Compressed Lateral and anteroposterior Anatomical Systematic Sequences «CLASS»: compressed MRI sequences with assessed anatomical femoral and tibial ACL's footprints, a feasibility study

Thürig, Grégoire; Panadero-Morales, R.; Giovannelli, Luca; Kocher, Franziska; Peris, José Luis Aguilar; Tannast, Moritz; Petek, Daniel

doi:10.1186/s40634-022-00445-3

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“…In an effort to reduce the error of non-anatomical reconstruction of the MPFL, we evaluated an MRI-based method to localize a patient-specific MPFL femoral footprint that could then be identified intraoperatively using fluoroscopy. As described by Thürig et al 21 , MRI data have been used to generate 2D anteroposterior and lateral views of the knee. These could then serve as an intraoperative template during fluoroscopic determination of the optimal femoral tunnel placement.…”

Section: Discussionmentioning

confidence: 99%

“…Being able to determine an individ-ualized insertion point for the MPFL on a preoperative lateral radiographic view of the knee could help reduce reconstruction failures related to femoral tunnel malposition. To test our belief that the magnetic resonance imaging (MRI)-generated Compressed Lateral and anteroposterior Anatomical Systematic Sequence (CLASS) algorithm described by Thürig et al 21 can be used to better understand and locate an individualized MPFL femoral insertion 22 , we proposed the following study questions:…”

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confidence: 99%

“…Being able to determine an individualized insertion point for the MPFL on a preoperative lateral radiographic view of the knee could help reduce reconstruction failures related to femoral tunnel malposition. To test our belief that the magnetic resonance imaging (MRI)-generated Compressed Lateral and anteroposterior Anatomical Systematic Sequence (CLASS) algorithm described by Thürig et al 21 can be used to better understand and locate an individualized MPFL femoral insertion 22 , we proposed the following study questions: (1) What is the location of the anatomical MPFL femoral insertion identified with the CLASS MRI technique in reference to a standardized coordinate system? (2) What are the intrarater reproducibility and interrater reliability for identifying the anatomical MPFL femoral insertion using the CLASS MRI technique?…”

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Patient-Individualized Identification of Medial Patellofemoral Ligament Attachment Site to Femur Using “CLASS” MRI Sequences

Uso,

Thürig,

Heimann

et al. 2023

JBJS Open Access

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Background: Malposition of the femoral tunnel during medial patellofemoral ligament (MPFL) reconstruction may increase the risk of recurrence of patellar dislocation due to isometric changes during flexion and extension. Different methods have been described to identify the MPFL isometric point using fluoroscopy. However, femoral tunnel malposition was found to be the cause of 38.1% of revisions due to patellar redislocation. This high rate of malposition has raised the question of individual anatomical variability. Methods: Magnetic resonance imaging (MRI) was performed on 80 native knees using the CLASS (MRI-generated Compressed Lateral and anteroposterior Anatomical Systematic Sequence) algorithm to identify the femoral MPFL insertion. The insertions were identified on the MRI views by 2 senior orthopaedic surgeons in order to assess the reliability and reproducibility of the method. The distribution of the MPFL insertion locations was then described in a 2-plane coordinate system and compared with MPFL insertion locations identified with other methods in previously published studies. Results: The CLASS MPFL footprint was located 0.83 mm anterior to the posterior cortex (line 1) and 3.66 mm proximal to the Blumensaat line (line 2). Analysis demonstrated 0.90 and 0.89 reproducibility and 0.89 and 0.80 reliability of the CLASS method to identify the anatomical femoral MPFL insertion point. The distribution did not correlate with previously published data obtained with other methods. The definitions of the MPFL insertion point in the studies by Schöttle et al. and Fujino et al. most closely approximated the CLASS location in relation to the posterior femoral cortex, but there were significant differences between the CLASS method and all 4 previously published methods in relation to the proximal-distal location. When we averaged the distances from line 1 and line 2, the method that came closest to the CLASS method was that of Stephen et al., followed by the method of Schöttle et al. Conclusions: The CLASS algorithm is a reliable and reproducible method to identify the MPFL femoral insertion from MRI views. Measurement using the CLASS algorithm shows substantial individual anatomical variation that may not be adequately captured with existing measurement methods. While further research must target translation of this method to clinical use, we believe that this method has the potential to create a safe template for sagittal fluoroscopic identification of the femoral tunnel during MPFL surgical reconstruction. Level of Evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

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