前交叉韧带重建术后解剖学移植物放置的计算机断层扫描评估：网格测量与角度测量的比较研究
Computed Tomography Assessment of Anatomic Graft Placement After ACL Reconstruction: A Comparative Study of Grid and Angle Measurements.
作者信息
Parkar Anagha P, Adriaensen Miraude E A P M, Giil Lasse M, Solheim Eirik
机构信息
Department of Radiology, Haraldsplass Deaconess Hospital, Bergen, Norway.
Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
出版信息
Orthop J Sports Med. 2019 Mar 19;7(3):2325967119832594. doi: 10.1177/2325967119832594. eCollection 2019 Mar.
BACKGROUND
The anatomic placement of anterior cruciate ligament (ACL) grafts is often assessed with postoperative imaging. In clinical practice, graft angles are measured to indicate anatomic placement on magnetic resonance imaging, whereas grid measurements are performed on computed tomography (CT). Recently, a study indicated that graft angle measurements could also be assessed on CT. No consensus has yet been reached on which measurement method is best suited to assess anatomic graft placement.
PURPOSE
To compare the ability of grid measurements and angle measurements to identify anatomic versus nonanatomic tunnel placement on CT performed in patients undergoing ACL reconstruction.
STUDY DESIGN
Case series; Level of evidence, 4.
METHODS
A total of 100 knees undergoing primary reconstruction with a hamstring graft (HAM group), 91 undergoing reconstruction with a bone-patellar tendon-bone graft (BPTB group), and 117 undergoing revision ACL reconstruction (REV group) were assessed with CT. Grid measurements of the femoral and tibial tunnels and angle measurements of grafts were performed. Graft placement, rated as anatomic or nonanatomic, was assessed with both methods. Pearson chi-square, analysis of variance, Kruskal-Wallis, and weighted kappa tests were performed as appropriate.
RESULTS
The grid assessment classified 10% of the HAM group, 4% of the BPTB group, and 17% of the REV group as nonanatomic ( < .001). The angle assessment classified 37% of the HAM group, 54% of the BPTB group, and 47% of the REV group as nonanatomic. The weighted kappa between angle measurements and grid measurements was low in all groups (HAM: 0.009; BPTB: 0.065; REV: 0.041).
CONCLUSION
The agreement between grid measurements and angle measurements was very low. The angle measurements seemed to overestimate nonanatomic tunnel placement. Grid measurements were better in identifying malpositioned grafts.
背景
前交叉韧带（ACL）移植物的解剖位置通常在术后通过影像学进行评估。在临床实践中，在磁共振成像上测量移植物角度以指示解剖位置，而在计算机断层扫描（CT）上进行网格测量。最近，一项研究表明，也可以在CT上评估移植物角度测量。关于哪种测量方法最适合评估移植物的解剖位置，尚未达成共识。
目的
比较网格测量和角度测量在接受ACL重建的患者中进行的CT上识别解剖与非解剖隧道位置的能力。
研究设计
病例系列；证据水平，4级。
方法
对总共100例接受腘绳肌移植物初次重建的膝关节（HAM组）、91例接受髌腱骨移植物重建的膝关节（BPTB组）和117例接受ACL翻修重建的膝关节（REV组）进行CT评估。对股骨和胫骨隧道进行网格测量，并对移植物进行角度测量。用两种方法评估移植物位置，分为解剖位置或非解剖位置。根据情况进行Pearson卡方检验、方差分析、Kruskal-Wallis检验和加权kappa检验。
结果
网格评估将HAM组的10%、BPTB组的4%和REV组的17%分类为非解剖位置（P <.001）。角度评估将HAM组的37%、BPTB组的54%和REV组的47%分类为非解剖位置。所有组中角度测量和网格测量之间的加权kappa值都很低（HAM组：0.009；BPTB组：0.065；REV组：0.
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