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Accuracy and reliability of determining the isometric point of the knee for multiligament knee reconstruction

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

To compare the accuracy and reliability of the anatomic and radiographic techniques for identifying the isometric point of the knee.

Methods

Only four specimens were used; however, eight experienced multiligament knee injury surgeons were recruited to address this limitation. Surgeons estimated the isometric point (EIP) on the medial and lateral sides using an anatomic and radiographic method. The x and y coordinates of the EIP were compared to the true isometric point (TIP). T-tests and interclass correlation coefficients (ICC) were performed to determine the accuracy and reliability between the methods.

Results

There was no difference in placement of the EIP on the medial side of the knee in the anterior/posterior (x; p = n.s.) and superior/inferior direction (y; p = n.s). The EIP was anterior (p = 0.001) to the TIP with the radiographic method on the lateral side and approached significance (p = 0.05) in the superior/inferior direction. The ICC (95 % CI) for identifying the EIP on the medial side in the anterior/posterior direction using the anatomic method was 0.64 (0.28–0.96) and 0.11 (−0.06 to 0.77) in the superior/inferior direction. Using the radiographic method, the ICC in the anterior/posterior and superior/inferior direction was 0.49 (0.14–0.94) and 0.15 (−0.47 to 0.81), respectively. On the lateral side, the ICC for the anatomic method was 0.84 (0.56–0.99) in the anterior/posterior direction and 0.36 (0.05–0.90) in the superior/inferior direction. Using the radiographic method, the ICC in the anterior/posterior and superior/inferior direction was 0.61 (0.26–0.96) and 0.89 (0.67–0.99), respectively.

Conclusions

There was no difference in accuracy on the medial side of the knee. On the lateral side, the anatomic method was more accurate in the anterior/posterior direction. Reliability was greater in the anterior/posterior direction on both sides of the knee. Surgeons were most likely to place the isometric point anterior and superior to the TIP on both the medial and lateral sides of the knee with either method which has the potential to cause graft lengthening. This should be taken into consideration during reconstruction/repair of the MCL/PMC and LCL/PLC.

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Authors and Affiliations

  1. Pan Am Clinic, 75 Poseidon Bay, Winnipeg, MB, R3M 3E4, Canada

    Jeff R. S. Leiter & Peter B. MacDonald

  2. Department of Surgery, University of Manitoba, Winnipeg, MB, R3M 3E4, Canada

    Jeff R. S. Leiter & Peter B. MacDonald

  3. Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN, USA

    Bruce A. Levy & Michael J. Stuart

  4. Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, USA

    James P. Stannard

  5. Department of Orthopaedic Surgery, Geisinger Medical Center, Danville, PA, USA

    Gregory C. Fanelli

  6. Department of Orthopaedic Surgery, University of Toronto, Toronto, ON, Canada

    Daniel B. Whelan

  7. Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA

    Robert G. Marx

  8. Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA

    Joel L. Boyd

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  1. Jeff R. S. Leiter
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  2. Bruce A. Levy
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  3. James P. Stannard
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  4. Gregory C. Fanelli
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  6. Robert G. Marx
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  7. Michael J. Stuart
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  8. Joel L. Boyd
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  9. Peter B. MacDonald
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Correspondence to Jeff R. S. Leiter.

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Leiter, J.R.S., Levy, B.A., Stannard, J.P. et al. Accuracy and reliability of determining the isometric point of the knee for multiligament knee reconstruction. Knee Surg Sports Traumatol Arthrosc 22, 2187–2193 (2014). https://doi.org/10.1007/s00167-013-2661-2

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  • DOI: https://doi.org/10.1007/s00167-013-2661-2

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