ÖN ÇAPRAZ BAĞ REKONSTRÜKSİYONU YAPILAN HASTALARDA TÜNEL GENİŞLİĞİNİN ÖLÇÜMÜNDE MANYETİK REZONANS GÖRÜNTÜLEME VE BİLGİSAYARLI TOMOGRAFİ’NİN KARŞILAŞTIRMALI GÜVENİLİRLİK ANALİZİ
Abstract
Giriş:
Ön çapraz bağ
(ÖÇB) cerrahisi sonrası tünel
genişlemesi radyolojik olarak farklı tetkikler ile ölçülebilmektedir. Hasta
takiplerinde tünel genişlemesinin değerlendirilmesinde bilgisayarlı tomografi
(BT) ve manyetik rezonans görüntüleme (MRG) tetkikleri kullanılmaktadır. Çalışmamızın
amacı; artroskopik ÖÇB tamiri uygulanan hastalarda femoral ve tibial tünel
genişliği ölçümünde görüntüleme tetkikleri arasındaki güvenilirliği analiz
etmektir.
Gereç ve
yöntemler:
Kliniğimizde
hamstring otogrefti kullanılarak asansör sistemi ile izoanatomik artroskopik
ÖÇB rekonstrüksiyonu yapılan ve takiplerinde lineer tünel genişlemesi olan 24
hasta çalışmaya dahil edildi. Hastaların BT ve MRG’de aksiyel, koronal ve
sagittal planda tünel genişlikleri, 5 gözlemci tarafından ölçüldü. Kesitler
üzerinde her gözlemci tarafından femoral ve tibial tüneller için giriş, orta,
çıkış genişliği PACS (Picture Archiving and Communication System) sistemi
üzerindeki cetvel uygulaması ile ölçüldü. Ölçümler birer hafta arayla tekrarlandı
ve bağımsız bir cerrah tarafından kayıt edildi.
Bulgular:
Çalışmamızda
femur ölçümlerinin tüm kesitlerinde toplam 90 ölçümden MRG’de 14, BT’de 11
anlamlı fark görüldü (p<0.05). Tibia ölçümlerinin tüm kesitlerinde toplam 90
ölçümden MRG’de 19, BT’de 11 anlamlı fark görüldü (p<0.05). Femur koronal
kesitlerinde gözlemci-içi güvenilirlik MRG’de 0.69, BT’de 0,85 olarak bulundu,
sagittal kesit için MRG’de 0.41 ve BT’de 0.77 ve aksiyel kesit için ise MRG’de
0.45 BT’de 0.78 olarak bulundu. Tibia kesitlerinde koronal ölçümlerde gözlemci-içi
güvenilirliğimizi MRG’de 0.66, BT’de 0.81, sagittal kesitlerde MRG’de 0.38,
BT’de 0.69, aksiyel kesitlerde MRG’de 0.45, BT’de 0.79 olarak bulundu. Femur
kesitlerinde gözlemcilerin ölçümü giriş, orta veya çıkıştan yapmaları arasında
anlamlı fark bulunmamıştır. Tibiada femur ölçümlerine göre hatalı ölçüm sayısı
daha yüksek ve güvenilirlik daha düşük bulundu.
Sonuçlar:
Sonuç olarak
lineer genişlemesi olan hastalarda tünelin girişinden, ortasından veya
çıkışından ölçümünün fark yaratmayacağını; ölçümlerde koronal kesitlerin
kullanılmasının ve mümkünse görüntülemede BT’nin tercih edilmesinin daha doğru
sonuçlar vereceğini düşünmekteyiz. Ancak ilerleyen yıllarda daha yüksek
çözünürlüklü MRG ile yapılacak karşılaştırmalı çalışmalarda benzer veya daha
fazla güvenilirlik saptanması durumunda tünel genişlemesi ölçümünde BT’nin
radyoaktif etkileri de düşünüldüğünde MRG daha tercih edilir hale
gelebilir.
Keywords
Ön çapraz bağ yırtığı Bilgisayarlı tomografi Manyetik rezonans görüntüleme Tünel genişliği Düz grafi
References
- Referans1- Ellison, A. E., Berg, E. E. Embryology, anatomy, and function of the anterior cruciate ligament. The Orthopedic clinics of North America, 1985;16(1),3.
- Referans2- Duthon, V. B., Barea, C., Abrassart, S., Fasel, J. H., Fritschy, D., Ménétrey, J. Anatomy of the anterior cruciate ligament. Knee Surgery, Sports Traumatology, Arthroscopy, 2006; 14(3), 204-213.
- Referans3- Kondo, E., Merican, A. M., Yasuda, K., Amis, A. A. Biomechanical analysis of knee laxity with isolated anteromedial or posterolateral bundle–deficient anterior cruciate ligament. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2014; 30(3), 335-343.
- Referans4- Fink, C., Zapp, M., Benedetto, K. P., Hackl, W., Hoser, C., Rieger, M. Tibial tunnel enlargement following anterior cruciate ligament reconstruction with patellar tendon autograft. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2001;17(2), 138-143.
- Referans5- Struewer, J., Efe, T., Frangen, T. M., Schwarting, T., Buecking, B., Ruchholtz, S., Ziring, E. Prevalence and influence of tibial tunnel widening after isolated anterior cruciate ligament reconstruction using patella-bone-tendon-bone-graft: long-term follow-up. Orthopedic reviews, 2012; 4(2), 21.
- Referans6- Weber, A. E., Delos, D., Oltean, H. N., Vadasdi, K., Cavanaugh, J., Potter, H. G., Rodeo, S. A. Tibial and femoral tunnel changes after ACL reconstruction: a prospective 2-year longitudinal MRI study. The American journal of sports medicine, 2015; 43(5), 1147-1156.
- Referans7- Webster, K. E., Feller, J. A., Elliott, J., Hutchison, A., Payne, R. A comparison of bone tunnel measurements made using computed tomography and digital plain radiography after anterior cruciate ligament reconstruction. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2004; 20(9), 946-950.
- Referans8- Shrout, P. E., Fleiss, J. L. Intraclass correlations: uses in assessing rater reliability. Psychological bulletin, 1979; 86(2), 420.
- Referans9- Crespo, B., Aga, C., Wilson, K. J., Pomeroy, S. M., LaPrade, R. F., Engebretsen, L., Wijdicks, C. A. Measurements of bone tunnel size in anterior cruciate ligament reconstruction: 2D versus 3D computed tomography model. Journal of experimental orthopaedics, 2014; 1(1), 2.
- Referans10- Kawaguchi, Y., Kondo, E., Kitamura, N., Kai, S., Inoue, M., Yasuda, K. Comparisons of femoral tunnel enlargement in 169 patients between single-bundle and anatomic double-bundle anterior cruciate ligament reconstructions with hamstring tendon grafts. Knee Surgery, Sports Traumatology, Arthroscopy, 2011; 19(8), 1249-1257.
- Referans11- Iorio, R., Di Sanzo, V., Vadalà, A., Conteduca, J., Mazza, D., Redler, A., et al. ACL reconstruction with hamstrings: how different technique and fixation devices influence bone tunnel enlargement. Eur Rev Med Pharmacol Sci 2013; 17:2956-2961.
- Referans12- Iriuchishima, T., Shirakura, K., Yorifuji, H., Aizawa, S., Fu, F. H. Size comparison of ACL footprint and reconstructed auto graft. Knee surgery, sports traumatology, arthroscopy, 2013; 21(4), 797-803.
- Referans13- Hwang MD, Jason WP, Metz S, Metz J. Tibial insertions of the anteromedial and posterolateral bundles of the anterıor cruciate ligament: Morphometry, arthroscopic landmarks and orientation model for bone tunnel placement. Arthroscopy. 2008; 24:154-161.
- Referans14- Zaffagini S, Martelli S, Acquaroli F. Computer investigation of ACL orientation during passive range of motion. Comput Biol Med. 2004; 34(2):153-163.
- Referans15- Olsen, O. E., Myklebust, G., Engebretsen, L., Bahr, R. Injury mechanisms for anterior cruciate ligament injuries in team handball a systematic video analysis. The American journal of sports medicine, 2004; 32(4); 1002-1012.
- Referans16- Zantop T, Brucker PU, Vidal A, Zelle BA, Fu FH. Intraarticular rupture pattern of the ACL. Clin Orthop Relat Res 2007; 454:48-53.
- Referans17- Gabriel, M. T., Wong, E. K., Woo, S. L. Y., Yagi, M., Debski, R. E. Distribution of in situ forces in the anterior cruciate ligament in response to rotatory loads. Journal of Orthopaedic Research, 2004; 22(1), 85-89.
- Referans18- L’Insalata, J. C., Klatt, B., Fu, F. H., Harner, C. D. Tunnel expansion following anterior cruciate ligament reconstruction: a comparison of hamstring and patellar tendon autografts. Knee Surgery, Sports Traumatology, Arthroscopy, 1997; 5(4), 234-238.
- Referans19- Clatworky MG, Annear P, Bulow JU, Barlett RJ. Tunnel widening in anterıor cruciate ligament reconstruction; a prospective evaluation of hamstring and patellar tendon grafts. Knee Surgery Sports Traumatol Arthroscopy 1999; 7(3);138-145.
- Referans20- Robbrecht, C., Claes, S., Cromheecke, M., Mahieu, P., Kakavelakis, K., Victor, J., Verdonk, P. Reliability of a semi-automated 3D-CT measuring method for tunnel diameters after anterior cruciate ligament reconstruction: a comparison between soft-tissue single-bundle allograft vs. autograft. The Knee, 2014; 21(5), 926-931.
- Referans21- Wilson TC, Kantaras A, Atay A, Johnson DL. Tunnel enlargement after anterıor cruciate ligament surgery. Am J Sports Medicine 2004; 32:543-549.
- Referans22- Marchant MHJrr, Willimon SC, Vinson E, Pietrobon R, Grrett We, Higgins LD. Comparison of plain radiography, computed tomography, and magnetic resonance imaging in the evaluation of bone tunnel widening after anterıor cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2010; 18:1059-1064.
- Referans23- Parkar AP, Adriaensen ME, Strand T, Inderhaug E, Harlem T, Solheim E. How to read post-operative radiographs and CT scans after single-bundle anteriorcruciate ligament reconstruction. Skeletal Radiol. 2013;42(11):1489-1500.
RELIABILITY ANALYSIS OF MAGNETIC RESONANCE IMAGING AND COMPUTERIZED TOMOGRAPHY IN THE MEASUREMENT OF TUNNEL WIDTH AFTER ANTERIOR CRUCIATE LIGAMENT REPAIR.
Abstract
Background:
Tunnel
widening after Anterior cruciate ligament (ACL) surgery can be measured by
several radiological methods. Computed tomography (CT) and magnetic resonance
imaging (MRI) are used the assessment of tunnel widening in patient follow-up.
The aim of our study is to analyse the reliability of tunnel width measuring
between two different radiographic methods.
Material and Methods:
24
patients who were performed isoanatomic Arthroscopic Anterior Cruciate Ligament
Reconstruction by using hamstring autograft with elevator system in our clinic
and had linear tunnel widening in their follow-up were included in the study.
Five observers measured the tunnel width on sagittal, coronal and axial images
of CT and MRI of the patients. Entrance, middle and out wide for the femoral
and tibial tunnels were measured by each observer on these sections with a
ruler application on the PACS system (Picture Archiving and Communication
System). The measurements were repeated with one week interval and the
measurements were documented by an independent surgeon.
Results:
14
significant differences in MRI measurements and 11 significant differences in
CT measurements were seen in a total of 90 femoral measurements in all sections
(p<0.05). 19 significant differences in MRI measurements and 11 significant
differences in CT measurements were seen in a total of 90 tibial measurements
in all sections (p<0.05). Intraobserver reliability of femoral coronal,
sagittal and axial sections was found 0.69 in MRI and 0.85 in CT, 0.41 in MRI
and 0.77 in CT, 0.45 in MRI and 0.78 in CT, respectively. Intraobserver reliability
of tibial coronal, sagittal and axial sections was found 0.66 in MRI and 0.81
in CT, 0.38 in MRI and 0.69 in CT, 0.45 in MRI and 0.79 in CT, respectively.
There was no significant difference between making the measurement of observer
in the entrance, middle or out at femoral sections. The tibial measurements
were found to be higher number of incorrect measurements and lower reliability
than femoral measurements.
Conclusions:
As a
result, there is no difference whether making the measurement of tunnel from
entrance, middle or out in patients with liner widening, the using of coronal
section in measurements and if possible CT scan preference would give more
accurate results. However, in later years the comparative studies with
higher-resolution MRI to measure the widening of the tunnel in case of similar
or greater reliability with computed tomography, MRI will be more preferable
when also we take into account of radioactive effects of CT.
Keywords
Anterior cruciate ligament tear computed tomography magnetic resonance imaging tunnel width conventional graphy
References
- Referans1- Ellison, A. E., Berg, E. E. Embryology, anatomy, and function of the anterior cruciate ligament. The Orthopedic clinics of North America, 1985;16(1),3.
- Referans2- Duthon, V. B., Barea, C., Abrassart, S., Fasel, J. H., Fritschy, D., Ménétrey, J. Anatomy of the anterior cruciate ligament. Knee Surgery, Sports Traumatology, Arthroscopy, 2006; 14(3), 204-213.
- Referans3- Kondo, E., Merican, A. M., Yasuda, K., Amis, A. A. Biomechanical analysis of knee laxity with isolated anteromedial or posterolateral bundle–deficient anterior cruciate ligament. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2014; 30(3), 335-343.
- Referans4- Fink, C., Zapp, M., Benedetto, K. P., Hackl, W., Hoser, C., Rieger, M. Tibial tunnel enlargement following anterior cruciate ligament reconstruction with patellar tendon autograft. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2001;17(2), 138-143.
- Referans5- Struewer, J., Efe, T., Frangen, T. M., Schwarting, T., Buecking, B., Ruchholtz, S., Ziring, E. Prevalence and influence of tibial tunnel widening after isolated anterior cruciate ligament reconstruction using patella-bone-tendon-bone-graft: long-term follow-up. Orthopedic reviews, 2012; 4(2), 21.
- Referans6- Weber, A. E., Delos, D., Oltean, H. N., Vadasdi, K., Cavanaugh, J., Potter, H. G., Rodeo, S. A. Tibial and femoral tunnel changes after ACL reconstruction: a prospective 2-year longitudinal MRI study. The American journal of sports medicine, 2015; 43(5), 1147-1156.
- Referans7- Webster, K. E., Feller, J. A., Elliott, J., Hutchison, A., Payne, R. A comparison of bone tunnel measurements made using computed tomography and digital plain radiography after anterior cruciate ligament reconstruction. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2004; 20(9), 946-950.
- Referans8- Shrout, P. E., Fleiss, J. L. Intraclass correlations: uses in assessing rater reliability. Psychological bulletin, 1979; 86(2), 420.
- Referans9- Crespo, B., Aga, C., Wilson, K. J., Pomeroy, S. M., LaPrade, R. F., Engebretsen, L., Wijdicks, C. A. Measurements of bone tunnel size in anterior cruciate ligament reconstruction: 2D versus 3D computed tomography model. Journal of experimental orthopaedics, 2014; 1(1), 2.
- Referans10- Kawaguchi, Y., Kondo, E., Kitamura, N., Kai, S., Inoue, M., Yasuda, K. Comparisons of femoral tunnel enlargement in 169 patients between single-bundle and anatomic double-bundle anterior cruciate ligament reconstructions with hamstring tendon grafts. Knee Surgery, Sports Traumatology, Arthroscopy, 2011; 19(8), 1249-1257.
- Referans11- Iorio, R., Di Sanzo, V., Vadalà, A., Conteduca, J., Mazza, D., Redler, A., et al. ACL reconstruction with hamstrings: how different technique and fixation devices influence bone tunnel enlargement. Eur Rev Med Pharmacol Sci 2013; 17:2956-2961.
- Referans12- Iriuchishima, T., Shirakura, K., Yorifuji, H., Aizawa, S., Fu, F. H. Size comparison of ACL footprint and reconstructed auto graft. Knee surgery, sports traumatology, arthroscopy, 2013; 21(4), 797-803.
- Referans13- Hwang MD, Jason WP, Metz S, Metz J. Tibial insertions of the anteromedial and posterolateral bundles of the anterıor cruciate ligament: Morphometry, arthroscopic landmarks and orientation model for bone tunnel placement. Arthroscopy. 2008; 24:154-161.
- Referans14- Zaffagini S, Martelli S, Acquaroli F. Computer investigation of ACL orientation during passive range of motion. Comput Biol Med. 2004; 34(2):153-163.
- Referans15- Olsen, O. E., Myklebust, G., Engebretsen, L., Bahr, R. Injury mechanisms for anterior cruciate ligament injuries in team handball a systematic video analysis. The American journal of sports medicine, 2004; 32(4); 1002-1012.
- Referans16- Zantop T, Brucker PU, Vidal A, Zelle BA, Fu FH. Intraarticular rupture pattern of the ACL. Clin Orthop Relat Res 2007; 454:48-53.
- Referans17- Gabriel, M. T., Wong, E. K., Woo, S. L. Y., Yagi, M., Debski, R. E. Distribution of in situ forces in the anterior cruciate ligament in response to rotatory loads. Journal of Orthopaedic Research, 2004; 22(1), 85-89.
- Referans18- L’Insalata, J. C., Klatt, B., Fu, F. H., Harner, C. D. Tunnel expansion following anterior cruciate ligament reconstruction: a comparison of hamstring and patellar tendon autografts. Knee Surgery, Sports Traumatology, Arthroscopy, 1997; 5(4), 234-238.
- Referans19- Clatworky MG, Annear P, Bulow JU, Barlett RJ. Tunnel widening in anterıor cruciate ligament reconstruction; a prospective evaluation of hamstring and patellar tendon grafts. Knee Surgery Sports Traumatol Arthroscopy 1999; 7(3);138-145.
- Referans20- Robbrecht, C., Claes, S., Cromheecke, M., Mahieu, P., Kakavelakis, K., Victor, J., Verdonk, P. Reliability of a semi-automated 3D-CT measuring method for tunnel diameters after anterior cruciate ligament reconstruction: a comparison between soft-tissue single-bundle allograft vs. autograft. The Knee, 2014; 21(5), 926-931.
- Referans21- Wilson TC, Kantaras A, Atay A, Johnson DL. Tunnel enlargement after anterıor cruciate ligament surgery. Am J Sports Medicine 2004; 32:543-549.
- Referans22- Marchant MHJrr, Willimon SC, Vinson E, Pietrobon R, Grrett We, Higgins LD. Comparison of plain radiography, computed tomography, and magnetic resonance imaging in the evaluation of bone tunnel widening after anterıor cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2010; 18:1059-1064.
- Referans23- Parkar AP, Adriaensen ME, Strand T, Inderhaug E, Harlem T, Solheim E. How to read post-operative radiographs and CT scans after single-bundle anteriorcruciate ligament reconstruction. Skeletal Radiol. 2013;42(11):1489-1500.
Details
| Subjects | Health Care Administration |
|---|---|
| Journal Section | Original research article |
| Authors | |
| Publication Date | December 1, 2017 |
| Submission Date | April 30, 2017 |
| Published in Issue | Year 2017 Volume: 50 Issue: 3 |
