Single photon emission computerized tomography and conventional computerized tomography (SPECT/CT) for evaluation of patients after anterior cruciate ligament reconstruction: a novel standardized algorithm combining mechanical and metabolic information

Hirschmann, Michael T.; Mathis, Dominic T.; Afifi, Faik K.; Rasch, Helmut; Henckel, Johann; Amsler, Felix; Wagner, Christopher R.; Friederich, Niklaus F.; Arnold, Markus

doi:10.1007/s00167-012-2083-6

Cited by 29 publications

(33 citation statements)

References 22 publications

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“…Numerous authors have highlighted the clinical value of 3D-CT for the assessment of tunnel position after ACL reconstruction [7][8][9][10][11][12]. Thus, 3D reconstructed CT images are increasingly used to investigate the femoral and tibial tunnel position after ACL reconstruction [7-9, 11, 12].…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…SPECT/CT allows accurate anatomical localisation of metabolic tracer activity [9]. Recently, we have introduced a novel diagnostic SPECT/CT algorithm for the challenging group of patients with problems after ACL reconstruction [6,9,14,15]. This standardised algorithm including grading and anatomical localization of SPECT/CT tracer uptake promises the identification of specific pathological tracer uptake patterns and distributions [9].…”

Section: Introductionmentioning

confidence: 99%

“…Recently, we have introduced a novel diagnostic SPECT/CT algorithm for the challenging group of patients with problems after ACL reconstruction [6,9,14,15]. This standardised algorithm including grading and anatomical localization of SPECT/CT tracer uptake promises the identification of specific pathological tracer uptake patterns and distributions [9]. It now allows the correlation of surgical factors such as tunnel position and orientation with mechanical alignment, clinical outcome and biological factors [9,16].…”

Section: Introductionmentioning

confidence: 99%

“…This standardised algorithm including grading and anatomical localization of SPECT/CT tracer uptake promises the identification of specific pathological tracer uptake patterns and distributions [9]. It now allows the correlation of surgical factors such as tunnel position and orientation with mechanical alignment, clinical outcome and biological factors [9,16]. It also promises the critical assessment of the osseointegration of the bonegraft-fixation complex.…”

Section: Introductionmentioning

confidence: 99%

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SPECT/CT tracer uptake is influenced by tunnel orientation and position of the femoral and tibial ACL graft insertion site

Hirschmann

Mathis

Rasch

et al. 2012

International Orthopaedics (SICOT)

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Purpose SPECT/CT is a hybrid imaging modality, which combines a 3D scintigraphy (SPECT) and a conventional computerised tomography (CT). SPECT/CT allows accurate anatomical localisation of metabolic tracer activity. It allows the correlation of surgical factors such as tunnel position and orientation with mechanical alignment, clinical outcome and biological factors. The purpose of this study was to investigate whether the SPECT/CT tracer uptake (intensity and distribution) correlates with the stability and laxity of the knee joint and the position and orientation of the tibial and femoral tunnels in patients after anterior cruciate ligament (ACL) reconstruction. Methods A consecutive series of knees (n066), with symptoms of pain and/or instability after ACL reconstruction were prospectively evaluated using clinical examination and 99mTc-HDP-SPECT/CT. Clinical laxity testing was performed using the Rolimeter (Ormed, Freiburg, Germany) including Lachman testing (0-2 mm, 3-5 mm, 6-10 mm, >10 mm), anterior drawer test (0-2 mm, 3-5 mm, 6-10 mm, >10 mm), pivot shift test (positive versus negative) and patientbased subjective instability (yes versus no).For analysis of SPECT/CT tracer uptake a previously validated SPECT/CT localisation scheme consisting of 17 tibial, nine femoral and four patellar regions on standardised axial, coronal, and sagittal slices was used. The tracer activity on SPECT/CT was localised and recorded using a 3D volumetric and quantitative analysis software.Mean, standard deviation, minimum and maximum of grading for each area of the localisation scheme were recorded. The position and orientation of the tibial and femoral tunnel was assessed using a previously published method on 3D-CT. Results Correlation of instability, pivot shift as well as clinical laxity testing with 99mTc-HDP-SPECT/CT tracer uptake intensity and distribution showed no significant correlation. 99mTc-HDP-SPECT/CT tracer uptake correlated significantly with the position and orientation of the ACL graft. A more horizontal femoral graft position showed significantly increased tracer uptake within the superior and posterior femoral regions. A more posteriorly-placed femoral insertion site showed significantly more tracer uptake within the femoral and tibial tunnel regions. A more vertical or a less medial tibial tunnel orientation showed significant increased uptake within the tibial and femoral tunnel regions. A more anterior tibial tunnel position showed significantly more tracer uptake in the femoral and tibial tunnel regions as well as the entire tibiofemoral joint. Conclusions SPECT/CT tracer uptake intensity and distribution showed a significant correlation with the femoral and tibial tunnel position and orientation in patients with symptomatic knees after ACL reconstruction. No correlation was found with stability or clinical laxity.Michael T. Hirschmann and Dominic Mathis contributed equally to this paper.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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SPECT/CT tracer uptake is influenced by tunnel orientation and position of the femoral and tibial ACL graft insertion site

Hirschmann

Mathis

Rasch

et al. 2012

International Orthopaedics (SICOT)

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Comparison of volumetric bone mineral density in the operated and contralateral knee after anterior cruciate ligament and reconstruction: A 1‐year follow‐up study using peripheral quantitative computed tomography

Mündermann

Payer

Felmet

et al. 2015

Journal Orthopaedic Research

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The purpose of this study was to quantify changes in volumetric bone mineral density (vBMD) in the tibial plateau of the operated and contralateral leg measured using peripheral quantitative computed tomography (pQCT) before and 3, 6, and 12 months after anterior cruciate ligament (ACL) reconstruction. The ACL was reconstructed with a hamstring tendon autograft using press-fit fixation. pQCT measurements of the proximal tibia were obtained in 61 patients after ACL reconstruction, and total, cortical, and trabecular vBMD were calculated. vBMD in the operated leg decreased from baseline to 3 months (À12% [total], À11% [cortical], and À12.6% [trabecular]; p < 0.001) and remained below baseline for 12 months after surgery (6 months: À9.5%, À9.4%, and À9.6%, p < 0.001; 12 months: À8%, À5%, and À11%, p < 0.001). vBMD in the contralateral leg was slightly reduced only 6 months after surgery. Including age and sex as covariates into the analysis did not affect the results. ACL reconstruction contributed to loss in bone mineral density within the first year after surgery. The role of factors such as time of weight-bearing, joint mechanics, post-traumatic inflammatory reactions, or genetic predisposition in modulating the development of posttraumatic knee osteoarthritis after ACL injury should be further elucidated. ß

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34 A Diagnostic Algorithm for Patients with Painful Total Knee Replacement: What to Do When

Hirschmann

2015

The Unhappy Total Knee Replacement

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Single photon emission computerized tomography and conventional computerized tomography (SPECT/CT) for evaluation of patients after anterior cruciate ligament reconstruction: a novel standardized algorithm combining mechanical and metabolic information

Abstract: The SPECT/CT algorithm presented is highly reliable and clinically feasible. Combining the 3D-mechanical information on tunnel placement and attachment areas and the 3D metabolic data will be helpful in evaluating patients with pain after ACL reconstruction.

Cited by 29 publications

References 22 publications

SPECT/CT tracer uptake is influenced by tunnel orientation and position of the femoral and tibial ACL graft insertion site

SPECT/CT tracer uptake is influenced by tunnel orientation and position of the femoral and tibial ACL graft insertion site

Comparison of volumetric bone mineral density in the operated and contralateral knee after anterior cruciate ligament and reconstruction: A 1‐year follow‐up study using peripheral quantitative computed tomography

34 A Diagnostic Algorithm for Patients with Painful Total Knee Replacement: What to Do When

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