Innocenti Bernardo, Salandra Pasquale, Pascale Walter, Pianigiani Silvia
BEAMS Department (Bio Electro and Mechanical Systems), École Polytechnique de Bruxelles, Université Libre de Bruxelles, Av. F. Roosevelt 50, Brussels, Belgium.
Università Politecnica delle Marche, Via Brecce Bianche, Ancona 60131, Italy.
Knee. 2016 Aug;23(4):575-81. doi: 10.1016/j.knee.2015.07.015. Epub 2016 May 28.
At present, increasing the accuracy of identification of knee ligament insertions is fundamental in developing accurate patient-specific three-dimensional (3D) models for preoperative planning surgeries, designing patient-specific instrumentation or implants, and conducting biomechanical analyses. The accuracy and reproducibility of magnetic resonance imaging (MRI) scans in identifying cruciate and collateral ligament insertions have not been investigated thus far, despite their wide use. This study aimed to define and validate a method for this purpose.
First, the femur and tibia bones were oriented. Then, the sites of cruciate and collateral ligament insertions were identified. The inter- and intra-class correlation coefficients (ICCs) were calculated after multiple operators were applied to the images of different patients. The effect of the quality of the available MRI scans on the accuracy of identifying ligament insertions was also investigated. Moreover, non-expert operators were also found to be capable of performing the procedure after a video tutorial, and its efficacy was tested.
The mean intra-observer variability was always <1.5mm for all landmarks, whereas the mean inter-observer variability was always <2.5mm except for the medial collateral ligament localized on the tibia (6.7mm). The ICCs showed good results, up to 0.99. A lower image quality had no noticeable effect on the procedure for identifying cruciate ligaments. Video tutorials were found to improve the ICCs up to 45%.
This procedure is suitable for the univocal and accurate identification of cruciate and lateral collateral ligaments on MRI scans.
This study demonstrates that MRI scans are highly suited to identifying cruciate ligament insertions.
目前，提高膝关节韧带附着点识别的准确性对于开发用于术前手术规划的精确患者特异性三维（3D）模型、设计患者特异性器械或植入物以及进行生物力学分析至关重要。尽管磁共振成像（MRI）扫描已被广泛使用，但其在识别交叉韧带和侧副韧带附着点方面的准确性和可重复性尚未得到研究。本研究旨在为此定义并验证一种方法。
首先，对股骨和胫骨进行定向。然后，识别交叉韧带和侧副韧带的附着点。在多名操作人员对不同患者的图像进行操作后，计算组内和组间相关系数（ICC）。还研究了现有MRI扫描质量对韧带附着点识别准确性的影响。此外，发现非专业操作人员在观看视频教程后也能够执行该程序，并对其效果进行了测试。
所有标志点的观察者内平均变异性始终<1.5mm，而观察者间平均变异性除位于胫骨的内侧副韧带外（6.7mm）始终<2.5mm。ICC显示出良好的结果，高达0.99。较低的图像质量对交叉韧带识别程序没有明显影响。发现视频教程可将ICC提高多达45%。
该程序适用于在MRI扫描中明确且准确地识别交叉韧带和外侧副韧带。
本研究表明MRI扫描非常适合识别交叉韧带附着点。
