Reliability of tunnel measurements and the quadrant method using fluoroscopic radiographs after anterior cruciate ligament reconstruction

Jaron P. Sullivan; Matthew J. Matava; David C. Flanigan; Yubo Gao; Carla L. Britton; Annunziato Amendola; Brian R. Wolf; K. S. Spindler; W. R. Dunn; J. L. Carey; C. L. Cox; J. T. Andrish; R. D. Parker; M. H. Jones; R. G. Marx; E. C. McCarty; A. F. Vidal; M. Wolcott; R. W. Wright; R. H. Brophy; M. V. Smith; C. C. Kaeding

doi:10.1177/0363546512458086

Reliability of tunnel measurements and the quadrant method using fluoroscopic radiographs after anterior cruciate ligament reconstruction

Jaron P. Sullivan, Matthew J. Matava, David C. Flanigan, Yubo Gao, Carla L. Britton, Annunziato Amendola, Brian R. Wolf, K. S. Spindler, W. R. Dunn, J. L. Carey, C. L. Cox, J. T. Andrish, R. D. Parker, M. H. Jones, R. G. Marx, E. C. McCarty, A. F. Vidal, M. Wolcott, R. W. Wright, R. H. BrophyM. V. Smith, C. C. Kaeding

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Abstract

Background: Anterior cruciate ligament (ACL) reconstruction tunnel placement is often evaluated by radiographs. This study examines the interobserver reliability of various radiographic measurements of ACL tunnels. Hypothesis: When ideal radiographic views are obtained the interobserver reliability of the measurements among experienced surgeons would be good to excellent. Study Design: Descriptive laboratory study. Methods: Tunnels for single-bundle ACL reconstruction were drilled and filled with metal interference screws or a tibial reamer on 73 cadaveric knees. Ideal fluoroscopic radiographs were obtained. Three independent reviewers performed 18 measurements including a modification of the grid method. For the grid method analysis reviewers fit a 16 × 12 grid to the lateral knee radiograph and the center of the femoral tunnel was marked. Interobserver reliability of the measurements was performed using intraclass correlation coefficients (ICCs). A precision grouping analysis was performed for the grid measurements to calculate the mean radius and standard deviation grouping distances. Results: The ICCs were excellent (>.75) for the tibial tunnel angles and tunnel measurements the clock face measurement and the Aglietti et al and Jonsson et al measurements. The ICCs were good (.4-.75) for an estimation of graft impingement Harner et al measurements and notch height. The mean radius for grid measurements was 0.6 ± 0.4 units (range 0-2.36 units) with each unit being 1 box in the 16 × 12 grid. When a circle was constructed with a 1.3-unit radius 95% of the 3 surgeons' measurements would be included in the area of that circle. Conclusion: Reliability of ACL tunnel measurements was good to excellent under ideal circumstances for the majority of measurements. The modified grid method demonstrated very acceptable reliability. Clinical Relevance: Measurements with good to excellent reliability can be used to evaluate ACL tunnel placement when ideal radiographic views are obtained.

Original language	English
Pages (from-to)	2236-2241
Number of pages	6
Journal	American Journal of Sports Medicine
Volume	40
Issue number	10
DOIs	https://doi.org/10.1177/0363546512458086
State	Published - Oct 1 2012

Keywords

ACL reconstruction
MOON
cruciate
reliability
tunnel

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Sullivan, J. P., Matava, M. J., Flanigan, D. C., Gao, Y., Britton, C. L., Amendola, A., Wolf, B. R., Spindler, K. S., Dunn, W. R., Carey, J. L., Cox, C. L., Andrish, J. T., Parker, R. D., Jones, M. H., Marx, R. G., McCarty, E. C., Vidal, A. F., Wolcott, M., Wright, R. W., ... Kaeding, C. C. (2012). Reliability of tunnel measurements and the quadrant method using fluoroscopic radiographs after anterior cruciate ligament reconstruction. American Journal of Sports Medicine, 40(10), 2236-2241. https://doi.org/10.1177/0363546512458086

@article{bbb0c67248f54d65b10157104e01b939,

title = "Reliability of tunnel measurements and the quadrant method using fluoroscopic radiographs after anterior cruciate ligament reconstruction",

abstract = "Background: Anterior cruciate ligament (ACL) reconstruction tunnel placement is often evaluated by radiographs. This study examines the interobserver reliability of various radiographic measurements of ACL tunnels. Hypothesis: When ideal radiographic views are obtained the interobserver reliability of the measurements among experienced surgeons would be good to excellent. Study Design: Descriptive laboratory study. Methods: Tunnels for single-bundle ACL reconstruction were drilled and filled with metal interference screws or a tibial reamer on 73 cadaveric knees. Ideal fluoroscopic radiographs were obtained. Three independent reviewers performed 18 measurements including a modification of the grid method. For the grid method analysis reviewers fit a 16 × 12 grid to the lateral knee radiograph and the center of the femoral tunnel was marked. Interobserver reliability of the measurements was performed using intraclass correlation coefficients (ICCs). A precision grouping analysis was performed for the grid measurements to calculate the mean radius and standard deviation grouping distances. Results: The ICCs were excellent (>.75) for the tibial tunnel angles and tunnel measurements the clock face measurement and the Aglietti et al and Jonsson et al measurements. The ICCs were good (.4-.75) for an estimation of graft impingement Harner et al measurements and notch height. The mean radius for grid measurements was 0.6 ± 0.4 units (range 0-2.36 units) with each unit being 1 box in the 16 × 12 grid. When a circle was constructed with a 1.3-unit radius 95% of the 3 surgeons' measurements would be included in the area of that circle. Conclusion: Reliability of ACL tunnel measurements was good to excellent under ideal circumstances for the majority of measurements. The modified grid method demonstrated very acceptable reliability. Clinical Relevance: Measurements with good to excellent reliability can be used to evaluate ACL tunnel placement when ideal radiographic views are obtained.",

keywords = "ACL reconstruction, MOON, cruciate, reliability, tunnel",

author = "Sullivan, {Jaron P.} and Matava, {Matthew J.} and Flanigan, {David C.} and Yubo Gao and Britton, {Carla L.} and Annunziato Amendola and Wolf, {Brian R.} and Spindler, {K. S.} and Dunn, {W. R.} and Carey, {J. L.} and Cox, {C. L.} and Andrish, {J. T.} and Parker, {R. D.} and Jones, {M. H.} and Marx, {R. G.} and McCarty, {E. C.} and Vidal, {A. F.} and M. Wolcott and Wright, {R. W.} and Brophy, {R. H.} and Smith, {M. V.} and Kaeding, {C. C.}",

year = "2012",

month = oct,

day = "1",

doi = "10.1177/0363546512458086",

language = "English",

volume = "40",

pages = "2236--2241",

journal = "American Journal of Sports Medicine",

issn = "0363-5465",

number = "10",

}

Sullivan, JP, Matava, MJ, Flanigan, DC, Gao, Y, Britton, CL, Amendola, A, Wolf, BR, Spindler, KS, Dunn, WR, Carey, JL, Cox, CL, Andrish, JT, Parker, RD, Jones, MH, Marx, RG, McCarty, EC, Vidal, AF, Wolcott, M, Wright, RW, Brophy, RH , Smith, MV & Kaeding, CC 2012, 'Reliability of tunnel measurements and the quadrant method using fluoroscopic radiographs after anterior cruciate ligament reconstruction', American Journal of Sports Medicine, vol. 40, no. 10, pp. 2236-2241. https://doi.org/10.1177/0363546512458086

TY - JOUR

T1 - Reliability of tunnel measurements and the quadrant method using fluoroscopic radiographs after anterior cruciate ligament reconstruction

AU - Sullivan, Jaron P.

AU - Matava, Matthew J.

AU - Flanigan, David C.

AU - Gao, Yubo

AU - Britton, Carla L.

AU - Amendola, Annunziato

AU - Wolf, Brian R.

AU - Spindler, K. S.

AU - Dunn, W. R.

AU - Carey, J. L.

AU - Cox, C. L.

AU - Andrish, J. T.

AU - Parker, R. D.

AU - Jones, M. H.

AU - Marx, R. G.

AU - McCarty, E. C.

AU - Vidal, A. F.

AU - Wolcott, M.

AU - Wright, R. W.

AU - Brophy, R. H.

AU - Smith, M. V.

AU - Kaeding, C. C.

PY - 2012/10/1

Y1 - 2012/10/1

N2 - Background: Anterior cruciate ligament (ACL) reconstruction tunnel placement is often evaluated by radiographs. This study examines the interobserver reliability of various radiographic measurements of ACL tunnels. Hypothesis: When ideal radiographic views are obtained the interobserver reliability of the measurements among experienced surgeons would be good to excellent. Study Design: Descriptive laboratory study. Methods: Tunnels for single-bundle ACL reconstruction were drilled and filled with metal interference screws or a tibial reamer on 73 cadaveric knees. Ideal fluoroscopic radiographs were obtained. Three independent reviewers performed 18 measurements including a modification of the grid method. For the grid method analysis reviewers fit a 16 × 12 grid to the lateral knee radiograph and the center of the femoral tunnel was marked. Interobserver reliability of the measurements was performed using intraclass correlation coefficients (ICCs). A precision grouping analysis was performed for the grid measurements to calculate the mean radius and standard deviation grouping distances. Results: The ICCs were excellent (>.75) for the tibial tunnel angles and tunnel measurements the clock face measurement and the Aglietti et al and Jonsson et al measurements. The ICCs were good (.4-.75) for an estimation of graft impingement Harner et al measurements and notch height. The mean radius for grid measurements was 0.6 ± 0.4 units (range 0-2.36 units) with each unit being 1 box in the 16 × 12 grid. When a circle was constructed with a 1.3-unit radius 95% of the 3 surgeons' measurements would be included in the area of that circle. Conclusion: Reliability of ACL tunnel measurements was good to excellent under ideal circumstances for the majority of measurements. The modified grid method demonstrated very acceptable reliability. Clinical Relevance: Measurements with good to excellent reliability can be used to evaluate ACL tunnel placement when ideal radiographic views are obtained.

AB - Background: Anterior cruciate ligament (ACL) reconstruction tunnel placement is often evaluated by radiographs. This study examines the interobserver reliability of various radiographic measurements of ACL tunnels. Hypothesis: When ideal radiographic views are obtained the interobserver reliability of the measurements among experienced surgeons would be good to excellent. Study Design: Descriptive laboratory study. Methods: Tunnels for single-bundle ACL reconstruction were drilled and filled with metal interference screws or a tibial reamer on 73 cadaveric knees. Ideal fluoroscopic radiographs were obtained. Three independent reviewers performed 18 measurements including a modification of the grid method. For the grid method analysis reviewers fit a 16 × 12 grid to the lateral knee radiograph and the center of the femoral tunnel was marked. Interobserver reliability of the measurements was performed using intraclass correlation coefficients (ICCs). A precision grouping analysis was performed for the grid measurements to calculate the mean radius and standard deviation grouping distances. Results: The ICCs were excellent (>.75) for the tibial tunnel angles and tunnel measurements the clock face measurement and the Aglietti et al and Jonsson et al measurements. The ICCs were good (.4-.75) for an estimation of graft impingement Harner et al measurements and notch height. The mean radius for grid measurements was 0.6 ± 0.4 units (range 0-2.36 units) with each unit being 1 box in the 16 × 12 grid. When a circle was constructed with a 1.3-unit radius 95% of the 3 surgeons' measurements would be included in the area of that circle. Conclusion: Reliability of ACL tunnel measurements was good to excellent under ideal circumstances for the majority of measurements. The modified grid method demonstrated very acceptable reliability. Clinical Relevance: Measurements with good to excellent reliability can be used to evaluate ACL tunnel placement when ideal radiographic views are obtained.

KW - ACL reconstruction

KW - MOON

KW - cruciate

KW - reliability

KW - tunnel

UR - http://www.scopus.com/inward/record.url?scp=84867071718&partnerID=8YFLogxK

U2 - 10.1177/0363546512458086

DO - 10.1177/0363546512458086

M3 - Article

C2 - 22962289

AN - SCOPUS:84867071718

SN - 0363-5465

VL - 40

SP - 2236

EP - 2241

JO - American Journal of Sports Medicine

JF - American Journal of Sports Medicine

IS - 10

ER -

Reliability of tunnel measurements and the quadrant method using fluoroscopic radiographs after anterior cruciate ligament reconstruction

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Keywords

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