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Radiodense ligament markers for radiographic evaluation of anterior cruciate ligament reconstruction


Borbas, Paul; Wieser, Karl; Rahm, Stefan; Fucentese, Sandro F; Koch, Peter P; Meyer, Dominik C (2014). Radiodense ligament markers for radiographic evaluation of anterior cruciate ligament reconstruction. The Knee, 21(6):1018-1022.

Abstract

INTRODUCTION: Early clinical and radiographic diagnosis of failed or loosened anterior cruciate ligament (ACL) reconstructions can be challenging. The aim of the present study is to retrospectively evaluate the use of radiologically visible markers in the ACL graft, serving as a potential diagnostic tool in ACL graft rupture and insufficiency.
METHODS: Twenty patients were included in the study. ACL reconstruction was performed with use of a hamstring autograft in hybrid fixation technique. The graft was marked with two radiodense suture knots, one at the tibial and femoral tunnel openings. Radiographs were performed postoperatively, after 6weeks and 12months. Four distances between markers and landmarks were measured in anteroposterior and three in lateral radiographic views and the positional change between the timepoints of measurement was calculated.
RESULTS: Measurements of the marker distances on radiographs showed an excellent interobserver reliability (κ=0.97). In two measured distal anteroposterior distances statistically significant changes could be detected between 6weeks and 12months postoperatively in one patient with MRI-documented ACL rerupture and in five patients with ACL elongation defined as anteroposterior-translation with side-to-side difference of ≥3mm measured with a Rolimeter device. On lateral radiographs, marker distances were highly variable and did not correlate with clinical ACL elongation.
CONCLUSION: The application of radiodense ACL graft markers is a straight-forward, non-expensive and potentially useful diagnostic tool to identify the position of the transplant and for diagnosis of graft elongation or failure. However, the method is sensitive to the radiological projection, which should be further studied and optimized.

Abstract

INTRODUCTION: Early clinical and radiographic diagnosis of failed or loosened anterior cruciate ligament (ACL) reconstructions can be challenging. The aim of the present study is to retrospectively evaluate the use of radiologically visible markers in the ACL graft, serving as a potential diagnostic tool in ACL graft rupture and insufficiency.
METHODS: Twenty patients were included in the study. ACL reconstruction was performed with use of a hamstring autograft in hybrid fixation technique. The graft was marked with two radiodense suture knots, one at the tibial and femoral tunnel openings. Radiographs were performed postoperatively, after 6weeks and 12months. Four distances between markers and landmarks were measured in anteroposterior and three in lateral radiographic views and the positional change between the timepoints of measurement was calculated.
RESULTS: Measurements of the marker distances on radiographs showed an excellent interobserver reliability (κ=0.97). In two measured distal anteroposterior distances statistically significant changes could be detected between 6weeks and 12months postoperatively in one patient with MRI-documented ACL rerupture and in five patients with ACL elongation defined as anteroposterior-translation with side-to-side difference of ≥3mm measured with a Rolimeter device. On lateral radiographs, marker distances were highly variable and did not correlate with clinical ACL elongation.
CONCLUSION: The application of radiodense ACL graft markers is a straight-forward, non-expensive and potentially useful diagnostic tool to identify the position of the transplant and for diagnosis of graft elongation or failure. However, the method is sensitive to the radiological projection, which should be further studied and optimized.

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1 citation in Web of Science®
2 citations in Scopus®
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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > Balgrist University Hospital, Swiss Spinal Cord Injury Center
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:December 2014
Deposited On:31 Dec 2014 11:52
Last Modified:05 Apr 2016 18:40
Publisher:Elsevier
ISSN:0968-0160
Publisher DOI:https://doi.org/10.1016/j.knee.2014.07.003
PubMed ID:25128383

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