title: The Influence of Meniscal and Anterolateral Capsular Injury on Knee Laxity in Patients With Anterior Cruciate Ligament Injuries.
abstract: The role of the anterolateral capsule (ALC) as a secondary restraint to quantitative rotatory laxity of patients with an anterior cruciate ligament (ACL) injury is currently debated.
  
  
  
  The purpose was to determine the influence of concomitant ALC injuries as well as injuries to other soft tissue structures on rotatory knee laxity in patients with an ACL injury. It was hypothesized that a concomitant ALC injury would be associated with increased rotatory knee laxity as measured during a quantitative pivot-shift test.
  
  
  
  Cross-sectional study; Level of evidence, 3.
  
  
  
  Forty-one patients with an ACL injury (average age, 23 ± 6.9 years) were enrolled. Two blinded musculoskeletal radiologists reviewed magnetic resonance imaging (MRI) scans for the presence of ACL injuries and concomitant soft tissue injuries including the ALC, medial collateral ligament, lateral collateral ligament, posterolateral corner, medial meniscus, and lateral meniscus. A standardized pivot-shift test was performed under anesthesia, and rotatory laxity was quantified according to anterior translation of the lateral tibial compartment during the pivot-shift maneuver. The Student t test was used to analyze the data. Statistical significance was set at P < .05.
  
  
  
  A complete ACL rupture was confirmed in all of the patients. MRI evidence of an ALC injury was observed in 21 (51%) of the patients. Patients with MRI evidence of an ALC injury had significantly higher rotatory knee laxity (3.6 ± 1.5 mm) compared with those without an ALC injury (2.7 ± 1.5 mm; P = .04). Lateral and medial meniscus injuries were detected in 17 (41%) and 19 (46%) patients, respectively. Patients with MRI evidence of either a medial meniscus injury or lateral meniscus injury had significantly higher rotatory knee laxity compared with patients without these injuries (medial meniscus: 3.7 ± 1.4 mm vs 2.7 ± 1.6 mm, respectively; lateral meniscus: 3.7 ± 1.7 mm vs 2.7 ± 1.3 mm, respectively) (P = .03 for both).
  
  
  
  MRI evidence of a concomitant injury to the ALC, medial meniscus, or lateral meniscus is associated with increased knee rotatory laxity in patients with an ACL injury. These structures may function as important secondary stabilizers in an ACL-injured knee. Careful assessment and proper treatment of injuries to these secondary stabilizers should be considered, especially in knees with a high level of the pivot shift.
authors: Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA musahlv@upmc.edu.
authors: Volker
authors: V
authors: Musahl
authors: Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors: Ata A
authors: AA
authors: Rahnemai-Azar
authors: Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors: Joanna
authors: J
authors: Costello
authors: Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors: Justin W
authors: JW
authors: Arner
authors: Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors: Freddie H
authors: FH
authors: Fu
authors: Department of Orthopaedic Surgery, Kobe University, Kobe, Japan.
authors: Yuichi
authors: Y
authors: Hoshino
authors: Istituto Ortopedico Rizzoli, Bologna, Italy.
authors: Nicola
authors: N
authors: Lopomo
authors: Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden.
authors: Kristian
authors: K
authors: Samuelsson
authors: Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors: James J
authors: JJ
authors: Irrgang
mesh_terms: D000293:Adolescent; D000328:Adult; D016118:Anterior Cruciate Ligament / Q000503:physiopathology*; D000070598:Anterior Cruciate Ligament Injuries / Q000503:physiopathology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000503:physiopathology*; D007718:Knee Injuries / Q000503:physiopathology; D007719:Knee Joint / Q000503:physiopathology*; D017844:Lateral Ligament, Ankle / Q000503:physiopathology; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008592:Menisci, Tibial / Q000503:physiopathology; D012421:Rupture / Q000503:physiopathology; D013977:Tibia / Q000503:physiopathology; D000070600:Tibial Meniscus Injuries; D055815:Young Adult
keywords: ACL; MRI; anterior cruciate ligament; anterolateral capsule; anterolateral ligament; lateral meniscus; medial meniscus; pivot shift; quantitative; rotatory laxity