Department of Trauma and Orthopaedic Surgery, Cologne Merheim Medical Centre, Witten/Herdecke University, Ostmerheimer Strasse 200, 51109, Cologne, Germany,
Arch Orthop Trauma Surg. 2014 Apr;134(4):529-36. doi: 10.1007/s00402-014-1931-x. Epub 2014 Jan 30.
Correct anatomic tunnel positions are essential in anterior cruciate ligament (ACL) reconstruction. To establish recommendations for tunnel positioning based on anatomical findings and to compare tunnel positions with clinical results, different radiological measurement methods as the quadrant method exist. Comparing the data of different observers requires the validation of the reliability of measurement methods. The purpose of this study therefore was to determine the reliability of the quadrant method to measure tunnel positions in ACL reconstruction. The hypothesis was, that the quadrant method shows a low inter- and intraobserver variability.
In a test/retest scenario 20 knee surgeons were asked to determine defined tunnel positions in five lateral radiographs applying the quadrant method. Rotation, angle deviation, height and depth of the quadrant as well as absolute and relative tunnel positions of each observation were measured along referenced scales. Mean sizes and angle deviations of the quadrants, tunnel positions and deviations between the test/retest positions were calculated as well as standard deviations and range.
Interobserver variability analyses, to plan as well as to determine tunnel positions in ACL reconstruction, showed a mean variability (SD) of <1 mm, with ranges of 2.5 mm for planning and 3.7 mm for determination of tunnel positions using the quadrant method. Intraobserver analysis showed mean variability with deviations of <1 mm and maximum standard deviations of 0.7 mm and ranges of up to 2.3 mm.
We confirmed the hypothesis that the quadrant method has a low inter- and intraobserver variability. Based on the presented validation data, the quadrant method can be recommended as reliable method to radiographically describe insertion areas of the ACL as well as to determine tunnel positions in ACL reconstruction intra and postoperatively.
在前交叉韧带（ACL）重建中，正确的解剖学隧道位置至关重要。为了根据解剖学发现制定隧道定位建议，并将隧道位置与临床结果进行比较，存在不同的影像学测量方法，如象限法。比较不同观察者的数据需要验证测量方法的可靠性。因此，本研究的目的是确定象限法测量 ACL 重建中隧道位置的可靠性。假设是象限法显示出较低的观察者内和观察者间变异性。
在测试/复测方案中，要求 20 名膝关节外科医生应用象限法在 5 张侧位 X 光片中确定定义的隧道位置。沿着参考刻度测量象限的旋转、角度偏差、高度和深度以及每个观察的绝对和相对隧道位置。还计算了象限、隧道位置和测试/复测位置之间偏差的平均值和角度偏差、隧道位置和偏差的标准偏差和范围。
观察者间变异性分析，用于规划和确定 ACL 重建中的隧道位置，显示出平均（SD）<1mm 的变异性，规划时的范围为 2.5mm，确定隧道位置时的范围为 3.7mm 使用象限法。观察者内分析显示平均变异性为<1mm，最大标准偏差为 0.7mm，范围最大为 2.3mm。
我们证实了象限法具有较低的观察者内和观察者间变异性的假设。基于所呈现的验证数据，象限法可作为可靠的方法推荐，用于对 ACL 的插入区域进行影像学描述，以及在 ACL 重建的术前和术后确定隧道位置。
