Validation of an MRI Protocol for Routine Quantitative Assessment of Tunnel Position in Anterior Cruciate Ligament Reconstruction

Grasso, Samuel; Linklater, James; Li, Qing; Parker, David

doi:10.1177/0363546518758950

Cited by 22 publications

(16 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This protocol included volumetric and near isotropic (0.5 3 0.5 3 0.65 mm) turbo spin echo sequences, which allowed multiplanar reconstructions along the ACLR and subsequent accurate anatomic measurements previously validated against 3-dimensional computed tomography. 13 Femoral notch volume, graft measurement and orientation, tunnel locations, and graft SI were recorded.…”

Section: Mri Measurementmentioning

confidence: 99%

Graft Size and Orientation Within the Femoral Notch Affect Graft Healing at 1 Year After Anterior Cruciate Ligament Reconstruction

et al. 2019

Self Cite

View full text Add to dashboard Cite

Background: The combined influence of anatomic and operative factors affecting graft healing after anterior cruciate ligament (ACL) reconstruction within the femoral notch is not well understood. Purpose: To determine the influence of graft size and orientation in relation to femoral notch anatomy, with the signal/noise quotient (SNQ) of the graft used as a measure of graft healing after primary single-bundle ACL reconstruction. Study Design: Case series; Level of evidence, 4. Methods: A total of 98 patients with a minimum 2-year follow-up after primary single-bundle ACL reconstruction with hamstring tendon autografts were included. Graft healing was evaluated at 1 year on magnetic resonance imaging (MRI) scan as the mean SNQ measured from 3 regions situated at sites at the proximal, middle, and distal graft. Patient characteristics, chondropenia severity score, tunnel sizes, tunnel locations, graft bending angle (GBA), graft sagittal angle, posterior tibial slope (PTS), graft length, graft volume, femoral notch volume, and graft-notch volume ratio (measured using postoperative 3-T high-resolution MRI) were evaluated to determine any association with 1-year graft healing. The correlation between 1-year graft healing and clinical outcome at minimum 2 years was also assessed. Results: There was no significant difference in mean SNQ between male and female patients ( P > .05). Univariate regression analysis showed that a low femoral tunnel ( P = .005), lateral tibial tunnel ( P = .009), large femoral tunnel ( P = .011), large tibial tunnel ( P < .001), steep lateral PTS ( P = .010), steep medial PTS ( P = .004), acute graft sagittal angle ( P < .001), acute GBA ( P < .001), large graft volume ( P = .003), and high graft-notch volume ratio ( P < .001) were all associated with higher graft SNQ values. A multivariate regression analysis showed 2 significant factors: a large graft-notch volume ratio ( P = .001) and an acute GBA ( P = .004). The 1-year SNQ had a weak correlation with 2-year Tegner Activity Scale score ( r = 0.227; P = .026) but no other clinical findings, such as International Knee Documentation Committee subjective and Lysholm scores and anterior tibial translation side-to-side difference. Conclusion: The 1-year SNQ value had a significant positive association with graft-notch volume ratio and GBA. Both graft size and graft orientation appeared to have a significant influence on graft healing as assessed on 1-year high-resolution MRI scan.

show abstract

Section: Mri Measurementmentioning

confidence: 99%

Graft Size and Orientation Within the Femoral Notch Affect Graft Healing at 1 Year After Anterior Cruciate Ligament Reconstruction

et al. 2019

Self Cite

View full text Add to dashboard Cite

show abstract

“… 13 , 24 , 25 Grasso et al. 26 proposed an MRI protocol for routine quantitative assessment of tunnel position in ACL reconstruction, but MRI is not easily accessible.…”

Section: Discussionmentioning

confidence: 99%

Positioning of the Tibial Tunnel After Single-Bundle ACL Primary Reconstruction on 3D CT scans: A New Method

Cremer

Peltier

Maubisson

et al. 2020

Arthroscopy, Sports Medicine, and Rehabilitation

View full text Add to dashboard Cite

Purpose To assess intra-articular tunnel aperture positioning after primary anterior cruciate ligament (ACL) reconstruction with either the reference standard method or the intercondylar area method in a single center using 3-dimensional (3D) computed tomography (CT) scans and to evaluate the intra-articular position of the tibial tunnel relative to the ACL footprint. Methods 3D CT scans were performed after 120 single-bundle primary ACL reconstruction cases. The center of the tibial tunnel aperture and the center of the ACL footprint were referenced on axial views of the tibial plateau in the anteroposterior (AP) and mediolateral (ML) planes according to a centimetric grid system including the whole plateau (reference standard). This was compared with a grid system based on intercondylar area bony anatomy. The posterior aspect of intertubercular fossa, anterior aspect of the tibial plateau, medial intercondylar ridge, and crossing point between lateral intercondylar ridge and posterior margin were used as landmarks to define the grid. Results According to the reference standard method, the center of the tibial tunnel aperture was positioned 0.57 ± 2.62 mm more posterior and 0.67 ± 1.55 mm more medial than the center of the footprint. According to the intercondylar area method, the center of the tibial tunnel aperture was positioned 1.32 ± 2.74 mm more posterior and 0.66 ± 1.56 mm more medial than the center of the footprint. The position difference between the center of the tunnel aperture and the center of the footprint were statistically correlated for both grids, with r = –0.887, P < .001 for AP positioning and r = 0.615, P < .001 for ML positioning. Conclusion This intercondylar area method using arthroscopic landmarks can be used to assess tunnel placement on 3D CT scans after ACL reconstruction. Level of Evidence III, retrospective comparative study.

show abstract

“…20,40,49 MRI undoubtedly has a role in planning revision surgery for 10 found that angle measurements did not differ between CT and MRI and suggested that MRI can be used to replace CT for identifying tunnel placement. Grasso et al 14 performed grid measurements on CT and MRI; however, the measurements were conducted on computer-generated models after adding digitized information acquired during revision surgery, not on actual CT or MRI scans. In our view, the clinical usefulness of angle and grid measurements on MRI has not been sufficiently established to date.…”

Section: Discussionmentioning

confidence: 99%

“…Recent studies show that there is little difference between angle measurements performed on MRI and CT and grid measurements performed on CT and 3D-MRI. 10,14 However, it is not known if both methods are equally adept in identifying the nonanatomic placement of grafts.…”

mentioning

confidence: 99%

Computed Tomography Assessment of Anatomic Graft Placement After ACL Reconstruction: A Comparative Study of Grid and Angle Measurements

Parkar

Adriaensen

Giil

et al. 2019

Orthopaedic Journal of Sports Medicine

View full text Add to dashboard Cite

Background:The anatomic placement of anterior cruciate ligament (ACL) grafts is often assessed with postoperative imaging. In clinical practice, graft angles are measured to indicate anatomic placement on magnetic resonance imaging, whereas grid measurements are performed on computed tomography (CT). Recently, a study indicated that graft angle measurements could also be assessed on CT. No consensus has yet been reached on which measurement method is best suited to assess anatomic graft placement.Purpose:To compare the ability of grid measurements and angle measurements to identify anatomic versus nonanatomic tunnel placement on CT performed in patients undergoing ACL reconstruction.Study Design:Case series; Level of evidence, 4.Methods:A total of 100 knees undergoing primary reconstruction with a hamstring graft (HAM group), 91 undergoing reconstruction with a bone–patellar tendon–bone graft (BPTB group), and 117 undergoing revision ACL reconstruction (REV group) were assessed with CT. Grid measurements of the femoral and tibial tunnels and angle measurements of grafts were performed. Graft placement, rated as anatomic or nonanatomic, was assessed with both methods. Pearson chi-square, analysis of variance, Kruskal-Wallis, and weighted kappa tests were performed as appropriate.Results:The grid assessment classified 10% of the HAM group, 4% of the BPTB group, and 17% of the REV group as nonanatomic (P < .001). The angle assessment classified 37% of the HAM group, 54% of the BPTB group, and 47% of the REV group as nonanatomic. The weighted kappa between angle measurements and grid measurements was low in all groups (HAM: 0.009; BPTB: 0.065; REV: 0.041).Conclusion:The agreement between grid measurements and angle measurements was very low. The angle measurements seemed to overestimate nonanatomic tunnel placement. Grid measurements were better in identifying malpositioned grafts.

show abstract

Validation of an MRI Protocol for Routine Quantitative Assessment of Tunnel Position in Anterior Cruciate Ligament Reconstruction

Cited by 22 publications

References 28 publications

Graft Size and Orientation Within the Femoral Notch Affect Graft Healing at 1 Year After Anterior Cruciate Ligament Reconstruction

Graft Size and Orientation Within the Femoral Notch Affect Graft Healing at 1 Year After Anterior Cruciate Ligament Reconstruction

Positioning of the Tibial Tunnel After Single-Bundle ACL Primary Reconstruction on 3D CT scans: A New Method

Computed Tomography Assessment of Anatomic Graft Placement After ACL Reconstruction: A Comparative Study of Grid and Angle Measurements

Contact Info

Product

Resources

About