Montreuil J, Saleh J, Cresson T, De Guise JA, Lavoie F. Tibial Tunnel Placement in ACL Reconstruction Using a Novel Grid and Biplanar Stereoradiographic Imaging.
Orthop J Sports Med 2021;
9:2325967121989369. [PMID:
34250158 PMCID:
PMC8239338 DOI:
10.1177/2325967121989369]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 10/16/2020] [Indexed: 11/17/2022] Open
Abstract
Background:
Nonanatomic graft placement is a frequent cause of anterior cruciate ligament
reconstruction (ACLR) failure, and it can be attributed to either tibial or
femoral tunnel malposition. To describe tibial tunnel placement in ACLR, we
used EOS, a low-dose biplanar stereoradiographic imaging modality, to create
a comprehensive grid that combines anteroposterior (AP) and mediolateral
(ML) coordinates.
Purpose:
To (1) validate the automated grid generated from EOS imaging and (2) compare
the results with optimal tibial tunnel placement.
Study Design:
Descriptive laboratory study.
Methods:
Using EOS, 3-dimensional models were created of the knees of 37 patients who
had undergone ACLR. From the most medial, lateral, anterior, and posterior
points on the tibial plateau of the EOS 3-dimensional model for each
patient, an automated and personalized grid was generated from 2 independent
observers’ series of reconstructions. To validate this grid, each observer
also manually measured the ML and AP distances, the medial proximal tibial
angle (MPTA), and the tibial slope for each patient. The ideal tibial tunnel
placement, as described in the literature, was compared with the actual
tibial tunnel grid coordinates of each patient.
Results:
The automated grid metrics for observer 1 gave a mean (95% CI) AP depth of
54.7 mm (53.4-55.9), ML width of 75.0 mm (73.3-76.6), MPTA of 84.9°
(83.7-86.0), and slope of 7.2° (5.4-9.0). The differences with corresponding
manual measurements were means (95% CIs) of 2.4 mm (1.4-3.4 mm), 0.5 mm
(–1.3 to 2.2 mm), 1.2° (–0.4° to 2.9°), and –0.4° (–2.1° to 1.2°),
respectively. The correlation between automated and manual measurements was
r = 0.78 for the AP depth, r = 0.68
for the ML width, r = 0.18 for the MPTA, and
r = 0.44 for the slope. The center of the actual tibial
aperture on the plateau was a mean of 5.5 mm (95% CI, 4.8-6.1 mm) away from
the referenced anatomic position, with a tendency toward more medial
placement.
Conclusion:
The automated grid created using biplanar stereoradiographic imaging provided
a novel, precise, and reproducible description of the tibial tunnel
placement in ACLR.
Clinical Relevance:
This technique can be used during preoperative planning, intraoperative
guidance, and postoperative evaluation of tibial tunnel placement in
ACLR.
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