Clinico-Radiological Correlation Between Anterior Cruciate Ligament Deficiency and Hyperextension of the Knee Joint: A Prospective Study

TL;DR

This study shows that a torn anterior cruciate ligament in the knee can lead to mild hyperextension, which contributes to knee instability and should be addressed during surgery.

Contribution

The study quantifies the relationship between ACL deficiency and knee hyperextension using a prospective clinical and radiological approach.

Findings

ACL deficiency is associated with measurable knee hyperextension, with a strong correlation between clinical and radiological assessments.

Hyperextension caused by ACL tears is typically less than five degrees but still contributes to significant instability.

Posterior tibial slope and notch width index showed no significant correlation with hyperextension in this study.

Abstract

Introduction: The anterior cruciate ligament (ACL) primarily restricts anterior sliding of the tibia over the fixed femur, thereby also postulating to prevent hyperextension of the knee joint. The main objective of our study was to identify the role of the ACL in the prevention of knee hyperextension and to quantify the amount of hyperextension caused by an ACL tear, apart from its well-established role in the prevention of anterior tibial translation on the fixed femur.

Methods: This prospective study was conducted in a tertiary care hospital. Eighty patients with unilateral ACL tears were assessed clinico-radiologically in the preoperative period to quantify the knee hyperextension, which was then compared with the uninjured contralateral knee of the same patient. Posterior tibial slope and notch width index were also assessed to rule out bias in our study.

Results: The mean age of patients in our study was 27.3 years. Out of 80 patients, 70 were male and 10 were female. The Pearson coefficient for clinically and radiologically assessed hyperextension was 0.919 (p-value 0.001) and 0.910 (p-value 0.001), respectively. Posterior tibial slope and notch width index assessment showed Pearson coefficients of -0.018 (p-value 0.887) and -0.068 (p-value 0.547), respectively.

Conclusion: Anterior cruciate ligament complete tear or deficiency produces knee hyperextension, which varies from patient to patient. Though the amount of hyperextension produced is mild (less than five degrees in most patients), it can cause a significant amount of knee instability. Hence, correction of knee hyperextension is crucial while performing ACL reconstruction.

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