Département d'orthopédie et traumatologie, hôpital de la Pitié-Salpêtrière, AP-HP, université de la Sorbonne, 47-83, boulevard de l'hôpital, 75013 Paris, France.
Département d'orthopédie et traumatologie, hôpital de la Pitié-Salpêtrière, AP-HP, université de la Sorbonne, 47-83, boulevard de l'hôpital, 75013 Paris, France.
Orthop Traumatol Surg Res. 2022 May;108(3):103238. doi: 10.1016/j.otsr.2022.103238. Epub 2022 Feb 9.
The most common mechanical complication following an anterior cruciate ligament (ACL) reconstruction is joint stiffness, due in part to cyclops syndrome. A narrow intercondylar notch is an anatomical risk factor. A reliable preoperative notch measurement would help anticipate proper graft size, or plan a notchplasty during the ligament reconstruction, if necessary. No study has yet assessed the accuracy of the methods used to measure notch size.
The novel measurement protocol proposed in this study would be more reproducible than the reference technique.
A total of 20 preoperative knee MRIs performed during the assessment of an ACL rupture were randomly selected. The notch size was measured using 2 methods: traditional (ratio of the notch and metaphyseal widths measured on a line drawn through the popliteal groove) and novel. The latter was measured using the same ratio but took into account the notch width in its proximal third, according to a coronal slice that passes through the ACL tibial attachment. Three orthopedic surgeons with different levels of experience (senior surgeon, junior surgeon and surgical resident) performed these measurement protocols twice on anonymized MRI scans, 10days apart. Spearman's rank correlation coefficient was used to assess the intraobserver correlations and a concordance index was used to assess the interobserver correlations. The influence of the second MRI reading was analyzed with a bootstrap test.
The mean intraobserver reliability was 0.73 for the reference method and 0.83 for the proposed method. The values of the bootstrap tests were higher for the proposed method (0.45 vs. 0.45 and 0.70; p<05 for interobserver; 0.49 vs. 0.69 and 0.62; p<05 for intraobserver).
The proposed measurement protocol showed a higher reproducibility in assessing notch size than the traditional method. This technique therefore provides a reliable assessment of the intercondylar notch width.
IV; retrospective study.
前交叉韧带（ACL）重建后最常见的机械并发症是关节僵硬，部分原因是独眼综合征。狭窄的髁间切迹是解剖学上的危险因素。可靠的术前切迹测量有助于预测合适的移植物大小，如果需要，也可以在韧带重建期间计划进行切迹成形术。目前还没有研究评估用于测量切迹大小的方法的准确性。
本研究提出的新测量方案比参考技术更具可重复性。
共随机选择了 20 例 ACL 撕裂评估期间进行的术前膝关节 MRI。使用 2 种方法测量切迹大小：传统方法（在通过腘窝沟绘制的线上测量切迹和干骺端宽度的比值）和新方法。后者使用相同的比值，但根据穿过 ACL 胫骨附着点的冠状切片，考虑了切迹近端三分之一的宽度。3 位具有不同经验水平的骨科医生（高级外科医生、初级外科医生和外科住院医师）在 10 天的间隔内对匿名 MRI 扫描进行了两次测量。采用 Spearman 秩相关系数评估观察者内相关性，采用一致性指数评估观察者间相关性。采用 bootstrap 检验分析第二次 MRI 阅读的影响。
参考方法的观察者内可靠性平均值为 0.73，建议方法为 0.83。bootstrap 检验的数值对于建议的方法更高（0.45 对 0.45 和 0.70；p<05 为观察者间；0.49 对 0.69 和 0.62；p<05 为观察者内）。
与传统方法相比，建议的测量方案在评估切迹大小时具有更高的可重复性。因此，该技术可提供可靠的髁间切迹宽度评估。
IV；回顾性研究。
