Radiographic acceptable zone of endobutton placement in ACL reconstruction: A prospective study

IF 2 Q2 ORTHOPEDICS Journal of Experimental Orthopaedics Pub Date : 2024-11-20 DOI:10.1002/jeo2.70082

Arash Sharafatvaziri, Mohammad Tahami, Maryam Salimi, Hamid Rabie, Fardis Vosoughi, Morad Karimpour, Ghazaleh Moradkhani, Mosayeb Soleymani

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Abstract

Purpose

During the transportal technique of anterior cruciate ligament (ACL) reconstruction, tunnel outlet location can be varied depending on certain anatomical and technical characteristics. Therefore, we aimed to find out the acceptable zone of endobutton location by introducing several radiographic values.

Methods

Postoperative lateral radiographs of 72 patients were assessed to measure the distances from the centre of the button to the posterior femoral cortex (D1) and to the most distal point of the lateral condyle (D2). Furthermore, based on the anteroposterior (AP) radiographs, the distances from the centre of the button to the lateral femoral cortex (D3) and from the centre of the button to the line connecting the most distal points of the medial and lateral femoral condyles (D4) were assessed. To measure the sensitivity and specificity of each radiographic value (D1, D2, D3 and D4), the area under the receiver operating characteristic curve was calculated. The alpha angle and femoral tunnel length values were considered as gold standards.

Results

Analyses showed that the mean values for D1, D2, D3 and D4 were 13.20 ± 0.54, 39.44 ± 0.31, 1.65 ± 0.15 and 42.66 ± 0.47 mm, respectively. The mean angle was found to be 38.6 ± 0.3°, and the mean femoral tunnel length was 38.6 ± 0.2 mm. Age was significantly related to D2 and the diameter of the femur in AP X-ray, while body mass index had a significant relation with D3 (p < 0.05).

Conclusion

In this study, a new method was proposed to evaluate the accuracy of anatomical tunnel placement in ACL reconstruction surgery postoperatively. The statistical analysis of the measured variables showed that the mean ratios were 21.79 ± 0.87 for D1, 65.65 ± 0.63 for D2 and 51.90 ± 0.73 for D4. The results indicated that if the tunnel exit location and endobutton placement in the postoperative radiological images fall within the suggested areas, it can be meaningfully concluded that the tunnel is correctly positioned intraarticularly and the ligament reconstruction is anatomical.

Level of Evidence

Level III.

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前交叉韧带重建术中内侧钮扣放置的X光片可接受区域：前瞻性研究

目的在前交叉韧带（ACL）重建的搬运技术中，隧道出口的位置可能因某些解剖和技术特征而有所不同。因此，我们旨在通过引入几种影像学数值来找出可接受的内疝位置区域。方法对 72 名患者的术后侧位X光片进行评估，测量从按钮中心到股骨后皮质（D1）和外侧髁最远点（D2）的距离。此外，还根据前胸（AP）X 光片，评估了从按钮中心到股骨外侧皮质（D3）的距离，以及从按钮中心到股骨内侧髁和外侧髁最远点连线（D4）的距离。为了测量每个放射学值（D1、D2、D3 和 D4）的敏感性和特异性，计算了接收者操作特征曲线下的面积。α角和股骨隧道长度值被视为金标准。结果分析表明，D1、D2、D3 和 D4 的平均值分别为 13.20 ± 0.54、39.44 ± 0.31、1.65 ± 0.15 和 42.66 ± 0.47 毫米。平均角度为 38.6 ± 0.3°，平均股骨隧道长度为 38.6 ± 0.2 mm。年龄与 D2 和 AP X 光股骨直径有明显关系，而体重指数与 D3 有明显关系（p < 0.05）。结论本研究提出了一种新方法，用于评估前交叉韧带重建手术术后解剖隧道放置的准确性。对测量变量的统计分析显示，D1、D2 和 D4 的平均比率分别为 21.79 ± 0.87、65.65 ± 0.63 和 51.90 ± 0.73。结果表明，如果术后放射影像中的隧道出口位置和内扣位置在建议的区域内，就可以有意义地断定隧道在关节内的位置正确，韧带重建符合解剖学原理。证据等级 III 级。

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