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The In Vivo Assessment of Tibial Motion in the Transverse Plane in Anterior Cruciate Ligament-Reconstructed Knees

William E. Nordt, III, MD^*,,, Paymaun Lotfi, MD, Eric Plotkin, RRT^*, and Brian Williamson, MD

^* West End Orthopaedic Clinic, Richmond, Virginia
Henrico Doctors’ Hospital, Richmond, Virginia
Medical College of Virginia, Richmond, Virginia

Address correspondence and reprint requests to William E. Nordt III, MD, West End Orthopaedic Clinic, 7601 Forest Avenue, Suite 228, Richmond, VA 23229

Twenty-one knees with acutely injured anterior cruciate ligaments were reconstructed with patellar tendon autografts. Eight of the knees had concomitant medial ligament injuries that were not addressed surgically. Follow-up evaluation (average, 25 months) included computed tomography measurements to analyze transverse-plane laxity in both translation and rotation. These measurements were performed with the patient’s leg in a load cell device that stabilizes the distal femur and applies known anterior translational force to the proximal tibia at approximately 20° of flexion. A torque apparatus was used to apply internal and external rotational torque to the leg. Images of the tibial plateau in neutral, internal, and external rotation were performed, with and without an anterior translational force. Both knees of each patient were tested and categorized as group I (anterior cruciate ligament-reconstructed) or group II (uninjured). Translation as meas-ured by computed tomography averaged 1 mm side-to-side difference. Internal rotation averaged 8.7° in group I knees and 10.8° in group II knees. External rotation averaged 9.1° in group I knees and 7.4° in group II knees. The eight knees with concomitant medial ligament injuries were analyzed separately; external rotation without anterior load in group I was 9.5°, compared with 5° in group II. This difference was significant (P < 0.01).

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