Anterior intermeniscal ligament: frequency in MRI studies and spatial relationship to the entry point for intramedullary
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ORIGINAL ARTICLE
Anterior intermeniscal ligament: frequency in MRI studies and spatial relationship to the entry point for intramedullary tibial nailing related to the risk of iatrogenic violation Joerg Franke1 · Kersten Mueckner2 · Volker Alt3 · Reinhard Schnettler4 · Anissa Paulina Franke1 · Sebastian Griewing4 · Bernd Hohendorff1 Received: 13 May 2018 / Accepted: 24 September 2018 © Springer-Verlag GmbH Germany, part of Springer Nature 2018
Abstract Background Anterior knee pain is the most common complication after intramedullary tibial nailing. Often, the cause is multifactorial and individually different. Violation of the anterior intermeniscal ligament (AIL) during intramedullary tibial nailing might be a possible origin of postsurgical anterior knee pain. Both the importance and function of the AIL remain somewhat ambivalent, and even the figures quoted in the literature for its existence in the population vary drastically. Our aim was to verify the estimated frequency of the AIL in the literature by retrospectively analysing the data of MRI studies conducted at our hospital. In addition, we attempted to assess the potential risk of AIL violation during intramedullary tibial nailing, based on the spatial arrangement. Methods Two independent examiners analysed the images generated in 351 MRI studies conducted at our hospital between June 2013 and May 2014. All cases who did not reveal any previous knee-joint injury or osteoarthritis of the knee were allocated to group I. All other cases were included in group II. To estimate the potential risk of AIL injury during the nailing procedure, the distance between the AIL and the theoretical entry point for intramedullary nailing was measured. Results We identified the AIL on the images of nearly all patients (96.5%) in group I. In group II, the presence of the AIL was confirmed in only 51.4% of cases (p 0.59. The exact binomial test (Fisher exact test) was conducted and the reliability coefficient values detailed by Landis and Koch were used to interpret ICC. The second subject of inference was related
Of the 351 MRIs of the knee joint analysed retrospectively, 170 images were allocated to group I because they revealed no previous knee injury, severe osteochondral lesions, or osteoarthritis. A total of 181 cases were allocated to group II due to evidence of fractures, meniscus injuries, patella dislocation, ACL and/or PCL rupture, osteochondral lesions, or arthritis of the knee joint. Presence of the AIL was confirmed in 164/170 cases (96.5%) in group I. In group II, the AIL was detectable only in 93/181 cases (51.4%). This difference was found to be highly significant (Fisher test p
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