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Tibial Tunnel Placement in ACL Reconstruction Using a Novel Grid and Biplanar Stereoradiographic Imaging

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 m...

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Autores principales: Montreuil, Julien, Saleh, Joseph, Cresson, Thierry, De Guise, Jacques A., Lavoie, Frédéric
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8239338/
https://www.ncbi.nlm.nih.gov/pubmed/34250158
http://dx.doi.org/10.1177/2325967121989369
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author Montreuil, Julien
Saleh, Joseph
Cresson, Thierry
De Guise, Jacques A.
Lavoie, Frédéric
author_facet Montreuil, Julien
Saleh, Joseph
Cresson, Thierry
De Guise, Jacques A.
Lavoie, Frédéric
author_sort Montreuil, Julien
collection PubMed
description 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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spelling pubmed-82393382021-07-08 Tibial Tunnel Placement in ACL Reconstruction Using a Novel Grid and Biplanar Stereoradiographic Imaging Montreuil, Julien Saleh, Joseph Cresson, Thierry De Guise, Jacques A. Lavoie, Frédéric Orthop J Sports Med Article 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. SAGE Publications 2021-03-11 /pmc/articles/PMC8239338/ /pubmed/34250158 http://dx.doi.org/10.1177/2325967121989369 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by-nc-nd/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 License (https://creativecommons.org/licenses/by-nc-nd/4.0/) which permits non-commercial use, reproduction and distribution of the work as published without adaptation or alteration, without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Article
Montreuil, Julien
Saleh, Joseph
Cresson, Thierry
De Guise, Jacques A.
Lavoie, Frédéric
Tibial Tunnel Placement in ACL Reconstruction Using a Novel Grid and Biplanar Stereoradiographic Imaging
title Tibial Tunnel Placement in ACL Reconstruction Using a Novel Grid and Biplanar Stereoradiographic Imaging
title_full Tibial Tunnel Placement in ACL Reconstruction Using a Novel Grid and Biplanar Stereoradiographic Imaging
title_fullStr Tibial Tunnel Placement in ACL Reconstruction Using a Novel Grid and Biplanar Stereoradiographic Imaging
title_full_unstemmed Tibial Tunnel Placement in ACL Reconstruction Using a Novel Grid and Biplanar Stereoradiographic Imaging
title_short Tibial Tunnel Placement in ACL Reconstruction Using a Novel Grid and Biplanar Stereoradiographic Imaging
title_sort tibial tunnel placement in acl reconstruction using a novel grid and biplanar stereoradiographic imaging
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8239338/
https://www.ncbi.nlm.nih.gov/pubmed/34250158
http://dx.doi.org/10.1177/2325967121989369
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