Tibiofemoral Kinematics of the Anterior Cruciate Ligament (ACL)-Deficient Weightbearing, Living Knee Employing Vertical Access Open “Interventional” Multiple Resonance Imaging

Abstract

Background Our current understanding of tibiofemoral kinematics in the anterior cruciate ligament (ACL)-deficient knee is very limited. Using vertical open-access MRI, it is possible to accurately analyze tibiofemoral motion in patients with isolated rupture of the ACL. Study Prospective cohort study. Purpose To assess if ACL rupture alters normal knee weightbearing kinematics. Methods Tibiofemoral motion was assessed through the arc of flexion from 0 ° to 90 ° in 10 patients with isolated rupture of the ACL in one knee and a normal contralateral knee. Midmedial and midlateral sagittal images were analyzed in all positions of flexion in both knees to assess the tibiofemoral relationship. Results In the lateral compartment of the knee, the tibial plateau is persistently subluxed anteriorly throughout the arc of flexion from 0 ° to 90 ° (flexion facet center to posterior tibial cortex distance of 15.8 mm ± 2.9 in ACL-deficient knees compared to 21.4 mm ± 1.4 in normal knees at 0 ° extension, P< .0001) when compared to normal knees. The medial tibiofemoral relationship is unchanged compared to normal knees. Conclusion Rupture of the ACL changes tibiofemoral kinematics producing anterior subluxation of the lateral tibial plateau. Clinical Significance Altered kinematics may explain, at least in part, the increased incidence of secondary osteoarthritis in patients with ACL rupture.