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Assessment of knee instability in ACL-injured knees using weight-bearing computed tomography (WBCT): a novel protocol and preliminary results

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Abstract

Objective

To propose a protocol for assessing knee instability in ACL-injured knees using weight-bearing computed tomography (WBCT).

Materials and methods

We enrolled five patients with unilateral chronic ACL tears referred for WBCT. Bilateral images were obtained in four positions: bilateral knee extension, bilateral knee flexion, single-leg stance with knee flexion and external rotation, and single-leg stance with knee flexion and internal rotation. The radiation dose, time for protocol acquisition, and patients’ tolerance of the procedure were recorded. A blinded senior radiologist assessed image quality and measured the anterior tibial translation (ATT) and femorotibial rotation (FTR) angle in the ACL-deficient and contralateral healthy knee.

Results

All five patients were male, aged 23–30 years old. The protocol resulted in a 16.2 mGy radiation dose and a 15-min acquisition time. The procedure was well-tolerated, and patient positioning was uneventful, providing good-quality images. In all positions, the mean ATT and FTR were greater in ACL-deficient knees versus the healthy knee, with more pronounced differences observed in the bilateral knee flexion position. Mean lateral ATT in the flexion position was 9.1±2.8 cm in the ACL-injured knees versus 4.0±1.8 cm in non-injured knees, and mean FTR angle in the bilateral flexion position was 13.5°±7.7 and 8.6°±4.6 in the injured and non-injured knees, respectively.

Conclusion

Our protocol quantitatively assesses knee instability with WBCT, measuring ATT and FTR in diverse knee positions. It employs reasonable radiation, is fast, well-tolerated, and yields high-quality images. Preliminary findings suggest ACL-deficient knees show elevated ATT and FTR, particularly in the 30° flexion position.

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Author information

Authors and Affiliations

  1. Hospital Sírio-Libanês, Institute of Radiology, R. Ovidio Pires de Campos, 65, São Paulo, 05403-911, Brazil

    Renata Vidal Leão & Carlos Felipe Teixeira Lobo

  2. Knee Group, Institute of Orthopaedics and Traumatology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil

    Sandro Ricardo Benites Zelada, Andre Giardino Moreira da Silva, Riccardo Gomes Gobbi & Camilo Partezani Helito

  3. Department of Orthopedic Surgery, University of São Paulo, São Paulo, Brazil

    Alexandre Leme Godoy-Santos

  4. Department of Radiology, Aspetar Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar

    Paulo Victor Partezani Helito

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  1. Renata Vidal Leão
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  2. Sandro Ricardo Benites Zelada
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Contributions

RVL and SZ: conceived the study and wrote the first draft of the manuscript.

CFTL: helped with manuscript writing and image selection.

AG and ALG-S: helped with final manuscript review.

RGG: helped in study design and with final manuscript review.

PVPH: image selection and final review of the manuscript.

CPH: helped in study design, data analysis, and final review.

Corresponding author

Correspondence to Renata Vidal Leão.

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Leão, R.V., Zelada, S.R.B., Lobo, C.F.T. et al. Assessment of knee instability in ACL-injured knees using weight-bearing computed tomography (WBCT): a novel protocol and preliminary results. Skeletal Radiol (2024). https://doi.org/10.1007/s00256-024-04562-1

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  • DOI: https://doi.org/10.1007/s00256-024-04562-1

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