U.O.C. Week Surgery, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy.
Scuola di Specializzazione in Ortopedia e Traumatologia, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy.
Knee Surg Sports Traumatol Arthrosc. 2023 Oct;31(10):4430-4436. doi: 10.1007/s00167-023-07510-z. Epub 2023 Jul 19.
The aim of this study is to describe and validate a simple and reliable method to pre-operatively predict the size of the ACL graft in the double strand technique with autologous semitendinosus-gracilis tendons on the same MRI used for ACL rupture diagnosis.
The study included 92 patients, with a median age of 31 years (IQR 26-41 years), 73/92 (79%) of whom were males. All patients that underwent an ACL reconstruction with doubled ST + GT between 2017 and 2022 were counted in the study.
Overall, the median predicted graft diameter from MR imaging was similar to the actual graft diameter with no significant differences (n.s.). Regarding the comparison between predicted and actual graft size, concordance was 78/92 (85%, 95% CI 76-91%), with κ = 0.797 which corresponds to a level of agreement defined as "Strong". Tendon sizes calculated on pre-operative MRI were evaluated both with intra-observer and inter-observer reliability demonstrating a statistically reproducible method. The predicted graft was then compared to the reported one with a statistically significant reliability found.
This study can help the surgeons to perform a fast pre-operative planning of an ACL reconstruction for graft selection. If the planned graft with ST and GT is smaller than 8 mm, the clinician can decide to switch to a different type of graft or plan a different graft preparing technique and, therefore, reduce the risk of post-operative ligament re-rupture. The method proposed is reliable and reproducible. The major strength of the planning technique proposed is that it relies on data that are already available for the clinician before surgery, without the need of further analysis.
IV.
本研究旨在描述和验证一种简单可靠的方法，即在同一台用于 ACL 撕裂诊断的 MRI 上，使用自体半腱肌-股薄肌腱的双股技术，对 ACL 重建中 ACL 移植物的大小进行术前预测。
本研究纳入了 92 例患者，中位年龄 31 岁（IQR 26-41 岁），73/92（79%）为男性。所有 2017 年至 2022 年间接受 ACL 重建并使用双股 ST+GT 的患者均纳入研究。
总体而言，MRI 预测的移植物直径与实际移植物直径相似，无显著差异（n.s.）。关于预测与实际移植物大小的比较，一致性为 78/92（85%，95%CI 76-91%），κ=0.797，表明一致性水平为“强”。术前 MRI 计算的肌腱大小，观察者内和观察者间的可靠性评估均显示出一种统计学上可重复的方法。预测的移植物与报告的移植物进行比较，发现具有统计学意义的可靠性。
本研究可帮助外科医生在 ACL 重建前快速规划移植物选择。如果计划使用 ST 和 GT 的移植物小于 8mm，临床医生可以决定切换到其他类型的移植物，或计划不同的移植物准备技术，从而降低术后韧带再断裂的风险。所提出的方法是可靠且可重复的。该规划技术的主要优势在于它依赖于外科医生在手术前已经掌握的数据，而无需进一步分析。
IV。
