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Keller G, Rachunek K, Springer F, Kraus M. Evaluation of a newly designed deep learning-based algorithm for automated assessment of scapholunate distance in wrist radiography as a surrogate parameter for scapholunate ligament rupture and the correlation with arthroscopy. LA RADIOLOGIA MEDICA 2023; 128:1535-1541. [PMID: 37726593 PMCID: PMC10700195 DOI: 10.1007/s11547-023-01720-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 09/04/2023] [Indexed: 09/21/2023]
Abstract
PURPOSE Not diagnosed or mistreated scapholunate ligament (SL) tears represent a frequent cause of degenerative wrist arthritis. A newly developed deep learning (DL)-based automated assessment of the SL distance on radiographs may support clinicians in initial image interpretation. MATERIALS AND METHODS A pre-trained DL algorithm was specifically fine-tuned on static and dynamic dorsopalmar wrist radiography (training data set n = 201) for the automated assessment of the SL distance. Afterwards the DL algorithm was evaluated (evaluation data set n = 364 patients with n = 1604 radiographs) and correlated with results of an experienced human reader and with arthroscopic findings. RESULTS The evaluation data set comprised arthroscopically diagnosed SL insufficiency according to Geissler's stages 0-4 (56.5%, 2.5%, 5.5%, 7.5%, 28.0%). Diagnostic accuracy of the DL algorithm on dorsopalmar radiography regarding SL integrity was close to that of the human reader (e.g. differentiation of Geissler's stages ≤ 2 versus > 2 with a sensitivity of 74% and a specificity of 78% compared to 77% and 80%) with a correlation coefficient of 0.81 (P < 0.01). CONCLUSION A DL algorithm like this might become a valuable tool supporting clinicians' initial decision making on radiography regarding SL integrity and consequential triage for further patient management.
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Affiliation(s)
- Gabriel Keller
- Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Eberhard Karls University Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany.
- Department of Diagnostic Radiology, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany.
| | - Katarzyna Rachunek
- Department of Hand, Plastic, Reconstructive and Burn Surgery, BG Trauma Center Tübingen, Eberhard Karls University of Tübingen, 72076, Tübingen, Germany
| | - Fabian Springer
- Department of Diagnostic and Interventional Radiology, University Hospital Tübingen, Eberhard Karls University Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
- Department of Diagnostic Radiology, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Mathias Kraus
- Institute of Information Systems, FAU Erlangen-Nuremberg, Nuremberg, Germany
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Kuru CA, Sezer R, Çetin C, Haberal B, Yakut Y, Kuru İ. Use of Generalizability Theory Evaluating Comparative Reliability of the Scapholunate Interval Measurement With X-ray, CT, and US. Acad Radiol 2023; 30:2290-2298. [PMID: 36604227 DOI: 10.1016/j.acra.2022.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/03/2022] [Accepted: 11/20/2022] [Indexed: 01/05/2023]
Abstract
RATIONALE AND OBJECTIVES There is no universally accepted standard technique for measuring the scapholunate interval and no specific sources of measurement error have been identified. We aimed to establish a set of normal radiological criteria for the scapholunate interval that could be used in comparative studies of wrist pathology to determine interobserver reliability and to identify potential errors that might influence measurements. MATERIALS AND METHODS A total of 60 healthy volunteers participated in the study. Scapholunate interval was measured by three independent observers using X-ray, CT, and US in four positions, including neutral, fist, radial and ulnar deviation. Inter-observer reliability was tested using intraclass correlation coefficient. Generalizability theory was applied to evaluate specific sources of measurement error related to participant, observer, imaging modality and measurement position. RESULTS In neutral position, the scapholunate interval measured by X-ray, CT, and US was 3.1 mm, 3.5 mm and 3.5 mm respectively. The interval remained constant during fist and radial deviation but decreased during ulnar deviation. Correlation coefficients ranged from 0.874 to 0.907 for X-ray, 0.773-0.881 for CT and 0.964-0.979 for US. In the generalizability study, the participant x modality x position interaction accounted for the largest proportion of total variance (29%). CONCLUSION X-ray, CT, and US are reliable modalities for measuring the scapholunate interval, with US having the highest reliability. Participant and position factors may independently contribute to measurement error. Therefore, standardized measurement positions are recommended to obtain reliable measurement results.
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Affiliation(s)
- Cigdem Ayhan Kuru
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Altindag, Ankara, Turkey (C.A.K.); Department of Radiology, Faculty of Medicine, Baskent University, Ankara, Turkey (R.S.); Department of Orthopedics and Traumatology, Faculty of Medicine, Baskent University, Ankara, Turkey (C.C., B.H., I.K.); Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hasan Kalyoncu University, Ankara, Turkey (Y.Y.)
| | - Rahime Sezer
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Altindag, Ankara, Turkey (C.A.K.); Department of Radiology, Faculty of Medicine, Baskent University, Ankara, Turkey (R.S.); Department of Orthopedics and Traumatology, Faculty of Medicine, Baskent University, Ankara, Turkey (C.C., B.H., I.K.); Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hasan Kalyoncu University, Ankara, Turkey (Y.Y.).
| | - Can Çetin
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Altindag, Ankara, Turkey (C.A.K.); Department of Radiology, Faculty of Medicine, Baskent University, Ankara, Turkey (R.S.); Department of Orthopedics and Traumatology, Faculty of Medicine, Baskent University, Ankara, Turkey (C.C., B.H., I.K.); Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hasan Kalyoncu University, Ankara, Turkey (Y.Y.)
| | - Bahtiyar Haberal
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Altindag, Ankara, Turkey (C.A.K.); Department of Radiology, Faculty of Medicine, Baskent University, Ankara, Turkey (R.S.); Department of Orthopedics and Traumatology, Faculty of Medicine, Baskent University, Ankara, Turkey (C.C., B.H., I.K.); Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hasan Kalyoncu University, Ankara, Turkey (Y.Y.)
| | - Yavuz Yakut
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Altindag, Ankara, Turkey (C.A.K.); Department of Radiology, Faculty of Medicine, Baskent University, Ankara, Turkey (R.S.); Department of Orthopedics and Traumatology, Faculty of Medicine, Baskent University, Ankara, Turkey (C.C., B.H., I.K.); Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hasan Kalyoncu University, Ankara, Turkey (Y.Y.)
| | - İlhami Kuru
- Faculty of Physical Therapy and Rehabilitation, Hacettepe University, Altindag, Ankara, Turkey (C.A.K.); Department of Radiology, Faculty of Medicine, Baskent University, Ankara, Turkey (R.S.); Department of Orthopedics and Traumatology, Faculty of Medicine, Baskent University, Ankara, Turkey (C.C., B.H., I.K.); Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Hasan Kalyoncu University, Ankara, Turkey (Y.Y.)
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de Villeneuve Bargemon JB, Mathoulin C, Jaloux C, Levadoux M, Gras M, Merlini L. Wide arthroscopic dorsal capsuloligamentous repair in patients with severe scapholunate instability. Bone Joint J 2023; 105-B:307-314. [PMID: 36854344 DOI: 10.1302/0301-620x.105b3.bjj-2022-0906.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
A conventional arthroscopic capsuloligamentous repair is a reliable surgical solution in most patients with scapholunate instability. However, this repair does not seem to be sufficient for more advanced injuries. The aim of this study was to evaluate the functional results of a wide arthroscopic dorsal capsuloligamentous repair (WADCLR) in the management of severe scapholunate instability. This was a prospective single-centre study undertaken between March 2019 and May 2021. The primary outcome was the evaluation of the reduction of the radiological deformity and the functional outcomes after WADCLR. A secondary outcome was the evaluation of the effectiveness of this technique in patients with the most severe instability (European Wrist Arthroscopy Society (EWAS) stage 5). The patients were reviewed postoperatively at three, six, and 12 months. The study included 112 patients (70 male and 42 female). Their mean age was 31.6 years (16 to 55). A total of three patients had EWAS stage 3A injuries, 12 had stage 3B injuries, 29 had stage 3C injuries, 56 had stage 4 injuries, and 12 had stage 5 injuries. There was a significant improvement of the radiological signs in all patients with a return to normal values. There was also a significant improvement in all aspects of function except for flexion, in which the mean increase was negligible (0.18° on average). There was also a significant improvement in all criteria for patients with a stage 5 injury, except for some limitation of extension, flexion, and radial and ulnar deviation, although these showed a trend towards improvement (except for flexion). WADCLR is a minimally invasive, easy, and reproducible technique with few complications, offering a clear improvement in function and a reduction in the radiological deformity at one year postoperatively.
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Affiliation(s)
- Jean-Baptiste de Villeneuve Bargemon
- Hand Surgery and Limb Reconstructive Surgery Department, La Timone Adult Hospital, Aix Marseille University, Marseille, France
- Hand, Wrist and Elbow Surgery, Saint Roch Private Hospital, Toulon, France
- International Wrist Center, Bizet Clinic, Paris, France
| | | | - Charlotte Jaloux
- Hand Surgery and Limb Reconstructive Surgery Department, La Timone Adult Hospital, Aix Marseille University, Marseille, France
| | - Michel Levadoux
- Hand, Wrist and Elbow Surgery, Saint Roch Private Hospital, Toulon, France
| | - Mathilde Gras
- International Wrist Center, Bizet Clinic, Paris, France
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