserLEPalmerM. A biomechanical study of pivot-shift and Lachman translations in anterior cruciate ligament-sectioned knees, anterior cruciate ligament-reconstructed knees, and knees with partial anterior cruciate ligament graft slackening: instrumented Lachman tests statistically correlate and supplement subjective pivot-shift tests. Arthroscopy. 2021;37(2):672-681.
35.
PanZDongQXuYZhouHXuWMaoY. Is treatment of Segond fracture necessary with combined anterior cruciate ligament reconstruction? Letter to the editor. Am J Sports Med. 2018;46(5):NP17.
36.
SaithnaAHelitoCPVieiraTDSonnery-CottetBMuramatsuK. The anterolateral ligament has limited intrinsic healing potential: a serial, 3-dimensional-magnetic resonance imaging study of anterior cruciate ligament-injured knees from the SANTI Study Group. Am J Sports Med. 2021;49(8):2125-2135.
37.
SobradoMFGiglioPNBonadioMB, et al. Outcomes after isolated acute anterior cruciate ligament reconstruction are inferior in patients with an associated anterolateral ligament injury. Am J Sports Med. 2020;48(13):3177-3182.
38.
SongGYHongLZhangH, et al. Clinical outcomes of combined lateral extra-articular tenodesis and intra-articular anterior cruciate ligament reconstruction in addressing high-grade pivot-shift phenomenon. Arthroscopy. 2016;32(5):898-905.
39.
Sonnery-CottetBBarbosaNCVieiraTDSaithnaA. Clinical outcomes of extra-articular tenodesis/anterolateral reconstruction in the ACL injured knee. Knee Surg Sports Traumatol Arthrosc. 2018;26(2):596-604.
40.
Sonnery-CottetBSaithnaACavalierM, et al. Anterolateral ligament reconstruction is associated with significantly reduced ACL graft rupture rates at a minimum follow-up of 2 years: a prospective comparative study of 502 patients from the SANTI Study Group. Am J Sports Med. 2017;45(7):1547-1557.
41.
SpindlerKPHustonLJWrightRW, et al. The prognosis and predictors of sports function and activity at minimum 6 years after anterior cruciate ligament reconstruction: a population cohort study. Am J Sports Med. 2011;39(2):348-359.
42.
SpindlerKPParkerRDAndrishJT, et al. Prognosis and predictors of ACL reconstructions using the MOON cohort: a model for comparative effectiveness studies. J Orthop Res. 2013;31(1):2-9.
43.
Van DyckPDe SmetERoelantEParizelPMHeusdensCHW. Assessment of anterolateral complex injuries by magnetic resonance imaging in patients with acute rupture of the anterior cruciate ligament. Arthroscopy. 2019;35(2):521-527.
44.
WangYMartel-PelletierJTeichtahlAJ, et al. The bulge sign—a simple physical examination for identifying progressive knee osteoarthritis: data from the Osteoarthritis Initiative. Rheumatology (Oxford). 2020;59(6):1288-1295.
45.
WrightRWMagnussenRADunnWRSpindlerKP. Ipsilateral graft and contralateral ACL rupture at five years or more following ACL reconstruction: a systematic review. J Bone Joint Surg Am. 2011;93(12):1159-1165.
