Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA.
Am J Sports Med. 2012 Oct;40(10):2236-41. doi: 10.1177/0363546512458086. Epub 2012 Sep 7.
Anterior cruciate ligament (ACL) reconstruction tunnel placement is often evaluated by radiographs. This study examines the interobserver reliability of various radiographic measurements of ACL tunnels.
When ideal radiographic views are obtained, the interobserver reliability of the measurements among experienced surgeons would be good to excellent.
Descriptive laboratory study.
Tunnels for single-bundle ACL reconstruction were drilled and filled with metal interference screws or a tibial reamer on 73 cadaveric knees. Ideal fluoroscopic radiographs were obtained. Three independent reviewers performed 18 measurements including a modification of the grid method. For the grid method analysis, reviewers fit a 16 × 12 grid to the lateral knee radiograph, and the center of the femoral tunnel was marked. Interobserver reliability of the measurements was performed using intraclass correlation coefficients (ICCs). A precision grouping analysis was performed for the grid measurements to calculate the mean radius and standard deviation grouping distances.
The ICCs were excellent (>.75) for the tibial tunnel angles and tunnel measurements, the clock face measurement, and the Aglietti et al and Jonsson et al measurements. The ICCs were good (.4-.75) for an estimation of graft impingement, Harner et al measurements, and notch height. The mean radius for grid measurements was 0.6 ± 0.4 units (range, 0-2.36 units), with each unit being 1 box in the 16 × 12 grid. When a circle was constructed with a 1.3-unit radius, 95% of the 3 surgeons' measurements would be included in the area of that circle.
Reliability of ACL tunnel measurements was good to excellent under ideal circumstances for the majority of measurements. The modified grid method demonstrated very acceptable reliability.
Measurements with good to excellent reliability can be used to evaluate ACL tunnel placement when ideal radiographic views are obtained.
前交叉韧带（ACL）重建隧道的放置通常通过 X 线片进行评估。本研究检查了 ACL 隧道的各种 X 线片测量的观察者间可靠性。
当获得理想的 X 线片视图时，经验丰富的外科医生之间的测量观察者间可靠性将是良好到优秀的。
描述性实验室研究。
在 73 个尸体膝关节上钻取并填充了单束 ACL 重建的隧道，并使用金属干扰螺钉或胫骨扩孔器填充。获得了理想的透视 X 线片。三位独立的评审员进行了 18 项测量，包括对网格方法的修改。对于网格方法分析，评审员将 16×12 的网格拟合到外侧膝关节 X 线片上，并标记股骨隧道的中心。使用组内相关系数（ICC）进行测量的观察者间可靠性。对网格测量值进行了精度分组分析，以计算平均半径和标准偏差分组距离。
胫骨隧道角度和隧道测量值、时钟面测量值、Aglietti 等人和 Jonsson 等人的测量值的 ICC 为优秀（>.75）。对于移植物撞击的估计、Harner 等人的测量值和切迹高度的 ICC 为良好（.4-.75）。网格测量的平均半径为 0.6±0.4 个单位（范围为 0-2.36 个单位），每个单位为 16×12 网格中的 1 个框。当用 1.3 个单位半径构建一个圆时，3 位外科医生的 95%的测量值将包含在该圆的区域内。
在大多数情况下，对于大多数测量值，在理想情况下 ACL 隧道测量的可靠性为良好到优秀。改良的网格方法显示出非常可接受的可靠性。
当获得理想的 X 线片视图时，具有良好到优秀可靠性的测量值可用于评估 ACL 隧道的放置。
