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The measurement of medial knee gap width using ultrasound

  • Knee Arthroplasty
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Medial knee instability is a key clinical parameter for assessing ligament injury and arthroplasty success, but current methods for measuring stability are typically either qualitative or involve ionizing radiation. The purpose of this study was to perform a preliminary analysis of whether ultrasound (US) could be used as an alternate approach for quantifying medial instability by comparing an US method with an approach mimicking the current gold standard fluoroscopy method.

Materials and methods

US data from the medial knee were collected, while cadaveric lower limbs (n = 8) were loaded in valgus (10 Nm). During post-processing, the US gap width was measured by identifying the medial edges of the femur and tibia and computing the gap width between these points. For comparison, mimicked fluoroscopy (mFluoro) images were created from specimen-specific bone models, developed from segmented CT scans, and from kinematic data collected during testing. Then, gap width was measured in the mFluoro images based on two different published approaches with gap width measured either at the most medial or at the most distal aspect of the femur.

Results

Gap width increased significantly with loading (p < 0.001), and there were no significant differences between the US method (unloaded: 8.7 ± 2.4 mm, loaded: 10.7 ± 2.2 mm) and the mFluoro method that measured gap width at the medial femur. In terms of the change in gap width with load, no correlation with the change in abduction angle was observed, with no correlation between the various methods. Inter-rater reliability for the US method was high (0.899–0.952).

Conclusions

Ultrasound shows promise as a suitable alternative for quantifying medial instability without radiation exposure. However, the outstanding limitations of existing approaches and lack of true ground-truth data require that further validation work is necessary to better understand the clinical viability of an US approach for measuring medial knee gap width.

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Acknowledgements

The authors gratefully acknowledge funding from the National Institute of Arthritis and Musculoskeletal Skin Diseases (F32 AR069459), the contributions of Félix Dandois, Darryl Thelen, Michael Vignos, and the support of the Vesalius Institute including Goedele Liégeois, Kristof Reyniers, and Jo Verbinnen.

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Authors and Affiliations

  1. Institute for Orthopaedic Research and Training, KU Leuven, Oude Markt 13, 3000, Louvain, Belgium

    Laura C. Slane, Josh A. Slane & Lennart Scheys

  2. University Hospitals Leuven, Campus Pellenberg, Weligerveld 1/Blok 1, 3212, Pellenberg, Belgium

    Lennart Scheys

  3. Institute for Orthopaedic Research and Training (IORT), KU Leuven, UZ Pellenberg, Weligerveld 1/Blok 1, 3212, Pellenberg, Belgium

    Laura C. Slane

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  1. Laura C. Slane
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Correspondence to Laura C. Slane.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Slane, L.C., Slane, J.A. & Scheys, L. The measurement of medial knee gap width using ultrasound. Arch Orthop Trauma Surg 137, 1121–1128 (2017). https://doi.org/10.1007/s00402-017-2740-9

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