Department of Orthopaedics Surgery (Ohashi), School of Medicine, Toho University, 2-17-6 Ohashi, Meguro-ku, Tokyo, 153-8515, Japan.
Knee Surg Sports Traumatol Arthrosc. 2018 Aug;26(8):2389-2394. doi: 10.1007/s00167-017-4797-y. Epub 2017 Nov 20.
The quadrant method was described by Bernard et al. and it has been widely used for postoperative evaluation of anterior cruciate ligament (ACL) reconstruction. The purpose of this research is to further develop the quadrant method measuring four points, which we named four-point quadrant method, and to compare with the quadrant method.
Three-dimensional computed tomography (3D-CT) analyses were performed in 25 patients who underwent double-bundle ACL reconstruction using the outside-in technique. The four points in this study's quadrant method were defined as point1-highest, point2-deepest, point3-lowest, and point4-shallowest, in femoral tunnel position. Value of depth and height in each point was measured. Antero-medial (AM) tunnel is (depth1, height2) and postero-lateral (PL) tunnel is (depth3, height4) in this four-point quadrant method. The 3D-CT images were evaluated independently by 2 orthopaedic surgeons. A second measurement was performed by both observers after a 4-week interval. Intra- and inter-observer reliability was calculated by means of intra-class correlation coefficient (ICC). Also, the accuracy of the method was evaluated against the quadrant method.
Intra-observer reliability was almost perfect for both AM and PL tunnel (ICC > 0.81). Inter-observer reliability of AM tunnel was substantial (ICC > 0.61) and that of PL tunnel was almost perfect (ICC > 0.81). The AM tunnel position was 0.13% deep, 0.58% high and PL tunnel position was 0.01% shallow, 0.13% low compared to quadrant method.
The four-point quadrant method was found to have high intra- and inter-observer reliability and accuracy. This method can evaluate the tunnel position regardless of the shape and morphology of the bone tunnel aperture for use of comparison and can provide measurement that can be compared with various reconstruction methods. The four-point quadrant method of this study is considered to have clinical relevance in that it is a detailed and accurate tool for evaluating femoral tunnel position after ACL reconstruction.
Case series, Level IV.
象限法由 Bernard 等人描述，已广泛用于前交叉韧带（ACL）重建的术后评估。本研究的目的是进一步发展四点象限法，我们称之为四点象限法，并与象限法进行比较。
对 25 例采用经皮外技术行双束 ACL 重建的患者进行三维 CT（3D-CT）分析。本研究的象限法中的四点定义为股骨隧道位置的最高点 1、最深处 2、最低点 3 和最浅点 4。测量各点的深度和高度值。四点象限法中前内侧（AM）隧道为（深度 1、高度 2），后外侧（PL）隧道为（深度 3、高度 4）。由 2 位骨科医生独立评估 3D-CT 图像。两位观察者在 4 周间隔后进行第二次测量。采用组内相关系数（ICC）评估观察者内和观察者间的可靠性。还评估了该方法与象限法的准确性。
AM 和 PL 隧道的观察者内可靠性几乎为完美（ICC＞0.81）。AM 隧道的观察者间可靠性为中等（ICC＞0.61），PL 隧道的观察者间可靠性几乎为完美（ICC＞0.81）。与象限法相比，AM 隧道位置深 0.13%，高 0.58%，PL 隧道位置浅 0.01%，低 0.13%。
四点象限法具有较高的观察者内和观察者间可靠性和准确性。该方法可评估隧道位置，而与骨隧道开口的形状和形态无关，可提供可与各种重建方法进行比较的测量值。本研究的四点象限法被认为具有临床相关性，因为它是一种评估 ACL 重建后股骨隧道位置的详细而准确的工具。
病例系列，IV 级。
