Reliability of early postoperative radiographic assessment of tunnel placement after anterior cruciate ligament reconstruction

Bryan A. Warme; Austin J. Ramme; Michael C. Willey; Carla L. Britton; John H. Flint; Annunziato S. Amendola; Brian R. Wolf; S. Jack; T. Andrish; R. D. Parker; E. C. McCarty; A. F. Vidal; R. W. Wright; R. Brophy; K. P. Spindler; W. R. Dunn; J. Carey; C. Cox; M. H. Jones; R. G. Marx; M. Wolcott; M. J. Matava; M. V. Smith; C. C. Kaeding; D. C. Flanigan; N. Grosland

doi:10.1016/j.arthro.2011.12.010

Reliability of early postoperative radiographic assessment of tunnel placement after anterior cruciate ligament reconstruction

Bryan A. Warme, Austin J. Ramme, Michael C. Willey, Carla L. Britton, John H. Flint, Annunziato S. Amendola, Brian R. Wolf, S. Jack, T. Andrish, R. D. Parker, E. C. McCarty, A. F. Vidal, R. W. Wright, R. Brophy, K. P. Spindler, W. R. Dunn, J. Carey, C. Cox, M. H. Jones, R. G. MarxM. Wolcott, M. J. Matava, M. V. Smith, C. C. Kaeding, D. C. Flanigan, N. Grosland

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Abstract

Purpose: To evaluate the interobserver and intraobserver reliability of radiographic assessment of tunnel placement in anterior cruciate ligament reconstruction. Methods: Seven sports fellowship-trained orthopaedic surgeons in the Multicenter Orthopaedic Outcomes Network (MOON) group participated in the study. We prospectively enrolled 54 consecutive patients after primary anterior cruciate ligament reconstruction. Postoperative plain radiographs were obtained including a full-extension anteroposterior view of the knee, a lateral view of the knee in full extension, and a notch view at 45° of flexion (Rosenberg view). Three blinded reviewers performed 8 different radiographic measurements including those of Harner and Aglietti/Jonsson. Intraclass correlation coefficients were used to determine reliability of the measurements. Intrarater reliability was assessed by repeated measurements of a subset of 20 patient images from 1 institution, and inter-rater reliability was assessed by use of all 54 sets of films from a total of 4 institutions. Results: Intraobserver reliability for femoral measures ranged from none to substantial, with notch height having the worst results. Intraobserver reliability was moderate to almost perfect for tibial measures. Interobserver reliability ranged from slight to moderate for femoral measures. The Harner method for determining tunnel depth was more reliable than the Aglietti/Jonsson method. Interobserver reliability for tibial measures ranged from fair to substantial. The presence of metal interference screws did not improve reliability of measurements. Conclusions: Postoperative radiographs are easily obtained, but our results show that radiographic measurements are of quite variable reliability, with most of the results falling into the fair to moderate categories. Level of Evidence: Level III, diagnostic study.

Original language	English
Pages (from-to)	942-951
Number of pages	10
Journal	Arthroscopy - Journal of Arthroscopic and Related Surgery
Volume	28
Issue number	7
DOIs	https://doi.org/10.1016/j.arthro.2011.12.010
State	Published - Jul 1 2012

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10.1016/j.arthro.2011.12.010

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Warme, B. A., Ramme, A. J., Willey, M. C., Britton, C. L., Flint, J. H., Amendola, A. S., Wolf, B. R., Jack, S., Andrish, T., Parker, R. D., McCarty, E. C., Vidal, A. F., Wright, R. W., Brophy, R., Spindler, K. P., Dunn, W. R., Carey, J., Cox, C., Jones, M. H., ... Grosland, N. (2012). Reliability of early postoperative radiographic assessment of tunnel placement after anterior cruciate ligament reconstruction. Arthroscopy - Journal of Arthroscopic and Related Surgery, 28(7), 942-951. https://doi.org/10.1016/j.arthro.2011.12.010

@article{3329cfd850844c049da7fe1330e0e8ed,

title = "Reliability of early postoperative radiographic assessment of tunnel placement after anterior cruciate ligament reconstruction",

abstract = "Purpose: To evaluate the interobserver and intraobserver reliability of radiographic assessment of tunnel placement in anterior cruciate ligament reconstruction. Methods: Seven sports fellowship-trained orthopaedic surgeons in the Multicenter Orthopaedic Outcomes Network (MOON) group participated in the study. We prospectively enrolled 54 consecutive patients after primary anterior cruciate ligament reconstruction. Postoperative plain radiographs were obtained including a full-extension anteroposterior view of the knee, a lateral view of the knee in full extension, and a notch view at 45° of flexion (Rosenberg view). Three blinded reviewers performed 8 different radiographic measurements including those of Harner and Aglietti/Jonsson. Intraclass correlation coefficients were used to determine reliability of the measurements. Intrarater reliability was assessed by repeated measurements of a subset of 20 patient images from 1 institution, and inter-rater reliability was assessed by use of all 54 sets of films from a total of 4 institutions. Results: Intraobserver reliability for femoral measures ranged from none to substantial, with notch height having the worst results. Intraobserver reliability was moderate to almost perfect for tibial measures. Interobserver reliability ranged from slight to moderate for femoral measures. The Harner method for determining tunnel depth was more reliable than the Aglietti/Jonsson method. Interobserver reliability for tibial measures ranged from fair to substantial. The presence of metal interference screws did not improve reliability of measurements. Conclusions: Postoperative radiographs are easily obtained, but our results show that radiographic measurements are of quite variable reliability, with most of the results falling into the fair to moderate categories. Level of Evidence: Level III, diagnostic study.",

author = "Warme, {Bryan A.} and Ramme, {Austin J.} and Willey, {Michael C.} and Britton, {Carla L.} and Flint, {John H.} and Amendola, {Annunziato S.} and Wolf, {Brian R.} and S. Jack and T. Andrish and Parker, {R. D.} and McCarty, {E. C.} and Vidal, {A. F.} and Wright, {R. W.} and R. Brophy and Spindler, {K. P.} and Dunn, {W. R.} and J. Carey and C. Cox and Jones, {M. H.} and Marx, {R. G.} and M. Wolcott and Matava, {M. J.} and Smith, {M. V.} and Kaeding, {C. C.} and Flanigan, {D. C.} and N. Grosland",

year = "2012",

month = jul,

day = "1",

doi = "10.1016/j.arthro.2011.12.010",

language = "English",

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journal = "Arthroscopy - Journal of Arthroscopic and Related Surgery",

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Warme, BA, Ramme, AJ, Willey, MC, Britton, CL, Flint, JH, Amendola, AS, Wolf, BR, Jack, S, Andrish, T, Parker, RD, McCarty, EC, Vidal, AF, Wright, RW, Brophy, R, Spindler, KP, Dunn, WR, Carey, J, Cox, C, Jones, MH, Marx, RG, Wolcott, M, Matava, MJ , Smith, MV, Kaeding, CC, Flanigan, DC & Grosland, N 2012, 'Reliability of early postoperative radiographic assessment of tunnel placement after anterior cruciate ligament reconstruction', Arthroscopy - Journal of Arthroscopic and Related Surgery, vol. 28, no. 7, pp. 942-951. https://doi.org/10.1016/j.arthro.2011.12.010

TY - JOUR

T1 - Reliability of early postoperative radiographic assessment of tunnel placement after anterior cruciate ligament reconstruction

AU - Warme, Bryan A.

AU - Ramme, Austin J.

AU - Willey, Michael C.

AU - Britton, Carla L.

AU - Flint, John H.

AU - Amendola, Annunziato S.

AU - Wolf, Brian R.

AU - Jack, S.

AU - Andrish, T.

AU - Parker, R. D.

AU - McCarty, E. C.

AU - Vidal, A. F.

AU - Wright, R. W.

AU - Brophy, R.

AU - Spindler, K. P.

AU - Dunn, W. R.

AU - Carey, J.

AU - Cox, C.

AU - Jones, M. H.

AU - Marx, R. G.

AU - Wolcott, M.

AU - Matava, M. J.

AU - Smith, M. V.

AU - Kaeding, C. C.

AU - Flanigan, D. C.

AU - Grosland, N.

PY - 2012/7/1

Y1 - 2012/7/1

N2 - Purpose: To evaluate the interobserver and intraobserver reliability of radiographic assessment of tunnel placement in anterior cruciate ligament reconstruction. Methods: Seven sports fellowship-trained orthopaedic surgeons in the Multicenter Orthopaedic Outcomes Network (MOON) group participated in the study. We prospectively enrolled 54 consecutive patients after primary anterior cruciate ligament reconstruction. Postoperative plain radiographs were obtained including a full-extension anteroposterior view of the knee, a lateral view of the knee in full extension, and a notch view at 45° of flexion (Rosenberg view). Three blinded reviewers performed 8 different radiographic measurements including those of Harner and Aglietti/Jonsson. Intraclass correlation coefficients were used to determine reliability of the measurements. Intrarater reliability was assessed by repeated measurements of a subset of 20 patient images from 1 institution, and inter-rater reliability was assessed by use of all 54 sets of films from a total of 4 institutions. Results: Intraobserver reliability for femoral measures ranged from none to substantial, with notch height having the worst results. Intraobserver reliability was moderate to almost perfect for tibial measures. Interobserver reliability ranged from slight to moderate for femoral measures. The Harner method for determining tunnel depth was more reliable than the Aglietti/Jonsson method. Interobserver reliability for tibial measures ranged from fair to substantial. The presence of metal interference screws did not improve reliability of measurements. Conclusions: Postoperative radiographs are easily obtained, but our results show that radiographic measurements are of quite variable reliability, with most of the results falling into the fair to moderate categories. Level of Evidence: Level III, diagnostic study.

AB - Purpose: To evaluate the interobserver and intraobserver reliability of radiographic assessment of tunnel placement in anterior cruciate ligament reconstruction. Methods: Seven sports fellowship-trained orthopaedic surgeons in the Multicenter Orthopaedic Outcomes Network (MOON) group participated in the study. We prospectively enrolled 54 consecutive patients after primary anterior cruciate ligament reconstruction. Postoperative plain radiographs were obtained including a full-extension anteroposterior view of the knee, a lateral view of the knee in full extension, and a notch view at 45° of flexion (Rosenberg view). Three blinded reviewers performed 8 different radiographic measurements including those of Harner and Aglietti/Jonsson. Intraclass correlation coefficients were used to determine reliability of the measurements. Intrarater reliability was assessed by repeated measurements of a subset of 20 patient images from 1 institution, and inter-rater reliability was assessed by use of all 54 sets of films from a total of 4 institutions. Results: Intraobserver reliability for femoral measures ranged from none to substantial, with notch height having the worst results. Intraobserver reliability was moderate to almost perfect for tibial measures. Interobserver reliability ranged from slight to moderate for femoral measures. The Harner method for determining tunnel depth was more reliable than the Aglietti/Jonsson method. Interobserver reliability for tibial measures ranged from fair to substantial. The presence of metal interference screws did not improve reliability of measurements. Conclusions: Postoperative radiographs are easily obtained, but our results show that radiographic measurements are of quite variable reliability, with most of the results falling into the fair to moderate categories. Level of Evidence: Level III, diagnostic study.

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U2 - 10.1016/j.arthro.2011.12.010

DO - 10.1016/j.arthro.2011.12.010

M3 - Article

C2 - 22381687

AN - SCOPUS:84863094309

SN - 0749-8063

VL - 28

SP - 942

EP - 951

JO - Arthroscopy - Journal of Arthroscopic and Related Surgery

JF - Arthroscopy - Journal of Arthroscopic and Related Surgery

IS - 7

ER -

Reliability of early postoperative radiographic assessment of tunnel placement after anterior cruciate ligament reconstruction

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