Clin Orthop Surg.  2013 Mar;5(1):19-25. 10.4055/cios.2013.5.1.19.

Prediction of Chronicity of Anterior Cruciate Ligament Tear Using MRI Findings

• Yoon JP
• Yoo JH
• Chang CB
• Kim SJ
• Choi JY
• Yi JH
• Kim TK

• KMID: 1402322
• DOI: http://doi.org/10.4055/cios.2013.5.1.19

Abstract

BACKGROUND
The estimation of anterior cruciate ligament (ACL) tear is required in certain cases involving legal and financial administration, such as the worker's compensation and/or insurance. The aim of this study is to propose and evaluate a quantitative evaluation instrument to estimate the chronicity of the ACL tear, based on the four magnetic resonance imaging (MRI) findings.
METHODS
One hundred and fifty one cases of complete ACL tear confirmed by arthroscopy were divided into 4 groups according to the time from ACL injury to MRI acquisition: acute (< 6 weeks), subacute (6 weeks to 3 months), intermediate (3 months to 1 year), and chronic (> 1 year). The four MRI findings including ACL morphology, joint effusion, posterior cruciate ligament angle, and bone bruise were analyzed for temporal changes among the 4 groups. Binary logistic regression equations were formulated using the MRI findings to estimate the chronicity of ACL tear in a quantitative manner, and the accuracy of the formulated regression equations was evaluated.
RESULTS
The four MRI findings showed substantial temporal correlation with the time-limits of ACL injury to be included in the estimation model. Three predictive binary logistic equations estimated the probability of the ACL injury for the three cutoff time-limits of 6 weeks, 3 months, and 1 year with accuracies of 82.1%, 89.4%, and 89.4%, respectively.
CONCLUSIONS
A series of predictive logistic equations were formulated to estimate the chronicity of ACL tear using 4 MRI findings with chronological significance.

Keyword

Anterior cruciate ligament; Chronicity; Magnetic resonance imaging; Predictive model

MeSH Terms

Adolescent
Adult
Anterior Cruciate Ligament/*injuries/surgery
Child
Chronic Disease
Female
Humans
Knee Injuries/*diagnosis
Logistic Models
Magnetic Resonance Imaging
Male
Middle Aged
Retrospective Studies
Time Factors
Young Adult

Figure

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  Fig. 1 Classification of anterior cruciate ligament (ACL) morphology on T2-weighted fat-suppressed magnetic resonance images. (A) Grade 1: early pattern of increased signal intensity and an edematous mass-like shape. (B) Grade 2: intermediate pattern of increased signal intensity with a fragmented shape. (C) Grade 3: low signal intensity and band-like fragmented shape. (D) Nonvisualization of the ACL.

• 

  Fig. 2 Bone bruise measured by signal contrast, which was defined as the ratio of mean signal intensity of a bone contusion (black circle) versus that of normal metaphyseal area (white circle).

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  Fig. 3 Equations by logistic regression models to estimate the chronicity of anterior cruciate ligament (ACL) tear. The ACL morphology (A1, A2), joint effusion (B), posterior cruciate ligament (PCL) angle (C), and bone contusion (D) were measured on magnetic resonance imaging, and the measured values were inserted into the 3 equations. Each equation represents the probability that the ACL tear occurred after the corresponding cutoff time of 6 weeks, 3 months, and 1 year, respectively. Thus, the probability that the injury chronicity was less than the cut-off time can be calculated by subtracting the probability that the ACL injury occurred at a point higher than the cut-off time from 1.

• 

  Fig. 4 A 33-year-old man underwent anterior cruciate ligament (ACL) injury 3 days before the magnetic resonance imaging (MRI) was taken. ACL morphology was grade 1 (A1 = 0, A2 = 0), joint effusion (B) was 10.6 mm, posterior cruciate ligament angle (C) was 138 degrees, and the bone contusion signal contrast (D) was 2.80. The logistic equations yield that the probability that the ACL injury occurred more than 6 weeks, 3 months, and 1 year is 12.9%, 1.5%, and 0.3%, respectively; and the probability that it occurred at less than each cutoff time is 87.1%, 98.5%, and 99.7%, respectively. This can be interpreted that the ACL tear must have occurred less than 6 weeks.

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