title: Single bundle anterior cruciate reconstruction does not restore normal knee kinematics at six months: an upright MRI study.
abstract: Abnormal knee kinematics following reconstruction of the anterior cruciate ligament may exist despite an apparent resolution of tibial laxity and functional benefit. We performed upright, weight-bearing MR scans of both knees in the sagittal plane at different angles of flexion to determine the kinematics of the knee following unilateral reconstruction (n = 12). The uninjured knee acted as a control. Scans were performed pre-operatively and at three and six months post-operatively. Anteroposterior tibial laxity was determined using an arthrometer and patient function by validated questionnaires before and after reconstruction. In all the knees with deficient anterior cruciate ligaments, the tibial plateau was displaced anteriorly and internally rotated relative to the femur when compared with the control contralateral knee, particularly in extension and early flexion (mean lateral compartment displacement: extension 7.9 mm (sd 4.8), p = 0.002 and 30° flexion 5.1 mm (sd 3.6), p = 0.004). In all ten patients underwent post-operative scans. Reconstruction reduced the subluxation of the lateral tibial plateau at three months, with resolution of anterior displacement in early flexion, but not in extension (p = 0.015). At six months, the reconstructed knee again showed anterior subluxation in both the lateral (mean: extension 4.2 mm (sd 4.2), p = 0.021 and 30° flexion 3.2 mm (sd 3.3), p = 0.024) and medial compartments (extension, p = 0.049).  Our results show that despite improvement in laxity and functional benefit, abnormal knee kinematics remain at six months and actually deteriorate from three to six months following reconstruction of the anterior cruciate ligament.
authors.affiliation: University of Aberdeen, Department of Orthopaedics, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK. j.a.nicholson.05@aberdeen.ac.uk
authors.forename: J A
authors.initials: JA
authors.lastname: Nicholson
authors.forename: A G
authors.initials: AG
authors.lastname: Sutherland
authors.forename: F W
authors.initials: FW
authors.lastname: Smith
mesh_terms: D000293:Adolescent; D000328:Adult; D016118:Anterior Cruciate Ligament / Q000601:surgery*; D000070598:Anterior Cruciate Ligament Injuries; D001265:Athletic Injuries / Q000601:surgery; D001696:Biomechanical Phenomena / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007718:Knee Injuries / Q000534:rehabilitation / Q000601:surgery*; D007719:Knee Joint / Q000473:pathology / Q000503:physiopathology*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D011446:Prospective Studies; D020127:Recovery of Function; D012421:Rupture / Q000601:surgery; D016896:Treatment Outcome; D016474:Weight-Bearing / Q000502:physiology; D055815:Young Adult