Inter- and Intrarater Reliability of the Femoral Tunnel Clock-Face Grading System During Anterior Cruciate Ligament Reconstruction

Mehta, Vishal; Petsche, Timothy S.; Rawal, Ashish

doi:10.1016/j.arthro.2016.07.028

Cited by 7 publications

(8 citation statements)

References 16 publications

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“…[2][3][4]17,23,24 However, it is also well established that conventional arthroscopic methods of femoral graft localization are lacking with respect to accuracy. 6,13,25,30,37 Recent work has focused on the anatomic reconstruction of the femoral footprint using preoperative imaging as a guide, with various groups utilizing magnetic resonance imaging (MRI) and computed tomography (CT) for femoral footprint characterization. 1,4,5,7,12,20,33 In particular, it has previously been demonstrated, using 3-dimensional (3D) MRI, that ACL graft placement at least partially overlaps the true ACL footprint 67% of the time.…”

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confidence: 99%

Reliability of Anatomic Bony Landmark Localization of the ACL Femoral Footprint Using 3D MRI

Sivakumaran

Jaffer

Marwan

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: Nonanatomic placement of anterior cruciate ligament (ACL) grafts is a leading cause of ACL graft failure. Three-dimensional (3D) magnetic resonance imaging (MRI) femoral footprint localization could enhance planning for an ACL graft's position. Purpose: To determine the intra- and interobserver reliability of measurements of the ACL femoral footprint position and size obtained from 3D MRI scans. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 41 patients with complete ACL tears were recruited between November 2014 and May 2016. Preoperatively, a coronal-oblique proton-density fast spin echo 3D acquisition of the contralateral uninjured knee was obtained along the plane of the ACL using a 1.5T MRI scanner. ACL footprint parameters were obtained independently by 2 musculoskeletal radiologists (observers A and B). The distal and anterior positions of the center of the footprint were measured relative to the apex of the deep cartilage at the posteromedial aspect of the lateral femoral condyle, and the surface area of the ACL femoral footprint was approximated from multiplanar reformatted images. After 1 month, the measurements were repeated. Intraclass correlation coefficients (ICCs) were calculated to assess for intra- and interobserver reliability. Bland-Altman plots were produced to screen for potential systematic bias in measurement and to calculate limits of agreement. Results: The ICCs for intraobserver reliability of the ACL femoral distal and anterior footprint coordinates were 0.75 and 0.78, respectively, for observer A. For observer B, they were 0.75 and 0.74, respectively. The ICCs for interobserver reliability were 0.75 and 0.85 for the distal and anterior coordinates, respectively. Bland-Altman plots demonstrated no significant systematic bias. For surface area measurements, the intraobserver ICCs were 0.37 and 0.62 for observers A and B, respectively. The interobserver reliability was 0.60. Observer B consistently measured the footprints as slightly larger versus observer A (1.19 ± 0.27 vs 1 ± 0.22 cm2, respectively; P < .001). Conclusion: Locating the center of the anatomic footprint of the ACL with 3D MRI showed substantial intra- and interobserver agreement. Interobserver agreement for the femoral footprint surface area was fair to moderate.

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confidence: 99%

Reliability of Anatomic Bony Landmark Localization of the ACL Femoral Footprint Using 3D MRI

Sivakumaran

Jaffer

Marwan

et al. 2021

Orthopaedic Journal of Sports Medicine

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“…The inside-out femoral tunnel was placed 7 mm from the posterior border of the lateral femoral condyle at the 9 o'clock position for a right knee and at the 3 o'clock position for a left knee, using the ACL remnants as anatomic reference. 14 , 15 , 16 The tibial tunnel is made according to standard protocol. Leaving the knee at 90° of flexion, the surgeon then passes the graft from the tibia to the femur.…”

Section: Surgical Techniquementioning

confidence: 99%

“… 6 , 8 , 9 , 10 , 11 , 12 , 13 Several techniques have been developed to try to anatomically address tunnels in the setting of an ACL reconstruction; however, an anatomic positioning does not necessarily indicate maintenance of integrity of the tunnels, specifically the femoral tunnel. 10 , 14 , 15 , 16 , 17 …”

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A Femoral Tunnel View Test During ACL Reconstruction

Temponi

Soares

Júnior

2017

Arthroscopy Techniques

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Despite technologic advances in the surgical techniques for anterior cruciate ligament (ACL) reconstruction, some patients continue to have violation of the femoral cortex, commonly referred to as wall blowout. These posterior or lateral cortical breaches lead to loss of graft containment and subsequent difficulty with graft fixation. If this intraoperative error is not promptly recognized and treated, the graft is at an increased risk of premature failure. Thus, in these situations, recognizing the complication and knowing strategies for alternative or salvage fixation are of importance. This article details a simple tunnel view test realized during ACL reconstruction that would enable determining the integrity and depth of the femoral tunnel. The femoral tunnel view test is a technically straightforward and quick test able to obtain a superior view of patient anatomy to facilitate accurate tunnel integrity evaluation during ACL reconstruction.

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“…2,5 Owing to variations in the anatomy of the ACL footprints among patients, creating anatomic ACL tunnels is challenging despite the various techniques and tools available to surgeons. 6,11,14,17,20,30 In previous studies using 3-dimensional magnetic resonance imaging (3D MRI), 6,11,14,20,30 significant mismatch between the native footprint and the reconstructed ones has been reported. The aim of this study was to compare the position of the tunnels created by a standard technique with the ones that are created using preoperatively assessed 3D MRI measurements of the anatomic footprint of the ACL (roadmapped technique).…”

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confidence: 99%

Three-Dimensional Magnetic Resonance Imaging for Guiding Tibial and Femoral Tunnel Position in Anterior Cruciate Ligament Reconstruction: A Cadaveric Study

Marwan

Böttcher

Laverdière

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: Femoral and tibial tunnel malposition for anterior cruciate ligament (ACL) reconstruction (ACLR) is correlated with higher failure rate. Regardless of the surgical technique used to create ACL tunnels, significant mismatches between the native and reconstructed footprints exist. Purpose: To compare the position of tunnels created by a standard technique with the ones created based on preoperative 3-dimensional magnetic resonance imaging (3D MRI) measurements of the ACL anatomic footprint. Study Design: Controlled laboratory study. Methods: Using 3D MRI, the native ACL footprints were identified. Tunnels were created on 16 knees (8 cadavers) arthroscopically. On one knee of a matched pair, the tunnels were created based on 3D MRI measurements that were provided to the surgeon (roadmapped technique), while on the contralateral knee, the tunnels were created based on a standard anatomic ACLR technique. The technique was randomly assigned per set of knees. Postoperatively, the positions of the tunnels were measured using 3D MRI. Results: On the tibial side, the median distance between the center of the native and reconstructed ACL footprints in relation to the root of the anterior horn of the lateral meniscus medially was 1.7 ± 2.2 mm and 1.9 ± 2.8 mm for the standard and roadmapped techniques, respectively ( P = .442), while the median anteroposterior distance was 3.4 ± 2.4 mm and 2.5 ± 2.5 mm for the standard and roadmapped techniques, respectively ( P = .161). On the femoral side, the median distance in relation to the apex of the deep cartilage (ADC) distally was 0.9 ± 2.8 mm and 1.3 ± 2.1 mm for the standard and roadmapped techniques, respectively ( P = .195), while the median distance anteriorly from the ADC was 1.2 ± 1.3 mm and 4.6 ± 4.5 mm for the standard and roadmapped techniques, respectively ( P = .007). Conclusion: Providing precise radiological measurements of the ACL footprints does not improve the surgeon’s ability to position the tunnels. Future studies should continue to attempt to provide tools to improve the tunnel position in ACLR. Clinical Relevance: This cadaveric study indicates that despite the use of 3D MRI in understanding the ACL anatomy, re-creating the native ACL footprints remains a challenge.

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Inter- and Intrarater Reliability of the Femoral Tunnel Clock-Face Grading System During Anterior Cruciate Ligament Reconstruction

Cited by 7 publications

References 16 publications

Reliability of Anatomic Bony Landmark Localization of the ACL Femoral Footprint Using 3D MRI

Reliability of Anatomic Bony Landmark Localization of the ACL Femoral Footprint Using 3D MRI

A Femoral Tunnel View Test During ACL Reconstruction

Three-Dimensional Magnetic Resonance Imaging for Guiding Tibial and Femoral Tunnel Position in Anterior Cruciate Ligament Reconstruction: A Cadaveric Study

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