MRI evaluation to predict tendon size for knee ligament reconstruction

Abstract

SummaryBackground: The aim of this study is to evaluate a possible correlation between specific anthropometric parameters and sizes of knee tendons commonly used for ACL reconstruction. We hypothesized that specific clinical and radiological knee measurements could be better tendon sizes predictors than age, gender, height and weight. Materials and methods: 100 consecutive patients were enrolled and 77 patients met the inclusion criteria of the study. All patients underwent a MRI of the knee with a 1.5 T super conducting MR System. For each patient, anthropometric data such as gender, height, weight, body mass index (BMI) and knee circumference were recorded. Specific MRI knee measurements were performed on each study: patellar tendon (PT) thickness and length, quadriceps tendon (QT) thickness, semitendinosus tendon (ST) diameter, gracilis tendon (GR) diameter, the largest patella and intercondylar width. Results: The mean ST diameter, QT thickness and PT thickness were higher in males than in females. No significant differences were noted between males and females concerning GT diameter and the knee circumference. In addition, male knees had greater patellar and intercondylar width than female knees. Significant, but only weak correlations were found between patient anthropometric data and hamstrings diameter, PT length, and QT and PT thickness. Intercondylar and patellar width present a moderate correlation between PT thickness, PT length and ST diameter. Conclusion:The intercondylar and patellar width presented a moderate correlation with PT thickness, PT length and ST diameter. Further, weak correlations were found between patient anthropometric data (gender, weight, height, BMI) and GR and ST diameter, PT length, and QT and PT thickness. This results may help surgeons during preoperative planning, specifically regarding graft choice and size. Level of evidence: III.

Clinical Anatomy of the Ligament of the Head of Femur

“…Also to obtain the full mechanical benefits of the graft, it is suggested that all proximal ligament attachment sites identified in this study might be considered during graft fixations, in addition to the posteroinferior aspect of the acetabular fossa that is commonly used as a fixation site (Simpson et al, 2011;Philippon et al, 2012;Mei-Dan and McConkey, 2014). Studies at the knee joint have demonstrated that an anatomical structure serving mechanical stability to a joint correlates to articular or body size (Camarda et al, 2018;Matsumoto et al, 2018). In the hip, it is also reported that the size of the FCF and the HOF correlate with each other and the femoral length (Hay, 1996;Perumal et al, 2017).…”

“…Studies at the knee joint have demonstrated that an anatomical structure serving mechanical stability to a joint correlates to articular or body size (Camarda et al, ; Matsumoto et al, ). In the hip, it is also reported that the size of the FCF and the HOF correlate with each other and the femoral length (Hay, ; Perumal et al, ).…”

MRI scans do not accurately predict hamstring graft diameter for ACL reconstruction

“…Table I. Following critical review of these papers the highest correlation score of 0.86 4 was achieved with only one surgeon and only one measurement at two times magnification. The 0.4 score seen in one paper 2 used a more robust technique of four times magnification and repeat measurements similar to our technique.…”

“…Our aim was to determine the reproducibility of MR graft measurements between two readers pre-operatively and to produce a measure of accuracy, rather than correlation between the MR measurements and the actual graft size. The previous literature has attempted pre-operative measurements of hamstring diameter and cross sectional area [1][2][3][4][5][6] . The diameter readings have shown poorer correlation and therefore we have focused on cross sectional area of the tendons as per the existing literature.…”

“…Several papers have attempted to predict hamstring graft size pre-operatively to facilitate planning for alternative grafts or techniques that may be used. Anthropometric data such as height and weight has been used to try and predict graft size but Camarda et al 4 have shown better correlation with radiological data from MR scanning. Table I shows the previous results on prediction of graft size [5][6][7][8][9] .…”