Abstract
Purpose
To investigate how the femoral sagittal cutting plane affects evaluation of the bone tunnel position after anterior cruciate ligament (ACL) reconstruction using the quadrant method in three-dimensional computed tomography (CT) imaging.
Methods
Thirty patients who underwent primary anatomic double-bundle ACL reconstruction and CT 2 weeks after surgery were enrolled. Three sagittal cutting planes with respect to the condylar axis were created using the CT images: at the top of the intercondylar notch (C-plane), 5% medial (M-plane), and 5% lateral (L-plane). The center of the bone tunnel position regarding depth and height of the anteromedial (AMB) and posterolateral bundle (PLB) were quantitatively evaluated using the quadrant method on the three different planes.
Results
The mean depths of AMB and PLB were 27.4 ± 4.4% and 39.7 ± 5.1%, 27.0 ± 4.2% and 37.6 ± 4.9%, and 27.4 ± 4.5% and 38.5 ± 6.0%, at the M, C and L planes, respectively. The mean heights of AMB and PLB were 30.8 ± 6.3% and 56.2 ± 5.6%, 30.4 ± 6.2% and 56.6 ± 5.6%, and 25.4 ± 7.0% and 52.9 ± 6.9% at the M, C, and L planes, respectively. Both AMB and PLB bone tunnels were evaluated as higher positions in the L-plane than the C-plane (p < 0.01, p = 0.02, respectively) and M-plane (p < 0.01, p = 0.04, respectively), but there were no significant differences between the C-plane and M-plane (n.s.). There was no significant difference in the anteroposterior direction for all planes.
Conclusion
In evaluations of the bone tunnel position with the quadrant method using three-dimensional CT, the bone tunnel position depends on the femoral sagittal cutting plane. A consistent evaluation method should be used when evaluating the bone tunnel position after ACL reconstruction to enable correct evaluation clinically.
Level of evidence
Case–control study, Level III.
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Acknowledgements
The authors acknowledge the Japan Sports Medicine Foundation for grant support and Editage for English correction.
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NM, DA, TM, and RK contributed to the study concept and design. NM, DA, YH, and TM contributed to the acquisition, analysis, and interpretation of the data. NM, DA, and TM drafted the article and NM, DA, TM and RK critically revised the article for important intellectual content. All authors had final approval of the version to be submitted for publication. NM, DA, and RK agreed to be held accountable for all aspects of the work to ensure that questions related to the accuracy or integrity of any part of the work are appropriately addressed.
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This study was supported by the Japan Sports Medicine Foundation.
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This study was approved by institutional review board (ID No. B190055) from Kobe University ethics committee.
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Miyaji, N., Araki, D., Hoshino, Y. et al. The sagittal cutting plane affects evaluation of the femoral bone tunnel position on three-dimensional computed tomography after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 29, 398–404 (2021). https://doi.org/10.1007/s00167-020-05963-0
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DOI: https://doi.org/10.1007/s00167-020-05963-0