Thürig Grégoire, Usó Marc Barrera, Panadero-Morales Raúl, Galley Julien, Schwab Joseph, Heimann Alexander, Tannast Moritz, Petek Daniel
Department of Orthopaedic Surgery and Traumatology, Hospital and University of Fribourg, Fribourg, Switzerland.
Department of Orthopaedic Surgery and Traumatology, Cantonal Hospital Schaffhausen, Schaffhausen, Switzerland.
Knee Surg Sports Traumatol Arthrosc. 2025 Sep;33(9):3134-3145. doi: 10.1002/ksa.12555. Epub 2024 Dec 15.
In modern anterior cruciate ligament (ACL) surgery, the focus is usually on anatomical reconstruction to restore the natural kinematics of the knee. The individual optimal positioning of the ACL footprints (FPs) in primary surgery is still controversial and, especially in revision surgery, difficult to realize surgically. In this regard, a new MRI-based sequence, the Compressed Lateral and anteroposterior Anatomic Systematic Sequence (CLASS) with marked femoral and tibial FPs as a template, could help. The purpose of this study was to (1) validate the reliability and reproducibility of the localization of femoral and tibial FPs of ACL in the generation of CLASS and (2) compare the identification of ACL FPs by CLASS with previously described methods.
Magnetic resonance imaging (MRI) of uninjured knees from a predominantly young cohort is used to apply the CLASS algorithm. ACL FPs were subsequently identified by a board-certified radiologist and an orthopaedic knee surgeon. Intraobserver reliability and interobserver reproducibility were assessed. Measurements of the ACL FPs according to established methods were performed and compared with the results from the literature.
Identification of ACL FPs and generation of CLASS images resulted in 'almost perfect' reliability and reproducibility. Most measurements also showed 'almost perfect' consistency. Statistical analysis showed significant variations between the deep-shallow and high-low positions when compared to the published literature.
The CLASS MRI sequence is a reliable and reproducible method for identifying ACL FPs. The observed variability in the location of the ACL FP underlines the importance of a patient-specific surgical approach.
Level II.
在现代前交叉韧带（ACL）手术中，重点通常是进行解剖重建以恢复膝关节的自然运动学。初次手术中ACL足迹（FP）的个体最佳定位仍存在争议，尤其是在翻修手术中，手术上难以实现。在这方面，一种基于MRI的新序列，即带有标记的股骨和胫骨FP作为模板的压缩外侧和前后解剖系统序列（CLASS）可能会有所帮助。本研究的目的是：（1）验证在生成CLASS时ACL股骨和胫骨FP定位的可靠性和可重复性；（2）将CLASS对ACL FP的识别与先前描述的方法进行比较。
使用来自主要为年轻队列的未受伤膝关节的磁共振成像（MRI）来应用CLASS算法。随后由一名获得委员会认证的放射科医生和一名骨科膝关节外科医生识别ACL FP。评估观察者内可靠性和观察者间可重复性。根据既定方法对ACL FP进行测量，并与文献结果进行比较。
ACL FP的识别和CLASS图像的生成具有“几乎完美”的可靠性和可重复性。大多数测量也显示出“几乎完美”的一致性。与已发表文献相比，统计分析显示深浅位置和高低位置之间存在显著差异。
CLASS MRI序列是识别ACL FP的可靠且可重复的方法。观察到的ACL FP位置的变异性强调了针对患者的手术方法的重要性。
二级。
